Blood test results

[jo1001]

These are the results for the blood tests taken on 07/11/2019 for my hair loss:

Serum TSH 5.05 mu/L Range 0.35 - 5.00 (abnormal)

Serum free T4 13.1 pmol/L Range 9.0 - 22.0 (normal)

Serum total 25-OH vit D 103 nmol/L Range 50 - 200 (normal)

Serum folate 4.6 ug/L Range 3.0 - 20.0 (normal)

Serum ferritin 117 ug/L Range 10 - 200 (normal)

Serum vitamin B12 631 ng/L Range 200 - 910 (normal)

What does everybody think? Thanks.

[SeasideSusie Remembering]

jo1001

Serum TSH 5.05 mu/L Range 0.35 - 5.00 (abnormal)

Serum free T4 13.1 pmol/L Range 9.0 - 22.0 (normal)

Clear as day. You are undermedicated. The aim of a 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. You need a dose increase, 25mcg immediately, retest in 6-8 weeks, continue if necessary with increasing/retesting every 6-8 weeks until your levels are where they need to be for you to feel well.

To support your request for an increase, you should emphasise to your GP that your TSH is over range, your FT4 is very low in range and that 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

[e-mail]

print it and highlight question 6 to show your doctor.

You can also refer to NHS Leeds Teaching Hospitals who say

pathology.leedsth.nhs.uk/pa...

Scroll down to the box

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

Your nutrient levels are all OK except that Folate is low, it's recommended to be at least half way through range. Eating folate rich foods will help, as will supplementing with a good B Complex such as Thorne Basic B, Igennus Super B or a Whole Food B Complex.

[jo1001 in reply to SeasideSusie]

Thank you SeasideSusie. Will ring GP in the morning for an appointment and I will also look into increasing my Folate.

[SlowDragon Administrator]

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

Official NHS guidelines saying TSH should be between 0.2 and 2.0 when on Levothyroxine

(Many of us need TSH nearer 0.2 than 2.0 to feel well)

See box

Thyroxine replacement in primary hypothyroidism

pathology.leedsth.nhs.uk/pa...

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. Teva is the only brand that makes 75mcg tablet.

If want to avoid Teva, you will need 50mcg plus 25mcg tablets. Or cut a 50mcg tablet in half

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 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...

Bloods should be retested 6-8 weeks after each dose increase (or brand change) in Levothyroxine