New results - do we ignore TSH

[Noisette13]

I’ve just had my results - non fasting and after levo

TSH 0.17. (.30-5.00) FT4. 16 (9-24) FT3 4.1 (3.5-6.5). Changed from TEVA on the 25mg but still not brilliant. Still to have vitamins checked

[Noisette13]

Sorry missed off I have Graves and had RAI nearly 2 years ago

[cazmania7 in reply to Noisette13]

How long after RAI did you start to feel unwell?

[SeasideSusie Remembering]

To see your normal circulating level of hormone you need a test where you've fasted overnight from evening meal/supper and last dose of Levo 24 hours before blood draw.

As you haven't fasted and you've taken your Levo, you have a TSH which may be higher than normal and your FT4 will be higher than your normal circulating level.

[Noisette13 in reply to SeasideSusie]

I’ll remember that on my nxt test

[SeasideSusie Remembering in reply to Noisette13]

If you want to save the information somewhere, always advised here when doing thyroid tests:

* 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.

[Schenks in reply to SeasideSusie]

Just replying to say thanks - so that I can find this again!!

[SlowDragon Administrator]

FT4 is only 47% through range

FT3 only 20% through range

chorobytarczycy.eu/kalkulator

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

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

nhs.uk/medicines/levothyrox...

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially if Thyroid antibodies are raised

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and fasting. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

Last Levothyroxine dose should be 24 hours prior to test, (taking delayed dose immediately after blood draw).

taking test this way, would likely result in much lower FT4

Essential to test vitamin D, folate, B12 and ferritin

Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies or all vitamins

thyroiduk.org.uk/tuk/testin...

Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have special offers, Medichecks usually have offers on Thursdays, Blue Horizon its more random

How much Levothyroxine are you currently taking?

You clearly need dose increase in Levothyroxine and get vitamin levels tested

As you have had RAI you have zero thyroid function

20% Patients with no thyroid can not regain full health on just Levothyroxine

ncbi.nlm.nih.gov/pmc/articl...

[Schenks in reply to SlowDragon]

Really important, thanks.

[pennyannie]

Hello again Noisette

I've just gone back into your marathon of a post - think 93 answers, has to be a record, somewhere for something !!!

It's a bit confusing as it doesn't necessarily roll in date and time sequence, and I got a bit lost following it all through.

I didn't realise this new blood test was after you had taken your medication, and that you had not fasted. So, it isn't an accurate reading, but more importantly, your T4 is showing a false high so, again, it's so obvious, even with these inflated reads, you need a dose increase of Levothyroxine.

[Noisette13]

Just out of interest can your levels affect your eyesight?

[DeeD123 in reply to Noisette13]

In what way do you mean

[Noisette13 in reply to DeeD123]

I get blurred and double vision even with my glasses!

[DeeD123 in reply to Noisette13]

Please be aware that thyroid eye disease isn’t confined to graves. I was diagnosed over 12 yrs ago when hashimotoes with no Graves present. I am now going through it for the second time which started after my tsh rose to 3.5. I would personally get it checked out

[FarmerDJ in reply to Noisette13]

When I was extremely hypo, TSH readings of 80, it blurred my vision. As soon as the levels started to balance out again my vision returned. TED is a possibility if you have graves...

[DeeD123 in reply to FarmerDJ]

You don’t have to have graves to have ted

[momindenver in reply to Noisette13]

When I was very hypothyroid, my eyes were dry and watery, and it did affect my vision.

[Carna]

Yes my eyesight was appalling when I was under medicated. My optician said I needed prescription glasses until I told him I was hypo and was not well. I went back when my medication was changed and I felt I could see better and he told me my eyesight was deteriorating as he would expect with age and that reading glasses were all that I needed and I could buy them from anywhere!

[Noisette13 in reply to Carna]

I have dreadful eyesight anyway but I had some new glasses recently and I just can’t get on with them. I’ve taken them back several times but they say prescription is correct. One day last month someone came into the surgery and said I just wish my levels would settle as my opticians refuses to do my test until then! Our opticians is a friend so don’t feel I can argue with him

[Carna]

Maybe tell your optician that you are trying to get your medication right and that until then any prescription you have now may not be what you need when it is. I am sure once you explain that eyesight, like just about everything else, is affected by thyroid function he will understand you will need a re-test when you feel well.

[silverfox7]

Yes. Your lens is held in place by muscles. If these sag then your lens won't be in the correct position