First Time Follow Up Lab Results

[Katie6402]

Started Levothyroxine 50 on 9/3/2019

Labs Taken

10/28/2019:

TSH: 2.60 (0.34 - 5.60 mlU/ml)

FREE T4: 1.11 (0.58 - 1.64 ng/dL)

T3, FREE: 3.00 (2.3 - 4.2 pg/mL)

TSH was 4.65 August 2019 and T4 and T3 values basically stayed the same from August - October.

I believe I started to feel a little better after a few weeks starting Levothyroxine, but I have felt my symptoms return over the last 2-3 weeks.

Any help/insight would be so appreciated!

[SeasideSusie Remembering]

You need a dose increase after those October results. 25mcg now, retest in 6-8 weeks. You may need further increases to reach your optimal dose and hormone levels.

The aim of a treated hypo patient generally is for TSH to be 1 or lower with FT4 and FT3 in the upper part of their ranges if that is where you feel well.

We always advise having thyroid tests no later than 9am, after an overnight fast from evening meal/supper, and drink water only before the test. Last dose of Levo should be 24 hours before blood draw to avoid a false high FT4 if testing too soon after taking your hormone replacement.

It's also a good idea to test

Vit D

B12

Folate

Ferritin

as optimal nutrient levels are needed for thyroid hormone to work properly. Many hypo patients have low nutrient levels.

[Katie6402 in reply to SeasideSusie]

Thank you so much!

[SlowDragon Administrator]

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 you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies

Ask GP to test vitamin levels and antibodies if not been done

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .

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

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

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

If antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).

About 90% of all primary hypothyroidism in Uk is due to Hashimoto's.

Low vitamins are especially common with Hashimoto's. Food intolerances are very common too, especially gluten. So it's important to get TPO and TG thyroid antibodies tested at least once .

Link about thyroid blood tests

thyroiduk.org/tuk/testing/t...

Link about antibodies and Hashimoto's

thyroiduk.org.uk/tuk/about_...

thyroiduk.org.uk/tuk/about_...

List of hypothyroid symptoms

thyroiduk.org.uk/tuk/about_...

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...

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

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

NICE guidelines

cks.nice.org.uk/hypothyroid...

The initial recommended dose is:

For most people: 50–100 micrograms once daily, preferably taken at least 30 minutes before breakfast, caffeine-containing liquids (such as coffee or tea), or other drugs.

This should be adjusted in increments of 25–50 micrograms every 3–4 weeks according to response. The usual maintenance dose is 100–200 micrograms once daily.

20% of Hashimoto's patients never have raised antibodies So you may need to ask for ultrasound scan of thyroid

healthunlocked.com/thyroidu...

[Katie6402 in reply to SlowDragon]

Thank you!!