Test Results

[custa]

Just had my annual thyroid test results:

Serum TSH level - 7.19 miu/L Normal range 0.27 - 4.20

Serum Free T4 - 17 - normal range 12.0 - 22.0

I take 1 x 100 mg levothyroxine daily and 1 x 25mg levothyroxine twice a week

On those results and suffering badly from brain fog and tiredness - is it likely I need my dose adjusting - up or down? Can't get anywhere near my GP for another 2 weeks.

[Lalatoot]

Based on those results you need to increase your dose. You will read on here that once treated with levothyroxine we need to aim for a tsh of 1 or under. Often we need t4 at the top of the range.

[SlowDragon Administrator]

Suggest you get full Thyroid and vitamin testing

These results suggest you are very under treated. TSH is very high.....

Has anything changed recently?

Eg Different brands of Levothyroxine are often not interchangeable

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also extremely 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).

Is this how you do your tests?

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

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

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...

Also what foods to avoid (eg recommended to avoid calcium rich foods at least four hours from taking Levo)

Bloods should be retested 6-8 weeks after dose increase in Levothyroxine

[custa in reply to SlowDragon]

Thanks for the information, most helpful.

I have been taking thyroxine for nearly 20 years and its always been a bit of a roller coaster.

Yes, it was a fasting test from 10pm the previous evening and blood was taken at 8.15 am - but last thyroxine tablet probably taken not quite 24 hours prior to the bloods being done.

I wasn't aware the last dose of thyroxine should be 24 hours previously - that's never been explained before to me.

As for the type of thyroxine I am taking - at the moment it seems to be a brand called TEVA but earlier in the year it was actavis

I have had issues in the past when my dose has been reduced because I was sweating and getting palpitations.

Is it best to take the medication in the morning or the evening? For many years I took it in the evening and only recently have I been told to take it half an hour before a caffeine drink or food in the morning - does it really make a difference?

What do others do?

[Lalatoot in reply to custa]

Yes it does make a difference to take it away from food and drink except for water. Having said that I have a friend who doesn't bother about that, takes it with breakfast or forgets to take for a day and it does not affect her. She is lucky! I have taken morning and I have taken it at night - it is a personal choice and what suits you. I split my dose now taking one dose about 6am and the other at 4pm.

[SlowDragon Administrator in reply to custa]

Different brands of Levothyroxine are not interchangeable for many people

Teva especially upsets many, many people

healthunlocked.com/search/p...

Teva may be the reason for such poor results

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

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

verywellhealth.com/best-tim...

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.