Blood Test- Opinions and feedback please

[j4brett]

Blood Test- opinions please?

Hi all, posted recently regarding my increase in levothyroxine from 75 to 100 and was asked to post my blood test results for further support. So here goes! Thanks in advance!

[Lora7again]

Your TSH is very high when mine was 9 I could not get out of bed. Did they not test your T4 or T3? Also some of your liver results are a bit high which has happened to me in the past because my thyroid was not working properly. Also my elderly Dad takes 100mcg a day because he is old you definitely need an increase.

[fuchsia-pink]

Can you edit the pic to remove your name and date of birth?

TSH of well over 10 ... this is much much too high! Can't see a free T4 or free T3 result, but on the basis of the TSH, you are severely under-medicated (and probably feeling rubbish).

Until you have a free T3 result, you won't know how well you convert T4 into T3, the active thyroid hormone - but 100 mcg of levo isn't very much so you should be asking for an increase ...

[j4brett in reply to fuchsia-pink]

Thank you but what does this all mean in simple terms? I'm only now exploring this and some of the explanations I dont understand. I've been on 75 for about 18months and as of last night I've increased to 100.

[Lora7again in reply to j4brett]

In simple terms your are under medicated and need to increase by 25mcg every 6 weeks until your TSH is 1 or lower and your T4 and T3 is in the upper third of the range. You also need to get your vitamins tested because they are probably low as well. You need to test your B12, Iron and Ferritin, Vitamin D and Folate. All your vitamins need to be optimal for the Levothyroxine to work.

[fuchsia-pink in reply to j4brett]

Your pituitary sends a message to your thyroid to produce thyroid hormones - this is the TSH reading = Thyroid Stimulating Hormone. In a euthyroid person [ie with no thyroid issues] the TSH will be in the reference range you quote above. If your thyroid doesn't produce enough hormone, and your pituitary works properly, it produces more TSH - ie to send a stronger message to your thyroid. If your thyroid produces produces too much hormone, you are hyper; if it doesn't produce enough you are hypo. So if your TSH is above the reference range this tells us you are hypo - ie your thyroid isn't producing enough hormone itself - and you should be prescribed levo. Once you are on levo, your TSH will go down, and settle at or below the lower end of the range.

Your thyroid produces T4 - an inactive hormone. So once your TSH is "wrong" the NHS's next step is to test your T4. If your TSH is too high, we would expect your free T4 to be too low - ie below range or in the bottom part of the range. Levo is T4 medicine, so taking that will/should increase your T4.

But your T4 is inactive. It converts to the active thyroid hormone, T3 - which is needed in every cell in yoru body. Some people (eg me!) are "poor converters" so our TSH is nice and low, an our T4 is nice and high, but we still don't feel well, because our T3 needs to be higher. If you get both T3 and T4 tested [at the same time] and T4 is much higher along the range than T3, that indicates you have a conversion problem.

Here it gets political. The NHS tests TSH and treats it with levo - because this is cheap [and the third most NHS prescribed medicine]. And lots of people are fine with this. It tests T4 if your TSH is "wrong" to check the levo is increasing your T4. But the NHS doesn't routinely test T3 - because T3 medicine (liothyronine) is spectacularly expensive in the UK - and many areas will not prescribe it [hence all the posts on this forum for private suppliers].

So to get a full set of results, you need TSH, free T3 and free T4 testing, While you're at it, you may as well have thyroid antibodies testing to see if you have hashimotos - which is very common, look at some of the posts on this. And because you absorb your thyroid meds best if key nutrients are optimised, you should also test ferritin, folate, Vit D and B12

Once you have and post all of these, you will get lots more advice on how to optimise your medication.

[SeasideSusie Remembering]

Hi Jamie

These are the results of your test done very recently (confused by the date on the screenshot)?

TSH: 11.4 (0.35-3.5)

Well, no wonder you had a dose increase. Your TSH is way, way too high for a treated Hypo patient. The aim of a treated Hypo patient on Levo, generally, is for TSH to be 1 or below with FT4 and FT3 in the upper part of their reference ranges. Even though you only have had TSH tested, your FT4 and FT3 must be very low with that high TSH. You are grossly undermedicated.

We know your GP has increased your dose from 75mcg to 100mcg Levo, you need to be retested 6-8 weeks after you started the 100mcg, then you will very likely need another 25mcg increase, again retest 6-8 weeks later and continue this retesting/increasing every 6-8 weeks until your levels are where they need to be for you to feel well.

Once your TSH level is down to about 1 we can then look at your FT4 and FT3 levels and see how well you are converting T4 to T3.

Do you have any previous results? I'm wondering if you have previously had TSH within range and this is a sudden and unexpected increase?

I would urge you to do a full thyroid/vitamin panel which wont be available from your GP, he may do some of the tests but not all that are needed that were outlined in my reply to your previous thread. We have private recommended labs where the full panel can be done by fingerprick or venous blood draw (extra cost).

The most popular tests here are:

Medichecks Thyroid Check ULTRAVIT medichecks.com/thyroid-func...

