It's not a significant difference, levels are never static and you can only compare results when tests are done under exactly the same conditions each time.
When doing thyroid tests, we advise:
* 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, coffee affects TSH so it's possible that other caffeine containing drinks may also 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 it can give false results (both Medichecks and Blue Horizon advise to leave Biotin/B Complex off).
These are patient to patient tips which we don't discuss with doctors or phlebotomists.
Do you do your tests like this?
Once you are diagnosed and taking thyroid hormone replacement, you don't have to worry about TSH level, it's not important, the important tests re FT4 and FT3 as those are the thyroid hormones, TSH is a pituitary hormone which tells the thyroid to make hormone when it detects there's not enough. So testing TSH alone is not an indicator of thyroid status, you need FT4 and, more importantly, FT3 as well.
Ah, no. I've never done my test as a fasting one and my most recent was at 11:30am in the morning. My surgery have never tested my FT3, and FT4 was only test back when I got a TSH of 11.9 in 2017
If you feel OK then I'd leave things as they are and not upset the status quo. However, if you have any symptoms then I'd retest as advised above and get a full thyroid panel. If your GP can't do all the tests then we have recommended private labs that offer a variety of test bundles that can be done as fingerprick tests at home, or you can have venous blood draw at extra cost. Blue Horizon and Medichecks are the ones most used by members:
It's always worth getting thyroid antibodies tested if not already done, plus vitamins as we need optimal nutrient levels for thyroid hormone to work properly. If you want to do the full testing bundle then look at Medichecks Thyroid Check ULTRAVIT or Blue Horizon Thyroid PLUS ELEVEN.
If you only want to do TSH, FT4 and FT3 then the NHS has recently announced MonitorMyHealth which is the basic panel done by an NHS hospital lab and the results should be accepted by your GP, this is the cheapest option for just the basic panel (£29):
Replacement therapy with levothyroxine should be initiated in all patients to achieve a TSH level of 0.5-2.0pmol/L.
New NHS England Liothyronine guidelines July 2019 clearly state on page 13 that TSH should be between 0.4-1.5 when OPTIMALLY treated with just Levothyroxine
Note that it says test should be in morning BEFORE taking levothyroxine
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)."
(That’s Ft3 at 58% minimum through range)
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
tukadmin@thyroiduk.org
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
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)
Is this how you do your tests?
Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins
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hello can anyone advise
High cholesterol, high blood pressure & subclinical
Update on bloods last TSH was 72.12!!
Blood results- have I been tested for Graves?
