Blood results

[Counsellor]

My GP has reduced my levothyroxine from 75mg to 50mg due to these results. TSH: 0.573 (range 0.570-3.6) and free T4: 16.3 (range 7.9-14). I have felt stable for 3 years but now have a flare up of symptoms/ hair thinning, nails breaking, itchiness. Can anyone comment? I don’t understand.

[Lora7again]

Tell them you need to take that dose to feel well and now you feel very ill because of the reduction. Doctors should go by how thyroid patients feel not blood results. My TSH is 0.70 which is slightly low and I am slight hyper which is great at this time of the year ... I have done all my Christmas shopping and wrapped the presents. Last Christmas my poor husband had to do the lot because I could hardly get out of bed I felt so ill.

[greygoose]

Your FT4 is rather over-range, so I can almost understand your doctor's reasoning. However, before reducing the dose, there are several things the doctor should have considered, and questions he should have asked...

* do you have Hashi's?

* what was your FT3? Although pretty certain it wasn't tested, it should be taken into consideration because your conversion could have been affected.

* what time of day was the blood drawn?

* how long did you leave between the last dose of levo and the blood draw?

* do you take any biotin - in a multi-vit or B complex or on its own?

Only when he has the answers to all those questions, will he be in a position to know with any certainty, whether or not he should reduce your dose.

[Counsellor in reply to greygoose]

This is what I thought. I haven’t been diagnosed with hashis but now I am wondering. FT3 of course wasn’t tested. L

[greygoose in reply to Counsellor]

And what about the answers to the other questions?

[Counsellor in reply to greygoose]

The test was at 10.30am. I took my levo at 4am. I don’t take any vitamins.

[SlowDragon Administrator in reply to Counsellor]

So you took Levothyroxine far to close to blood test....hence high FT4

Most people on Levothyroxine have low vitamin levels and most need to supplement virtually continuously to maintain optimal vitamin levels and this helps improve how Thyroid hormones work.

Low vitamins can cause symptoms in their own right too

Low vitamin D - joint and bone pain,and poor sleep

Low ferritin - hairloss

Low B vitamins - thin nails and pins & needles

Always test vitamin levels before starting on any supplements

[Counsellor in reply to SlowDragon]

Thank you

[greygoose in reply to Counsellor]

So, there you have it. You only left a gap of 6.5 hours, when it's recommended to leave 24. So, that's why your FT4 was so high.

Next time you get tested, make sure you get an early morning blood draw - when the TSH is highest before 9 am - and fast over-night. Leave 24 hours between your last dose of levo and the blood draw, and your FT4 will be a lot lower, guaranteed! And your TSH probably higher.

[Counsellor in reply to greygoose]

I have a test tomorrow and will do this

[SlowDragon Administrator in reply to Counsellor]

All blood tests should be as early as possible in morning and before eating or drinking anything other than water to get highest TSH

ncbi.nlm.nih.gov/pmc/articl...

Last dose Levothyroxine 24 hours prior to blood test.

[greygoose in reply to Counsellor]

Good.

[SlowDragon Administrator]

75mcg was a very low dose ....woukd suspect you have low vitamin levels

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 thyroid antibodies if antibodies never been tested

You may need to get full Thyroid testing privately as NHS refuses to test TG antibodies if TPO antibodies are negative

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

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

monitormyhealth.org.uk/thyr...

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

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

Come back with new post once you get results

[Counsellor in reply to SlowDragon]

Thank you for this advice