Shouldn't my TSH have lowered?

[Peacefull]

Hi,

I had my recent blood results and am a little confused. For the first test i was taking 50mcg Levothyroxine and the second I'm taking 75mcg. I also have a confirmed Hasimotos diagnosis.

my results are:

Name Free T3 Free T4 TSH

Standard Range 3.5-6.5 pmol/L 10.0-19.8 pmol/L 0.35-5.50 mU/L

21/6/19 4.3 12.8 2.93

02/8/19 5.1 15.5 2.94

Although my FT3 and FT4 are in better range my TSH has (only slightly) gone up.

I had been feeling so much better but gone downhill slightly over the last week (could be a flare or just a virus?) Not sure if I should expect a dosage increase?

Any input would be much appreciated.

Thanks

Ally

[SeasideSusie Remembering]

Peacefull

Did you do both tests under the same conditions?

Did you do them both early morning?

Did you drink water only before the tests?

Always advised here:

* Book the first appointment of the morning, or with private tests at home no later than 9am. This is because TSH is highest early morning and lowers throughout the day. If we are looking for a diagnosis of hypothyroidism, or looking for an increase in dose or to avoid a reduction then we need TSH to be as high as possible.

* Fast overnight - have your evening meal/supper as normal the night before but delay breakfast on the day of the test and drink water only until after the blood draw. Eating may lower TSH, caffeine containing drinks affect TSH.

* If taking thyroid hormone replacement, last dose of Levo should be 24 hours before blood draw, if taking NDT or T3 then last dose should be 8-12 hours before blood draw. Adjust timing the day before if necessary. This avoids measuring hormone levels at their peak after ingestion of hormone replacement. Take your thyroid meds after the blood draw. Taking your dose too close to the blood draw will give false high results, leaving any longer gap will give false low results.

* If you take Biotin or a B Complex containing Biotin (B7), leave this off for 7 days before any blood test. This is because if Biotin is used in the testing procedure it will give false results (Medichecks definitely use Biotin, they have confirmed this and the amount of time to leave the supplement off).

These are patient to patient tips which we don't discuss with doctors or phlebotomists.

How long had you been taking 75mcg before the second test?

[Peacefull in reply to SeasideSusie]

Hi Susie,

Thanks for your prompt response. My answers :

Did you do both tests under the same conditions? Yes

Did you do them both early morning? Yes within a half hour of 8.45

Did you drink water only before the tests? Had a decaf coffee before both.

Always advised here:

* Fast overnight - Good to know

* If taking thyroid hormone replacement, last dose of Levo should be 24 hours before blood draw, - yes complied with this

* If you take Biotin or a B Complex containing Biotin (B7), leave this off for 7 days before any blood test. - Will check on this.

How long had you been taking 75mcg before the second test? - 6 weeks

Thanks Ally

[SlowDragon Administrator]

The aim of Levothyroxine is to increase the dose slowly in 25mcg steps upwards until TSH is under 2 (many need TSH significantly under one) and most important is that FT4 in top third of range and FT3 at least half way in range

important to regularly test vitamin D, folate, ferritin and B12

All four vitamins need to be regularly tested and frequently need supplementing to maintain optimal levels

NHS guidelines on Levothyroxine including that most patients eventually need somewhere between 100mcg and 200mcg Levothyroxine.

nhs.uk/medicines/levothyrox...

Levothyroxine should always be taken on empty stomach and then nothing apart from water for at least an hour after

Many people take Levothyroxine soon after waking, but it may be more convenient and more effective taken at bedtime

verywellhealth.com/best-tim...

All medication at least two hours away from Levo. Some like HRT, PPI's, magnesium, iron or vitamin D, at least four hours away

Many people find Levothyroxine brands are not interchangeable.

Once you find a brand that suits you, best to make sure to only get that one at each prescription. Watch out for brand change when dose is increased or at repeat prescription.

Many patients do NOT get on well with Teva brand of Levothyroxine. Though it is the only one for lactose intolerant patients. Teva is the only brand that makes 75mcg tablet.

[Peacefull in reply to SlowDragon]

Hi Slowdragon,

Thanks for the reply.

I do always take my levo at about 6am and my vitamins (folate, Selenium, D3 and General B) at lunchtime. Ive not had them checked since End of june, when would you suggest getting them rechecked? What would you consider regularly in this instance?

I seem to prefer the Wockhardt but can only get it in 25mcg so have asked my gp to prescribe in those amounts.

I'm hoping he's going to offer a dosage increase, but if not i will have to request it.

Thanks

Ally

[greygoose]

If it were a Hashi's flare, your TSH would be suppressed and your Frees well over-range. So, it's not that. But, levels can often jump around with Hashi's. Plus, your Frees are still quite low. So, the good news is that you stand more chance of getting an increase in dose!

[Peacefull in reply to greygoose]

Oh ok that's good to know. I think the issue will be that if that happens on a test he will want me to reduce. But hey, we'll cross that bridge etc...

Thanks for the ongoing support, you guys are brilliant and i know many of us would be feeling more overwhelmed without the advice you offer.

Thanks Ally

[GKeith]

It looks, to me, as if you do better on 75mcg T4. Usually if both are "a little high" in range the T4 is converting (properly) to T3 but if you FT4 level is "normal" or high & the FT3 is low, it's not converting the T4 (to T3) properly. You need a good endo to look at your bloods and see if you need to get more T4 or maybe add some T3.