feeling very unwell and doctor gp in Ireland prescribed her 25 levothyroxine
June
tsh 2.02
t4 12.1
atp 15
feeling worse but GP didn't want to give her more medication
In August she was change the dosage after private consultation in Spain by a specialist doctor and given 50 levothyroxine.
October
tsh 2,2
t4 12
She is feeling very unwell but the GP doesn't want to give her more medication. I don't understand why the t4 still so low.. Can you please give me your opinion please
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begsedsol
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For full Thyroid evaluation your daughter needs TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also EXTREMELY important to test vitamin D, folate, ferritin and B12
Just testing TSH and FT4 is completely inadequate
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 thyroid antibodies
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).
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.
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
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.
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 .
20% of Hashimoto's patients never have raised antibodies
Thank you slowDragon, but I am confused why the tsh has gone much better but ft4 hasn't actually it has gone worse. She doesn't feel better after months of taken the tablets
Because the TSH is a bad indicator of thyroid status. It's not a linear relationship with the FT4. The TSH dropping doesn't always mean the FT4 has risen, the pituitary just recognises that there is now a bit more hormone in the blood, but cant tell you if it's enough. In any case, 2.2 is still too high.
And, the FT4 won't rise if she's not taking enough of it. I think your doctor is very short-sighted - not to say ignorant - not to increase her dose. Have you tried asking him for his reasons? I think he owes you an explanation.
Thank you greygoose, I am going to call him tomorrow and ask about it but last time when I called he told me that if the tsh is between the parameters everything is okay, I never got to talk to the doctor just the nurse, I am not quite sure if she passed the message to the doctor or she just told me that to keep me happy. It seems that they follow numbers but not symptoms, because my poor daughter has been in bits for nearly a year now. Thanks again for all your help always
Well, they are 100% wrong about that. Once you are on thyroid hormone replacement, the TSH doesn't tell you very much at all. It's the FT3 the most important number, but failing that, they should at least be looking at the FT4.
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