Recent results after being medicated

[jordystreet91]

Hi all, hope everyones keeping well and safe

Today had some results back from my TFT

Tsh 3.8

after speaking with the doctor 2 month ago he put me 25 mcg of levothyroxine and I felt a lot better after being put on it but still not feeling quite my best, is it right to think i could ask my doctor for an increase?

[SlowDragon Administrator]

Standard starter dose of levothyroxine is 50mcg unless frail, heart condition or over 65 years old

The aim of Levothyroxine is to increase the dose slowly in 25mcg steps upwards until TSH is under 2 (many need TSH significantly under one) and most important is that FT4 is in top third of range and FT3 at least half way through range

Bloods should be retested 6-8 weeks after each dose increase

NHS guidelines on Levothyroxine including that most patients eventually need somewhere between 100mcg and 200mcg Levothyroxine.

nhs.uk/medicines/levothyrox...

Also what foods to avoid (eg recommended to avoid calcium rich foods at least four hours from taking Levo)

All four vitamins need to be regularly tested and frequently need supplementing to maintain optimal levels

Previous posts shows very low vitamin levels

Are you still supplementing to improve?

When were they last tested?

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)

Very important to regularly retest vitamin levels, likely to need ongoing supplements to maintain optimal levels

Post re how to push for dose increase in levothyroxine

healthunlocked.com/thyroidu....

[jordystreet91 in reply to SlowDragon]

thanks for the reply, yes I'm still taking the vitamins although I havent had a recent test for them, I'm going to be doing a private blood test for my vitamins and I'll post results when they come back, also I had the test at half past 8 in the morning after 24 hours after my last dose on only water

[SeasideSusie Remembering]

jordystreet91

Is that all that was tested? Not even FT4 included? (Always include reference ranges when posting results as they vary from lab to lab )

The aim of a thyroid patient on Levo, generally, is for TSH to be 1 or below with FT4 and FT3 in the upper part of their reference ranges if that is where you feel well.

25mcg is just a starter dose, usually for children, the elderly or those with a heart condition. Retesting should be done 6 weeks after starting Levo, followed by an increase in dose of 25mcg if necessary, and retesting/increasing should continue every 6-8 weeks until your levels are where they need to be for you to feel well.

You can ask your GP for an increase in dose and use the following information to support your request:

From NHS Leeds Teaching Hospitals who say

pathology.leedsth.nhs.uk/pa...

Scroll down to the box

Thyroxine Replacement Therapy in Primary Hypothyroidism

TSH Level .................. This Indicates

0.2 - 2.0 miu/L .......... Sufficient Replacement

> 2.0 miu/L ............ Likely under Replacement

Also, Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine (the magazine for doctors):

"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).*"

*He recently confirmed, during a public meeting, that this applies to Free T3 as well as Total T3.

You can obtain a copy of the article by emailing Dionne at

[e-mail]

print it and highlight question 6 to show your doctor.

Are your nutrient levels optimal, they need to be for thyroid hormone to work properly.

[jordystreet91 in reply to SeasideSusie]

Yeah sorry I had my results over the phone earlier and I stupidly forgot to ask the reference ranges but I asked for a call back from the doctor so i could discuss it with him, just wanted to know if it's the right thing to ask for an increase and coming from the replies I definitely should be lol, i think if I'm going to have a full thyroid test and vitamins tho I'm going to have to do it myself because he likes to say they are normal and no need for another test, I have been supplementing

[shaws Administrator in reply to jordystreet91]

I think many doctors have it wrong i.e. TSH. Due to the rules/regulations that people cannot be diagnosed until the TSH is 10, they seem to believe that if it is 'somewhere' 'in range' that we're on a sufficient dose. They also think that a TSH of 1 or lower means we've become hypERthyroid but this isn't the case. We need it around 1 or lower with symptoms resolving.

[jordystreet91 in reply to shaws]

Well I've not long come off the phone to the doctor and hes not upping my dose hes keeping it as it is and put it on repeat now which is better than nothing I suppose

[metomorrow]

Hi,

I think it will be a case of getting a blood test done every 6 weeks to see if your levels are within the accepted range. If after that you are not feeling well still then you will need to see your GP again. Everyone is different with these things and although medically speaking your levels could be fine some people still continue to feel below par. At this point it can be beneficial to see an Endocrinologist.