Difference in stopping meds before TSH testing? Is it worth it?

[ChrisCh]

Just had some lab work done and did not take my np throid the night before as usual. TSH is 7.5 (.33-5.33) last year I did the same and it was 8.5. 3 years prior I was taking meds in the morning and took my meds before testing and had results under 2. Could the results really be that off from about 36 hrs without? Or is this an issue with reformulation. I do feel tired in the mornings but then am pretty much the same all day as previous years.

Any ideas? I feel I am not getting an accurate test reading by not taking the pill as usual. Should I start taking a bit more? Last time I tried that I had an all day headache and felt nauseous. And that was adding about 10-15mg more (splitting pill so inaccurate). My daily dose and for several years is 50 mg np throid

[greygoose]

Stopping or taking your meds before the blood draw won't have any effect on your TSH - unless you leave them off for about a month!

Taking your meds before the blood draw - or leaving too long a gap between the last dose and the blood draw - will affect your FT4 and FT3.

Leaving 36 hours is much to long. And will give you false low FT4/3 When you're taking NDT, you should leave a gap of 8 to 12 hours only. That will give you your normal circulating level of FT3. The FT4 isn't that important.

[ChrisCh in reply to greygoose]

Thank you for that information. I only had the TSH tested this time. So I wonder what is causing such a rise from previous years. Maybe I’ll try titrating up a bit. How long would you say it takes to actually feel a difference?

[greygoose in reply to ChrisCh]

Feel a difference in what? The TSH itself doesn't make you feel anything. It is the FT3 that causes symptoms when it's too high or too low. So, you really need that tested - especially as you are on NDT. The TSH doesn't tell you anything much at all, despite what doctors think.

What is probably causing the rise is that your thyroid is failing even further. It's unrealistic to think you can stay on the same dose forever and still feel well. The disease evolves.

[ChrisCh in reply to greygoose]

In fact now that I think about it these higher numbers is what I had from about 8 years ago when I started taking thyroid meds. Wonder why I’m bothering?

[greygoose in reply to ChrisCh]

Because your TSH would be a lot higher without the NDT. And you'd be a lot sicker.

[ChrisCh in reply to greygoose]

Humm ok thx

[swebes in reply to greygoose]

Chiming in here: I read this advice all the time - take meds 24 hours prior for T4, 12 hours prior for T3. But what about when your T4/T3 med is compounded into a single pill and you can't take them separately? When should the last dose be taken?

[greygoose in reply to swebes]

That is the case for NDT. So, you take it 8 - 12 hours before the blood draw, as I explained above.

[swebes in reply to greygoose]

Ahh! My brain did not process that! Thank you 🤗

[greygoose in reply to swebes]

You're welcome.

[SlowDragon Administrator]

Usually when correctly treated on NDT TSH is under one, and FT3 in top third of range

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

Do you have Hashimoto's?

When were vitamin levels last tested?

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 NDT 8-12 hours prior to blood test

[ChrisCh in reply to SlowDragon]

Recent tests on B12 458

D 3. 36

Folate not tested

Ferritin. 136. From 1 1/2 yrs ago. And have been donating blood to reduce that.

All other iron levels were optimal

Antibodies taken a few years ago and they were like about 5.

Thank you for your advice

[SlowDragon Administrator in reply to ChrisCh]

B12 looks slightly low. What's the range on this?

Vitamin D - as you are not in UK this is presumably measured in ng/ml . Aiming to improve to around 40ng/ml (100nmol)

Ferritin- aiming for half way in range

Do you have high iron?

Are you diagnosed with hemochromatosis?

Did you have BOTH TPO and TG antibodies tested

20% of Hashimoto's patients never have raised antibodies

healthunlocked.com/thyroidu...

[ChrisCh in reply to SlowDragon]

No high iron

Aiming to bring my Ferritin down to 30-50 hence the blood donations

No no hemochromatosis

Nor am I Hashimoto

Yes had both antibodies tested

Vit D was 560 in the summer (I’m in search of the sun going to Costa Rica in January for a vit D boost!

B12 range is to 1000 but I’m 64 so I hear it’s tough to bring up.

Thanks so much for all your advice.

I’m taking a bit more meds now to about 60mg and hope that sorts out my tingling fingers when reading in bed and slow mornings.

[Krisinua in reply to SlowDragon]

How do h take it 8 to 12 hours prior when we take our meds in the morning? And lab closes at 3pm

[SlowDragon Administrator in reply to Krisinua]

You split the T3 or NDT dose through the day. Take half your dose as normal in morning. Take remaining dose about 8-9pm

Get blood test 8am following morning

Last dose Levothyroxine 24 hours prior to blood test

[HRH8591 in reply to SlowDragon]

Splitting the dose - is that on the day of the test? I usually have mine done in the morning. Does fasting make any difference? Thanks

[SlowDragon Administrator in reply to HRH8591]

eat as normal the day before test.

In morning of test just water, before test.

[Lucky2020 in reply to SlowDragon]

Thanks but I take levothyroxine first thing in the morning between 7 and 7.30 am but it is just one pill. How can I split my dose ? normally here blood test are around 09.00 thanks

[SlowDragon Administrator in reply to Lucky2020]

Lucky2020

With just Levothyroxine you don't need to split your dose.

Getting blood test as early as possible in morning You just delay taking your Levothyroxine until straight after blood test.

No food or drink apart from water before blood test

Remember to stop taking any supplements that contains biotin a week before any blood test

It's only T3 that needs splitting day before a test.

[SlowDragon Administrator in reply to Krisinua]

Many people split their NDT dose everyday anyway, rather than take as single dose

[SilverAvocado]

TSH is fairly slow to change, so it probably won't be impacted by when you take your tablets. FreeT4 and freeT3 are a more direct measure of how much hormone is in your blood, so they will change quite a bit.

Our bodies change quite a bit over time in how they use thyroid hormone, so it's not too surprising your results from years ago aren't the same as they are today. This is why it's important to get tested and adjust dose every year or so even once we reach an ideal dose. Your current results suggest you're very undermedicated, so you'd likely feel better with an increase.

[ChrisCh in reply to SilverAvocado]

Thank you for that. I am trying to take a bit more from last night.

[Kandahar]

The irony is that those, who have not had much experience of this site, have been able to be brainwashed by GPs into believing that TSH is the be-all and end-all. Instead of it being of little interest.

Please just bear in mind that it’s how you feel that’s important.