Tests results & Endo appt today

[Aslangal]

Hi All 👋

My appt is today, not yesterday (brain fog lol)

On getting my letter out for the appt, I realised the Endocrinologist had asked the GP to repeat my bloods and also suggested the GP try me on Eltroxin as a different brand of Levothyroxine. He says ‘more stable levels seen with this form). He says the blood tests taken at the Surgery were still not available to him and could they be repeated.

The letter was issued week before Christmas. I simply thought GP would be contacting me post but didn’t hear anything and I totally forgot till I got the letter out.

He also put these readings:

B12 310ng/L

Folate 3.9ug/L

Vit D 24nmol/L

His aim is to get my TSH to <2.5mu/L he says.

Any advice? GP calling me between 11 & 1 but my appointment is 2pm.

Thanks in advance. 🤓

[SlowDragon Administrator]

Thyroid hormones need optimal vitamin levels

Vitamin D is extremely deficient at under 25nmol

GP should have prescribe LOADING dose of vitamin D

Have they done so?

That's 300,000iu in total over 6-8 weeks

Local CCG guidelines

clinox.info/clinical-suppor...

Vitamin D levels should be retested at end of the course

Folate and B12 look low. Can you add ranges on these results

You need ferritin tested and full iron panel test for Anaemia

Coeliac blood test too, especially if you have autoimmune thyroid disease also called Hashimoto's diagnosed by high thyroid antibodies

[Aslangal in reply to SlowDragon]

Yes I just finished the loading dose of 300,000 and started on the daily dose of 800iu

[SlowDragon Administrator in reply to Aslangal]

Has GP retested vitamin D at end of loading dose.? they should have done so

What was result?

Aiming to improve vitamin D to around 80nmol and around 100nmol may be better

Local CCG guidelines

clinox.info/clinical-suppor...

After having vitamin D deficiency it’s perhaps unlikely 800iu is high enough maintenance dose

Test twice yearly via vitamindtest.org.uk

Vitamin D mouth spray by Better You is good as avoids poor gut function.

It's trial and error what dose each person needs.

Frequently with thyroid issues we need higher dose than average. 2000iu per day is not uncommon, perhaps more in winter

Testing twice year to check levels

[SlowDragon Administrator]

Most important results are FT3 followed by FT4

TSH is frequently suppressed when on adequate dose of Levothyroxine to bring FT3 to OPTIMAL levels

If endo is only dosing according to TSH you will need a new endocrinologist

Most patients with no thyroid function of their own will have a TSH significantly under one when FT3 and FT4 are at good levels

Low vitamin levels are very indicative of being under treated

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)."

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

[e-mail]

Professor Toft recent article saying, addition of small dose of T3 alongside Levothyroxine may be necessary for many, especially after RAI

rcpe.ac.uk/sites/default/fi...

Have you had cholesterol tested?

High cholesterol linked to being under treated (especially low FT3) and therefore still hypothyroid

[Aslangal in reply to SlowDragon]

No to cholesterol check

[pennyannie]

Hey there Lynn

Well, it's a bit of a non starter isn't it ?

So sorry, as you had pinned a lot on this appointment and it seems your doctor hasn't followed up with the vitamin or mineral supplementation, nor actioned the current blood tests ready for today's appointment.

Since you have had RAI thyroid ablation I think your TSH needs to very low, even suppressed within the range.

Why would you want to start to stimulate a gland that has been medically treated with RAI in order to kill it off and disable/stop it's production of thyroid hormones ?

[helvella Administrator Thyroid UK]

and also suggested the GP try me on Eltroxin as a different brand of Levothyroxine.

So that you are aware - Mercury Pharma levothyroxine and Mercury Pharma Elxtroxin are absolutely, 100% identical. Only packaging differs.

Experience here suggests that whilst the make matters, with some people doing far better on one make than another, there is no way of predicting which person will do better on which product. (Except where someone is known to be sensitive/intolerant/allergic to one of the ingredients.)

There are currently four makes available in the UK: Wockhardt, Mercury Pharma, Actavis (also packaged as Almus for Boots and Northstar for Lloyds) and Teva.

Which have you been taking?

[Aslangal in reply to helvella]

Teva

[helvella Administrator Thyroid UK in reply to Aslangal]

Some people find it the best they have ever had; others cannot tolerate it.

A big "no thank you" from me.

[Aslangal]

Teva

[SlowDragon Administrator in reply to Aslangal]

Teva brand upsets many, many people

It’s a Marmite brand. Some love it (usually if lactose intolerant ) but many hate it.

healthunlocked.com/search/p...

Teva is the only lactose free levothyroxine tablet. It contains mannitol instead. Mannitol can upset gut flora