Good morning, I am new to the forum and I am sure this has been posted numerous times before, but if there is anyone that could help me I would be very grateful.
I have received the results but cant make head nor tail of them and would really appreciate any direction on this.
My thanks in advance
It says the results are 'satisfactory' to start with but not normal
Serum TSH level 2.04 miu/L (0.25 - 4.0)
Serum Free T4 level 16 pmol/L (11.0 - 22.0)
I have tried to google but its just confusing the matter even more :o(
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MurphysMama
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Google isn't a lot of help because reference ranges vary from lab to lab so we use the ranges that come with your results to interpret them.
Can you tell us if you have a diagnosis of a thyroid condition and if you take any thyroid meds, if so what dose? Results are interpreted differently according to the answers
Presumably those are the only two thyroid tests done?
What time of day did you have the blood draw?
Did you fast from the previous evening meal/supper or did you eat before the test?
Did you drink water only, or did you have coffee, tea, cola, etc, before the test?
If you are on Thyroid replacement hormone, when did you take your last dose?
Thank you so much for coming back to me, I really do appreciate it.
So approx 2.5 years ago I had some serious heart palpitations, it turned out to be my thyroid, had radio iodine treatment and eventually put onto levothyroxine to 50mg. I have gained about 3’stone in weight, quite tired sometimes, generally alittle lack lustre at times and just lately struggling with joint and muscle pain in my legs. When I approached my GP I was told that I should prepare myself for menopause, and should maybe try anti depressants!
I had an old blood test request that I didn’t use when I left the doctor after the anti depressant advice, that was approx 11 months ago, but leg pains made me dig it out to see how I was doing test wise.
I’ve never been told to fast before bloods or go at any particular time.
I have always taken my table at night because I couldn’t cope with the nausea in the mornings, however over the last 3/4 weeks I take tablet in the mornings with water, then approx an hour later I had a coffee, so I would of had my bloods drawn about 10.30/11am.
OK, so you're Hypo due to RAI and on Levo 50mcg. I'm assuming that was your starter dose and hasn't been increased since.
After starting Levo, retesting should be done 6 weeks later and a dose increase of 25mcg if necessary, with further testing/increasing every 6-8 weeks until your levels are where they need to be for you to feel well.
The aim of a treated hypo patient generally, when on Levo, is for TSH to be 1 or below or wherever it needs to be for FT4 and FT3 to be in the upper part of their reference ranges, if that is where you feel well.
I'm assuming the reference ranges were the same for both sets of tests.
Previous blood test was Nov 2018
TSH: 2.27 (0.25 - 4.0)
FT4: 17 (11.0 - 22.0)
With those results you should have had an increase in dose as your TSH was too high and your FT4 only 55% through it's range.
Your latest results:
TSH: 2.04 miu/L (0.25 - 4.0)
FT4: 16 pmol/L (11.0 - 22.0)
again show TSH too high and FT4 only 45% through range.
Unfortunately most doctors think that if our result falls anywhere within the range then it's perfect but it's not the case.
Your symptoms of weight gain and fatigue are very likely symptoms of hypothyroidism as you are undermedicated.
Your joint and muscle pains are possibly due to the undermedication but can also be a symptom of low Vit D.
For thyroid hormone to work properly we need optimal nutrient levels (although doctors are ignorant of this fact) and we Hypos often have low levels or deficiencies. We should therefore test:
Vit D
B12
Folate
Ferritin
and address any low levels.
You can ask your GP to do these tests, he may or may not but you can always do them with a private test from one of our recommended labs if necessary.
With your current level you need an increase of 25mcg immediately, retest in 6 weeks, then as mentioned above retesting/increasing should be carried out every 6-8 weeks until your levels are right for you to feel well.
In support of your request for a dose increase, you can use the following information:
Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine (the magazine for doctors):
"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l. In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance. But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l. This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l).*"
*He recently confirmed, during a public meeting, that this applies to Free T3 as well as Total T3.
You can obtain a copy of the article by emailing Dionne at
tukadmin@thyroiduk.org
print it and highlight question 6 to show your doctor.
