Test results

[Morg2020]

Hi just had test results since starting levothroxine 50mcg and Ferrous fumarate 210mg in March

Serum TSH level 2.64mU/L (0.27-4.20)

Serum ferritin 105ug/L (15-300)

Previous test in Feb

Serum TSH 4.6

Serum free T4 level 13.3pmol/L (11.0-25.0)

Serum ferritin 45ug/L

GP said normal and continue on levothroxine 50mcg

Ferritin levels have gone up but I’m still experiencing excessive hair shedding.

I’ve started taking nourikin any advice would be greatly appreciated.

[greygoose]

your GP doesn't know much about thyroid, does he. 50 mcg is just a starter dose and should be increased by 25 mcg now. Your TSH is still to high - even though it is in-range - it should come down to 1 or under when on levo.

And just testing TSH is totally inadequate. Your FT3 is probably quite low, and that will be contributing to your hair-loss, as well.

I’ve started taking nourikin

Never heard of that before. But, my goodness! That's expensive for what it is. Do note that it contains biotin, which can affect blood test results. So, do stop it a week before any blood test is due to be given. Not sure it's worth the money, though. You could buy biotin and vit C much cheaper if you bought them on their own.

Have you also had your vit D, vit B12 and folate tested? If your ferritin was low, they could also be.

[SlowDragon Administrator]

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)

If/when also on T3, make sure to take last third or half of daily dose 8-12 hours prior to test, even if this means adjusting time or splitting of dose day before test

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...

See/phone GP

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...

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.

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...

[Morg2020]

Hi Gp hasn't tested vitamin B12 or vitamin D3 but I have been taking supplements for these.

Will Gp test for FT3 and what medication do they give if this is low.

I have only been taking nourikin for 7 days and had blood test last Friday.

Maybe worth getting private blood test, this is all new to me and I appreciate your advice. I did ask to have hormone blood test as probably hitting menopause but gp wont do this. My initial concern going to Gp last Nov was excess hair shedding which hasn't got any better and started on lev in March. Thanks