Help with test results please!

[Shotap37]

I was diagnosed with hypothyroidism 10 years ago & have consistently been on 100mg of levothyroxine with my TSH suppressed under 1. However since the birth of my children my TSH has gradually increased/fluctuated:

11/07/16- TSH 0.87 (had first child in June 2015)

22/06/17- TSH 0.6

13/10/17- TSH 1.26

26/09/18- TSH 2.62 (had second child in April 2018)

10/12/18- TSH 0.92; serum free T4 21.4 (12-22); serum free T3 4.3 (3.1-6.8); ferritin 79 (30-400)

18/04/19-TSH 1.74

14/11/19- TSH 2.36 (0.27-4.2); free T3 4.45 (3.1-6.8); free thyroxine 16.8 (12-22); ferritin 93.7 (13-150); thyroglobulin antibodies 12 (<115); thyroid peroxidase antibodies <9 (<34); CRP HS 0.43 (<5); folate serum 9.3 (>3.89); B12 active 104 (>37.5)

The last set are through medichecks who say it is all in the normal range.

I’d really appreciate some advise/guidance as to whether I am optimally treated as I’m fed up with ongoing symptoms.

Many thanks in advance for your time and advice!

[SlowDragon Administrator]

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)

Is this how you did the last test?

your FT4 is only 48% through range

And FT3 only 36% through range

Helpful calculator for working out % through the range

chorobytarczycy.eu/kalkulator

See GP and ask for 25mcg dose increase in Levothyroxine

Bloods should be retested 6-8 weeks after each dose increase

Make sure that sand brand Levothyroxine is prescribed for 25mcg tablets

You also need vitamin D tested

vitamindtest.org.uk

[Shotap37 in reply to SlowDragon]

Yes that’s how I took mine 😊 thank you that’s helpful. Is there anything I can say or take to highlight this need as I’m convinced because they are in ‘normal’ range the docs won’t prescribe anymore.

[SlowDragon Administrator in reply to Shotap37]

Getting vitamin D test first.....improve to optimal if low

See GP and request dose increase .....ask for it as a"trial" if they are reluctant

Perhaps 100/125mcg alternate days....if they are very reluctant

If they won't agree to any dose increase then request referral to endocrinologist

Email Dionne at Thyroid Uk for list of recommended thyroid specialist endocrinologists

thyroiduk.org.uk/tuk/About_...

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...

New NHS England Liothyronine guidelines July 2019 clearly state on page 13 that TSH should be between 0.4-1.5 when treated with just Levothyroxine

Note that it says test should be in morning BEFORE taking Levo thyroxine

Also to test vitamin D, folate, B12 and ferritin

sps.nhs.uk/wp-content/uploa...

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,

"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)."

You can obtain a copy of the articles from Thyroid UK email print it and highlight question 6 to show your doctor

please email Dionne at

[e-mail]

[silverfox7]

MediChecks are right saying ‘in the normal range but often its where in the range that is important. Doctors often say pretty much the same, normal as in normal range. Many of us though feel at our best when TSH is nearer one or even under and we need to get FT4 and FT3 at acceptable levels as well. It’s also important to test Cit D, B12, folate and Ferritin as these help our thyroid to work much better but readings need to be optimal, not just in range but I made a huge improvement when I took this on board. I completely reversed my conversion issues, plus it also helped my general health so well worth the effort. Please be aware though it you increase Vit D you also need to take the co factors of K2 and magnesium.

Increasing Vit D also increases calcium levels but too much calcium travelling around in the blood may not be good for us as we could stand to cause kidney or gall stones or calcified muscle. K2 will take the excess calcium out of the blood and send it to the teeth and bones and magnesium will kick it in there. It works quickly at doing that as my retesting showed.