I was diagnosed with UAT last September and currently taking 75mg Levothyroxine. My symptons improved initially but have returned . My latest blood results have just come back :
Serum free T4 level 12.7 pmol/L [11.0 - 23.0]
Serum TSH level 0.53 mU/L [0.27 - 4.5]
After a telephone conversation this morning , my GP is flatly refusing to increase my dosage despite my argument that T4 should be at top of range - stating that is this was done , I could become overactive.
A full range of other bloods were done at same time and GP is saying that they want to prescribe statins as a result of my cholesterol results :
Serum cholesterol level 6.2 mmol/L
Serum triglyceride levels 0.8 mmol/L
Serum HDL cholesterol level 2.9 mmol/L
Serum LDL cholesterol level 2.9 mmol/L
Serum cholesterol/HDL ratio 2.1 mmol/mmol
Ive posted in the cholesterol forum for an interpretation of these results as I understood a 2.1 ratio to be good.
Ive asked the GP for some time to think about it and to do my own research.
Any help or advise on where to go from here would be greatly appreciated.
Thank you
Written by
Debslee
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You are over-medicated when your free T3 goes over range. And if s/he won't test free T3, how will s/he know? But your free T4 is crawling along the bottom of the range instead of in the top quartile, where you will feel well again.
Do you have results for key nutrients - ferritn, folate, vit D and B12? - your levo works best when these are nice and high.
So imho really you need better blood testing and an increase in levo to bring your free T4 up. Can you organise private testing if s/he won't do it?
Vit D wasn't taken this time however I do take regular Vit D gels as my levels were low when first diagnosed and a private test carried out in January indicated that levels were good.
My recent ferratin, folate and Vit B12 are :
Serum vitamin B12 level 450 ng/L [197.0 - 771.0]
Serum folate level 7.8 ug/L [2.0 - 18.7]
Serum ferritin level 103.4 ug/L [20.0 - 260.0]
Im really concerned / confused about the cholesterol results as I understand that an underactive thyroid can affect LDL and I think / hope that any additional medication (i.e. statins ) could be avoided if my Thyroid levels were correct.
I think a private consultation may be my only option with the Thyroid issue but Id really like to get to the bottom of the cholesterol with my GP and was going to ask for a consultation about this alone once I understand the results better ?
If you have an underactive thyroid (hypothyroidism), treatment may be delayed until this problem is treated. This is because having an underactive thyroid can lead to an increased cholesterol level, and treating hypothyroidism may cause your cholesterol level to decrease, without the need for statins. Statins are also more likely to cause muscle damage in people with an underactive thyroid.
Hi Debslee- I have high cholesterol and my GP put me on Statins .I did not feel well on them so stopped and did blood tests via medichecks.They showed that my FT3 was bottom 1% of range (even though my TSH was low .668) I requested a levo increase from my GP who was concerned that I would go hyper with a low TSH but luckily recognised the significance of low FT3.After 8 weeks I retested and my FT3 had increased and cholesterol decreased.So if I was you I would get my FT3 tested to show that you aren't overmedicated then hopefully your gp will agree to an increase in levo .Also regarding cholesterol ratio I was told by an NHS dietician that the cholesterol ratio goal is 4.5 or less,LDL 3 or less HDL 1.2 or more and Total 5 or less.😚
KazLS thankyou so much for your reply . It’s given me hope ! . I will definitely get a full range of tests done . My GP has been supportive of medichecks results in the past ( today I was dealt with by different Dr ) so hopefully she can be persuaded if the results come back as expected . I was so disappointed when told I needed statins as I’ve always had a slightly high total cholesterol but also high HDL and have previously been told this is all ok as it’s the “good cholesterol “ that’s causing my overall result to be out of range . I have a very healthy diet , run 3 times a week , walk miles daily and go to the gym ( when open ) and work hard to stay healthy . I’m not overweight medically but struggle to lose weight due to thyroid issues - so frustrating !
If it makes you feel any better your cholesterol is still lower than mine:-)Like you I eat really healthily, exercise daily and I have a low BMI. The dietician told me that high cholesterol was generally not down to diet and she actually encouraged me to eat higher fat foods!I am awaiting for some T3 to arrive from Germany and will be adding a low dose of 5 mcg to my levo -which I will decrease to 75 mcg from 75/100 mcg alternate days to see if that will raise my FT3 above mid range and decrease my cholesterol levels further-FYI i weigh 46 KG so my levo dose is currently slightly above the 1.6 per KG guidelines.
guidelines by weight might help push for dose increase
Even if we don’t start on full replacement dose, most people need to increase dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until on full replacement dose
Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.
Suggest you get full thyroid and vitamin testing privately
For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also EXTREMELY important to regularly 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, best not mentioned to GP or phlebotomist)
Is this how you do your tests?
Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins
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
tukadmin@thyroiduk.org
print it and highlight question 6 to show your doctor.
As for statins, please read the post by humanbean and the links she gives in the first reply in this thread:
SeasideSusie, thank you for your reply. I used askmyGP for my consultation and referenced Dr Tofts report when asking fir an increased dose - unfortunately it didn’t make any difference. I was dealing with a locum and not my usual GP so will try again once I’ve done a full range of private tests .
Thankyou for the information on statins, I’ll certainly research that issue further x
The really crucial finding in healthy people is that their TSH is most likely to be low in range. Almost 85% of (healthy) people have a TSH which is in the lower half of the reference range.
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