Medichecks results - help in interpreting please

[Debslee]

I posted last week for advice following the results of latest blood tests at GP surgery (I was diagnosed with UAT last September and currently taking 75mg Levothyroxine). My symptoms improved initially but have returned with a vengeance, however my GP has flatly refused to increase my dose stating that my blood results were in range and that I would be likely to become overmedicated / Hyperthyroid if my dose was increased.

Following advice from this site, I have taken a Thyroid Vit + test with Medichecks My results as follows:

GP blood results taken 4.6.20 (8.30am following 12 hr fast)

Serum free T4 level 12.7 pmol/L [11.0 - 23.0]

Serum TSH level 0.53 mU/L [0.27 - 4.5]

A full range of other bloods were done at same time .Most came back within range except :

Eosinophil count - observation 0.07 10*9/L [0.02 - 0.5] – not sure if this is relevant

My cholesterol results which I’ve since had advice for and understand are fairly good seems to have caused my GP more concerned and Ive been offered statins (which I’ve refused for time being)

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

Serum non high density lipoprotein cholesterol level 3.3 mmol/L

Medichecks results taken 15.6.20 (8.30am following 12 hour fast)

TSH 1.38 (0.27-4.2)

Free T3 3.25 (3.1-6.8)

Free Thyroxine 12.4 (12 – 22)

Inflammation CRP HS - 4.05mg/l (>5)

Thyroglobulin antibodies - 132 kIU/L (0-115)

Thyroid Peroxidase antibodies - >9 (0 – 34)

Ferritin – 103 ug/L (13 – 150)

Folate serum – 5.9 ug/L (3.89- 19.45)

Vitamin B12 - 106 pmol/L (37.5-187.5)

Vitamin D – 96.5 nmol/L (50-175)

I take 2,000iu Vit D and 250mg magnesium daily.

I think I understand most of these results, particularly Thyroid ( that I’m under medicated and increase in T4 is unlikely to cause me to become overmedicated due to T3 being low in range) but I’m not confident enough on rational behind this to explain my reasoning to the GP when I ask for a 2nd opinion.

My thyroglobulin antibodies are over range however thyroid peroxidase antibodies are low in range – not sure what this indicates and would be grateful if someone could enlighten me.

I initially managed to persuade my GP to commence treatment based on my Medichecks results together with NICE guidelines so if anyone could direct me to anything relevant to my situation I’d be very grateful. As mentioned in my previous post – I referred to Dr Toft’s paper at my first appointment but it had little effect – I will however include the information again when I ask for 2nd opinion.

I also understand that underactive Thyroid can also be the cause of raised cholesterol and that statins can cause side effects in Hypothyroid patients. I intend to ask for my Thyroid to be better managed before commencing any cholesterol treatment.

Any further help or advise on where to go from here would be greatly appreciated.

Many thanks

Debra

[Debslee]

Hi Lora - yes I think so too , unfortunately my GP doesn’t agree and won’t prescribe an increased dose !

I intend to ask for a second opinion but need to gather evidence together to try to persuade him/her

[greygoose]

I also understand that underactive Thyroid can also be the cause of raised cholesterol and that statins can cause side effects in Hypothyroid patients. I intend to ask for my Thyroid to be better managed before commencing any cholesterol treatment.

It's low T3 that causes high cholesterol. Cholesterol is made in the liver, and transported round the body, to where it's needed, in the blood, attached to proteins. And, it's the proteins they test, rather than the cholesterol itself. When T3 is low, the body cannot process cholesterol correctly, so it builds up in the blood.

Statins can cause side effects in anybody, hypo or not, and are really not a good idea for anyone, but especially not for women. High cholesterol is a symptom, not a disease, and it won't do you any harm. It does not cause heart attacks or strokes. In fact, people with high cholesterol tend to live longer than others.

TSH 1.38 (0.27-4.2)

Free T3 3.25 (3.1-6.8)

Free Thyroxine 12.4 (12 – 22)

Your FT3 and FT4 are very low, and your TSH does not correspond. One would expect it to be higher with those low Frees. But, it would seem, your doctor is only looking at the TSH, and believes that a low TSH indicates over-medication. That's not always true. You are only over-medicated if your FT3 is over-range - and yours is a long way off that! An increase of 25 mcg levo probably wouldn't raise it very much at all.