You can use code THYROIDUK for a 10% discount on any test not on special offer

or

Blue Horizon Thyroid PREMIUM GOLD bluehorizonbloodtests.co.uk... (previously known as Thyroid Check Plus Eleven)

Both tests include the full thyroid and vitamin panel. They are basically the same test but with the following small differences:

For the fingerprick test:

Blue Horizon requires 1 x microtainer of blood (0.8ml), Medichecks requires 2 x microtainers (total 1.6ml)

Blue Horizon includes Total T4 (can be useful but not essential). Medichecks doesn't include this test.

B12 - Blue Horizon does Total B12 which measures bound and unbound (active) B12 but doesn't give a separate result for each. Medichecks does Active B12.

Total B12 shows the total B12 in the blood. Active B12 shows what's available to be taken up by the cells. You can have a reasonable level of Total B12 but a poor level of Active B12. (Personally, I would go for the Active B12 test.)

Blue Horizon include magnesium but this is an unreliable test so don't let this sway your decision, it also tests cortisol but that's a random cortisol test and to make any sense of it you'd need to do it fasting before 9am I believe.

At the moment Medichecks have a special offer of 25% off fingerprick tests if you want to take advantage of that.

TIPS FOR DOING FINGERPRICK TEST

* Be well hydrated, drink plenty of water the day before, and before you do the test.

* Some people take a shower before hand, some run up and down the stairs to get blood flowing. Personally, as I can't run up and down the stairs, I circle my arm round, windmill style.

* Have a bowl full of hot water, dip hand in and out, swish around, hand needs to go red. If blood flow stops, you can always swish round in the hot water again.

* Stand up to do the test. Make sure your arm is straight down when collecting the blood. Either use a small step stool to raise yourself well above the work surface, or put the collection tube on a lowish shelf. One member uses an ironing board so she can get the perfect height.

* Prick finger on the side, not the tip. I find that half way between the nail bed and tip is about right, or maybe slightly nearer the nail bed rather than the tip. I use my ring finger, but middle finger is next best for me.

* Do not squeeze your finger to get the blood out, it can damage the blood and it may not be usable

I've recently done 2 tests. The first one there was very little blood coming out which was unusual for me so I used a second finger and between the two I gradually filled the tube. However, when I checked the prick site for the first finger the actual cut was very small and as I've had some of these lancets fail before I put it down to that. When I did the second test this is what I did

* Prick my finger as usual, make a very slight twist with the lancet whilst blade is still in the finger. I'm not talking 90 degrees or anything, just a very slight twist to make the cut just slightly bigger, it doesn't hurt or cause a blood bath! This made a big difference, 11 generous drops of blood filled the tube in less 2 minutes.

If you supplement with Biotin, or a B complex containing it (B7), leave it off for 7 days before doing any blood tests as it can give false results when biotin is used in the testing procedure, and most labs do use it.

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, 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 it can give false results (most labs use biotin).

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

[Lora7again]

Jamie, a lot of us have been neglected by the medical profession who have no idea how to treat thyroid disease and we have had to do our own research because some Doctors do not seem to care. Thyroid disease is not taken seriously imho and I have been offered counselling and anti-depressants in the past when all I wanted was treatment. I have managed to help myself with advice from sites like this one and other sites in the USA. The reason this site exists is because we are not getting any help from our Doctors. Hopefully once you get your T4 and T3 levels up and and your TSH down you will start to have a better quality of life.

[j4brett in reply to Lora7again]

Thank you for your support. Any tips on on getting T3 and T4 up and TSH down?

[Lora7again in reply to j4brett]

You need more Levothyroxine but it is not a quick fix I'm afraid so you need to increase it gradually. Also get your vitamins tested because having low vitamins can make you feel ill as well. When I was first diagnosed my vitamin D was 7 and I felt very ill because I had been left untreated for over 2 years. My family actually thought I had cancer because I looked so thin and ill. My hair was thin and my nails were dropping off and I was very depressed. Hopefully once you get your levels right you will start to feel a lot better.

[SeasideSusie Remembering in reply to j4brett]

Any tips on on getting T3 and T4 up and TSH down?

Jamie - read my reply above. The only way to do this is to increase Levo in stages, 25mcg each time, 6-8 weeks between increases and test. This gives you the thyroid hormone needed to reduce TSH and increase hormone levels - FT4 and FT3. Aim for TSH of 1 or below, then see where FT4 and FT3 are.

You also need optimal nutrient levels for thyroid hormone to work so it's essential to test Vit D, B12, Folate and Ferritin, as I have mentioned.

It would also be useful to know if you have Hashi's (autoimmune thyroid disease) and the antibody tests to show this are included in the tests from Medichecks or Blue Horizon as mentioned.

[Outandabout in reply to Lora7again]

I feel the same, since getting into my 2 minor problems, compared to others on these sites, I have found the advice here invaluable.

[SlowDragon Administrator]

As others have said ..

It's not a quick fix .

Each dose increase takes at least 6-8 weeks to have full effect

So there's no point retesting until then

You are likely to need further increases

When did you last have blood tested before this? Do you have those results?

As others have said ...

The aim on levothyroxine is to increase dose up if TSH is higher than 2 (many people need TSH under one)

[SlowDragon Administrator]

You could test vitamin D now via

vitamindtest.org.uk

After 6-8 weeks

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

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

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

[SlowDragon Administrator]

Links showing Median TSH graph of population who DO NOT have thyroid disease

healthunlocked.com/thyroidu...