underactive/overactive thyroid blood test interval and treatment. #thyroxin #underactive thyroid

[leedsunited11]

My wife has an underactive/overactive (it fluctuates a lo) thyroid but only has a blood test once every six months which her doctor then adjusts her thyroxin to , but i think it should once every month so her thyroxin can be adjusted to suit the fluctuation . Can anyone who has a overactive /underactive thyroid please tell me what their treatment is if it is different ... Thanks Shane

[greygoose]

Tests should be six weeks after any change in dose - up or down. Every month would be too soon. Besides, her dose shouldn't need changing that frequently. Sounds as if her doctor is dosing by the TSH and he should not be doing that. That's the best way to keep the patient sick. The TSH is not a good indicator of thyroid status, he should at least be testing the FT4 - and taking it into consideration - but ideally, the FT3, which is the most important number.

[helvella Administrator]

I think I'd be right in saying most only get tested once a year.

I'm going to suggest that your wife's doctor adjusts according to TSH (only)? And always adjusts by 25 micrograms a day (or more)?

What is probably happening is that after one test, the dose gets reduced, after the next, it gets increased. She is always either under- or over-dosed.

Add in issues like time of day for blood draw, when she took her tablet, and it could be changing even more.

Once a year testing is grossly inadequate but, on the basis we are never going to get tested every week or month, my approach is to question my own dose and how I feel - I'd like to say "every day" but don't want to over-claim!

Or pay for private tests? (I recent had a private test and the combination of that test, and how I feel having increased my dose slightly, have now had a GP test. Appointment tomorrow!)

[NWA6]

Has she had antibody tests?

[Wetsuiter]

i think GreyGoose has called it here. 6 monthly tests are ok when nothing changes, but when dose changes, there should be another test 6 weeks later.

[Wetsuiter in reply to Wetsuiter]

although i think new NICE guidelines say 3 months after dose change

[LunaMa]

Hi Shane

If your wife has autoimmune hypothyroidism, where the immune system attacks the thyroid gland, then she may well fluctuate between having under active and overactive symptoms. It takes time (about 6 weeks) for the body to respond to thyroxine, so changing the dose monthly probably wouldn’t help her.

If you could post any blood test results you ,any get some more specific suggestions.

[Lora7again]

I get tested every 6 months but they only test the TSH which is no use to me. I usually pay for private bloods from medichecks which is more detailed and shows vitamin levels and antibodies. If I show my private blood results to my doctor he refuses to accept them and he thinks my high antibodies of 4000 mean nothing.

[SlowDragon Administrator]

Sounds like your wife has Hashimoto's

GP should not be dosing according to TSH but aiming to prescribe dose Levothyroxine high enough to bring FT4 and FT3 levels optimal....that frequently means very low TSH

Do you have any recent blood test results and ranges you can add?

Important to know exactly what has been tested and equally important what hasn't been tested yet

For full Thyroid evaluation your wife needs 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

You will probably need to get full Thyroid testing privately as NHS refuses to test TG antibodies if TPO antibodies are negative and won't test FT3

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...

For thyroid including antibodies and vitamins

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

Cheapest option for just TSH, FT4 and FT3 £29 (via NHS private service )

monitormyhealth.org.uk/thyr...

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

If she has Hashimoto's then many, many people find strictly gluten free diet helps or is essential

Come back with new post once you get full results

[leedsunited11 in reply to SlowDragon]

Thanks for the reply, I'm going to show my wife your advice and see what she is or is not doing and look into the private tests. Once again thanks