You can also refer to NHS Leeds Teaching Hospitals who say
Thyroxine Replacement Therapy in Primary Hypothyroidism
TSH Level .................. This Indicates
0.2 - 2.0 miu/L .......... Sufficient Replacement
> 2.0 miu/L ............ Likely under Replacement
Advice for taking Levo:
Take your Levo on an empty stomach, one hour before or two hours after food, with a glass of water only, no tea, coffee, milk, etc, and water only for an hour either side, as absorption will be affected. Take any other medication and supplements 2 hours away from Levo, some need 4 hours (Vit D, magnesium, iron, calcium, and some others). If it suits you to take it at night then that's fine as long as the timing is right, if you have your main meal in the evening then leave 3 hours before taking Levo and avoid coffee, milk, etc.
For future reference when having 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 can give false results (many labs use Biotin, including the private labs we recommend).
These are patient to patient tips which we don't discuss with doctors or phlebotomists.
I have in the last week just started vitamin D3 10ug
10ug D3 = 400iu units. If you have a low level then that dose will do nothing to help, it's not even a maintenance dose for someone with a decent level to start with.
We should always test Vit D then base the dose we take on the result and what we need to achieve the level recommended by the Vit D Council/Vit D Society.
There are also important cofactors needed when taking D3, so if you test your level, post your result on the forum, then a suggestion for the dose/cofactors you need can be made.
I take Reishi Mushroom Complex
I'm afraid I have no knowledge of that so can't comment.
Good evening! So I took your advice regarding blood tests and talking to doctor armed with these writings - 3 months of a 25mg increase to a total of 75mg.
I just have received these results back this evening ...
I would discuss your below range calcium with your GP.
Those that are within range raise no red flags so I wouldn't worry about them. If they are repeated in the future, compare them and see if there are any drastic changes.
I can't help with FSH and LH.
You still need the following tested:
Vit D
B12
Folate
Ferritin
3 months of an extra 25mcg Levo has minimally improved your results.
As the aim of a treated hypo patient generally, when on Levo, is for TSH to be 1 or below or wherever it needs to be for FT4 and FT3 to be in the upper part of their reference ranges, if that is where you feel well, then you could still have a way to go and may need another increase of 25mcg, retest in 6-8 weeks.
Did you do your test as advised in my previous reply?
You really need to test those nutrients, low Vit D can cause joint pains.
Most people would need TSH below 1. T4 isn't that high either. I still had symptoms when T4 was near the top of the range.
If you are not yet having treatment ask for a "Clinical trial" of thyroxine. I always say that a "Trial" means you can't blame them if it doesn't work, so they are more likely to agree!
So, am I right in thinking you had your thyroid ablated with RAI and are now hypothyroid.
What were you diagnosed with originally, was it Graves Disease ?
A fully functioning working thyroid would be supporting you on a daily basis with approximately 100 T4 + 10 T3.
I just think that if there has been a medical intervention and the thyroid either surgically removed or ablated with RAI that both these vital hormones should be on the patients prescription for if, and probably when required.
Some people can simply get by on T4-Levothyroxine alone :
Some people simply stop converting, at some point in time, the T4 into T3 :
and some people simply need both these essentials hormones dosed and monitored independently to bring them into balance and to a level of well being acceptable to the patient.
Levothyroxine is a prohormone and your body needs to convert it into T3 which is the active hormone that the body runs on. I read most people run on about 50 T3 daily in order to function.
Your conversion of the T4 into T3 can be compromised if your ferritin, folate, B12 and vitamin D are not optimal in the ranges so these need to be checked out with a blood tests.
The first step is to obtain the necessary blood tests as already mentioned by Seaside Susie.
Once with these results start a new post, with the results plus the ranges so people better able than me can advise accordingly.
You might like to take a look at the following book, written by a doctor Barry Durrant - Peatfield who has hypothyroidism. Your Thyroid and How To Keep It Healthy is an easy, sometimes insightful, funny read, but very relevant as though we may not now have this amazing little gland, we do need to know how to compensate for the loss.
I have Graves Disease and had my thyroid ablated with RAI in 2005. and I became very unwell some 8 years later.
It is a massive learning curve but thanks to this amazing site and a couple of books I've managed to turn things around for myself and am now in much better health.
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