Can I have advice on blood test results please?

[arwenamen]

I have been feeling really unwell for the past 6 months, fatigue, mental health(depressed, mood swings, paranoid) , weight gain etc. All the things I know seem to relate to my thyroid.

I had a blood test done in may 2019 results were: free T4 18.7 (range 12.0 - 22.0)

Serum TSH 0. 70 (range 0.27 - 4.20)

Blood test done last week is showing results as follows:

free T4 16.0 (range 12.0 - 22.0)

Serum TSH 0.73 (range 0.27 - 4.20)

Would this suggest that my medication could do with a slight adjustment? To me with my symptoms I would think so but I wanted some advice if possible as my doctor has said nothing is required, I’m within range.

I’m currently on 75mcg levothyroxine

Thanks in advance!

Ruth

[SeasideSusie Remembering]

arwenamen

Your new results show that your FT4 is only 40% through it's range compared with 67% last time and your TSH is virtually the same.

Do you always do your test under the same conditions so that they can be compared accurately, i.e.

* Book the first appointment of the morning, or with private tests at home no later than 9am. This is because TSH is highest early morning and lowers throughout the day. If we are looking for a diagnosis of hypothyroidism, or looking for an increase in dose or to avoid a reduction then we need TSH to be as high as possible.

* Fast overnight - have your evening meal/supper as normal the night before but delay breakfast on the day of the test and drink water only until after the blood draw. Eating may lower TSH, caffeine containing drinks affect TSH.

* If taking thyroid hormone replacement, last dose of Levo should be 24 hours before blood draw, if taking NDT or T3 then last dose should be 8-12 hours before blood draw. Adjust timing the day before if necessary. This avoids measuring hormone levels at their peak after ingestion of hormone replacement. Take your thyroid meds after the blood draw. Taking your dose too close to the blood draw will give false high results, leaving any longer gap will give false low results.

* If you take Biotin or a B Complex containing Biotin (B7), leave this off for 7 days before any blood test. This is because if Biotin is used in the testing procedure (which most labs do) it can give false results.

These are patient to patient tips which we don't discuss with doctors or phlebotomists.

If so then a dose increase would seem reasonable as 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.

[Lora7again]

That is a low dose are you elderly? My Dad is 78 and takes 100mcg a day so think you might need an increase. Also how are your vitamin levels because they can affect how you absorb Levothyroxine.

[arwenamen in reply to Lora7again]

I’m 38 but was diagnosed when I was in my 20’s and have tried to manage with the dose I’ve been prescribed as well as exercise and diet. I’ve just found lately that I seem to be going downhill again and the diet and exercise aren’t working as well. My energy levels have dropped badly but the worst part is my mood. Struggling badly on that one. No idea what my vitamin levels are like unfortunately!

[Lora7again in reply to arwenamen]

I think you need an increase of 25mcg and you need to get a blood test to check your vitamin levels because if we have low vitamins the levothyroxine does not work as well. You need to test B12, Iron and Ferritin, Vitamin D and Folate. I don't know if the NHS will do this for you but you can ask. I have to pay for private blood tests to test my levels because my GP will only test the TSH and nothing else which is disgusting because he knows I have Graves disease because it is written on my notes. Anyway if you can get them to test these vitamins please post them on here for us to look at. I have a TSH of 0.70 and feel very well and I am not taking anything except vitamin D spray and selenium for my very high antibodies. Read my story on my profile page.