Help with blood test results please?

[K12yla]

Hi, I was diagnosed with a multinodule goitre in March and have been on 25mcg levothyroxine since. Go did blood test in April which was only tsh which was 2.7 (0.27-4.2). I feel awful at the minute and did a private blood test tsh 3.81(0.27-4.2) ft3 4.7(3.1-6.8) ft4 19.6 (12-22) I haven’t had vitamin d tested since February which was 31 and have been taking supplements of 1000ui since. I think my dosage needs increasing but gp says not as still within range I’m so confused

[Lalatoot]

You do need a dose increase in my opinion. when on levo TSH should be 1 or less.

[K12yla in reply to Lalatoot]

Thank you for the reply my gp is adamant I shouldn’t be below 2. It’s just a constant battle with them.

[SlowDragon Administrator in reply to K12yla]

GP has that wrong way around ...on levothyroxine TSH shouldn’t be above 2

Email Dionne at Thyroid UK for list of recommend thyroid specialist endocrinologists...NHS and Private

[e-mail]

[SlowDragon Administrator]

New NHS England Liothyronine guidelines July 2019 clearly state on page 13 that TSH should be between 0.4-1.5 when treated with just Levothyroxine

Note that it says test should be in morning BEFORE taking Levo thyroxine

Also to test vitamin D, folate, B12 and ferritin

sps.nhs.uk/wp-content/uploa...

Aim is to bring a TSH under 2.5

gp-update.co.uk/SM4/Mutable...

Official NHS guidelines saying TSH should be between 0.2 and 2.0 when on Levothyroxine

(Many of us need TSH nearer 0.2 than 2.0 to feel well)

See box

Thyroxine replacement in primary hypothyroidism

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

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]

[SlowDragon Administrator]

When were folate, ferritin and B12 last tested

Have you had thyroid antibodies tested

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

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

List of private testing options

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus ultra vitamin

medichecks.com/products/thy...

Medichecks often have special offers, if order on Thursdays

Thriva Thyroid plus vitamins

thriva.co/tests/thyroid-test

Blue Horizon Thyroid Premium Gold includes vitamins

bluehorizonbloodtests.co.uk...

[K12yla in reply to SlowDragon]

Thank you for your reply it’s been a while since I had a full vitamin and mineral test which I have done today. The tests I have done privately I have done before 6am with 24 hours since last dose of Levo. I have spoken to my gp again today and they are doing a full vitamin check. Antibody tests were last done over a year ago and I don’t remember the results sorry.

[SlowDragon Administrator in reply to K12yla]

NHS usually only test thyroid antibodies once

You are legally entitled to printed copies of your blood test results and ranges.

The best way to get access to current and historic blood test results is to register for online access to your medical record and blood test results

UK GP practices are supposed to offer everyone online access for blood test results. Ring and ask if this is available and apply to do so if possible, if it is you may need "enhanced access" to see blood results.

In reality many GP surgeries do not have blood test results online yet

Alternatively ring receptionist and request printed copies of results. Allow couple of days and then go and pick up.

Important to see exactly what has been tested and equally important what hasn’t been tested yet

[That_mountain_girl in reply to SlowDragon]

Nop, they charge for printed results here in Scotland

[SlowDragon Administrator in reply to K12yla]

So what were vitamin results and thyroid antibodies results?

Please add

Vitamin D at 1000iu is often not high enough dose

Even NHS guidelines recommend 1600iu per day for 6 months

Often with Hashimoto’s we need higher dose that average

[SlowDragon Administrator in reply to K12yla]

Vitamin D

GP will often only prescribe to bring levels to 50nmol.

Some areas will prescribe to bring levels to 75nmol

leedsformulary.nhs.uk/docs/...

GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)

mm.wirral.nhs.uk/document_u...

NHS Guidelines on dose vitamin D required

ouh.nhs.uk/osteoporosis/use...

But with Hashimoto’s, improving to around 80nmol or 100nmol by self supplementing may be better

ncbi.nlm.nih.gov/pubmed/218...

vitamindsociety.org/pdf/Vit...

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

Test twice yearly via vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function. There’s a version made that also contains vitamin K2 Mk7

It’s trial and error what dose we need, with hashimoto’s we frequently need higher dose than average

Calculator for working out dose you may need

40ng/ml = 100nmol

grassrootshealth.net/projec...

Government recommends everyone supplement October to April

gov.uk/government/news/phe-...

With your Vit D, are you also taking it's important cofactors - magnesium and Vit K2-MK7?

Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

[fuchsia-pink]

You are discovering just how meaningless "in range" and "normal" mean.

For example, a typical free T4 range might be 12 - 22. If your result is 12.2 you will feel dreadful; if it's 20 you probably won't - but both are "in range"

As it is, as others have said, your TSH is too high; your free T4 is nice and high (76% through range) but your free T3 is only 43% through range - so I second Lalatoot and suggest you need more than the tiny "starter dose" of levo you are currently on - which is half of the more usual "stater dose" of 50 mcg.

[K12yla in reply to fuchsia-pink]

Thank you for your reply. I have been requesting this from my gp for a couple of months but feel like I am banging my head against a brick wall at the minute

[That_mountain_girl]

I had vitamin D deficiency, and could not get my blood tested until end of April. But by the time I got the test my levels had increased. All I did was soaked in 12-15 mins sun whenever got a chance. Keep taking 1000 IU - it can work as maintainance dose but sun this summer will be excellent way to help you increase your level. One can never overdose from sun. How beautiful!