My thyroglobulin antibodies are over range however thyroid peroxidase antibodies are low in range – not sure what this indicates and would be grateful if someone could enlighten me.

Tg antibodies can be raised for many reasons - they can be high with Grave's disease, for example, but that's obviously not your problem - but only indicate Hashi's if very high. Yours isn't that high, so probably has no bearing on your thyroid status. However, as antibodies fluctuate, one test doesn't tell you very much at all. It certainly doesn't completely rule out Hashi's.

[Debslee in reply to greygoose]

Thank you Greygoose , this is very helpful information

[greygoose in reply to Debslee]

You're welcome.

[SlowDragon Administrator]

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

NICE guidelines on full replacement dose

nice.org.uk/guidance/ng145/...

1.3.6

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.

gp-update.co.uk/Latest-Upda...

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...

The aim of Levothyroxine is to increase the dose slowly in 25mcg steps upwards until TSH is under 2 (many patients 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

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

nhs.uk/medicines/levothyrox...

Also note 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

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)

Note that they say here that Ft4 will be in top third of range

See box

Thyroxine replacement in primary hypothyroidism

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

nhs.uk/conditions/statins/c...

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.

If GP still refuses ......Ask for trial 25mcg increase in levothyroxine

If still refuses then you will need to see endocrinologist

Email Dionne at Thyroid UK for list of recommended NHS and private endocrinologists

[e-mail]

[SlowDragon Administrator]

gp-update.co.uk/Latest-Upda...

Traditionally we have tended to start patients on a low dose of levothyroxine and titrate it up over a period of months.

RCT evidence suggests that for the majority of patients this is not necessary and may waste resources.

For patients aged >60y or with ischaemic heart disease, start levothyroxine at 25–50μg daily and titrate up every 3 to 6 weeks as tolerated.

For ALL other patients start at full replacement dose. For most this will equate to 1.6 μg/kg/day (approximately 100μg for a 60kg woman and 125μg for a 75kg man).

If you are starting treatment for subclinical hypothyroidism, this article advises starting at a dose close to the full treatment dose on the basis that it is difficult to assess symptom response unless a therapeutic dose has been trialled.

A small Dutch double-blind cross-over study (ArchIntMed 2010;170:1996) demonstrated that night time rather than morning dosing improved TSH suppression and free T4 measurements, but made no difference to subjective wellbeing. It is reasonable to take levothyroxine at night rather than in the morning, especially for individuals who do not eat late at night.

[Debslee]

Thankyou so much for all of this information Slowdragon, I’m so grateful abs will read it all before composing my note to GP asking for a 2nd opinion .

Would any of you kind people be able to offer any advice on my vitamin levels please , particularly if any additional supplements are required

Thank you again x

[SlowDragon Administrator]

As you didn’t “reply” only posted this last question..I wasn’t alerted

Your folate is rather low

Supplementing a good quality daily vitamin B complex, one with folate in not folic acid may be beneficial.

chriskresser.com/folate-vs-...

B vitamins best taken after breakfast

Igennus Super B is good quality and cheap vitamin B complex. Contains folate. Full dose is two tablets per day. Many/most people may only need one tablet per day. Certainly only start on one per day (or even half tablet per day for first couple of weeks)

Or Thorne Basic B or jarrow B-right are other options that contain folate, but both are large capsules

If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before any blood tests, as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

Did you get GP to agree dose increase in levothyroxine

Make sure to stick to same brand levothyroxine at each prescription

[Debslee in reply to SlowDragon]

Thankyou so much again . I had realised that I’d not posted the question correctly but I’ve been rather preoccupied this last week as in the middle of helping my elderly parents with a rather large house move ( 25 years of hoarding to sort through !) and haven’t got around to updating

I did have some success - my GP thought it was strange that T4 & T3 weren’t higher in range and agreed to increase to 100mg . He commented “ maybe I wasn’t imbibing the thyroxine correctly ? “ and will retest in 6 weeks. He also said my cholesterol was good and that I should have not been offered statins !

I’m grateful for the dose increase for now but may well be back for more advise in 6 weeks if no improvement

Once again thank you everyone for your brilliant advice xx