Results advice please.

[Beads]

Well that was quick, for the thyroid tests, my vitamin levels were a separate sample, results not through yet.

December 2019, before treatment.

Feb 2020’ started on 50mcg levo, after doc tests where TSH was similar to the medichecks result.

May 2020, results after 8 weeks of 50mcg.

Doc result, TSH only, 4.3 (0.27-4.2), dose increase to 100mcg.

August 2020, results below and the trend line from the previous medichecks tests.

When doc increased the dose he said to check again (with his blood check) in 3 months or if I felt well in 6 months. I’d told him about the May medichecks test and he probably figured (rightly) that I’d do another test myself and get back to him if not all right.

I’m feeling mostly alright, my hair is shedding but that may be because it’s longer than normal so I’m noticing it more. The air hunger is better, I’m not ‘yawning’ as much as I was. Running is ok until I find a hill, I’m still having to walk up those, it feels like it’s an issue freeing up energy for my cells fast enough. Stamina is not too bad so long as I don’t go too fast.

Looking at my results, the doc will get upset as he’ll only test TSH, see it’s under range and panic. But T4 is near the top and T3 about halfway, so I’m not over medicated.

After all that waffle I’m going to get to the point and ask the questions.

If I tweak my dose by reducing to 6days 100mcg and nothing on the 7th, that will bring my TSH up a bit, possibly to the bottom of the range, yes?

Posts here the last few weeks have suggested that TSH promotes the conversion of T4 to T3, so might this also help boost my T3 levels? That sort of makes sense as last year when I had dire levels of T4 and over range TSH my T3 was relatively normal.

Try it for 8 weeks, see how I feel, get another set of tests??

[SlowDragon Administrator]

Guidelines on dose by weight is 1.6mcg per kilo of your weight

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?

You need vitamin levels tested ...if not been tested yet or recently..

Medichecks - JUST vitamin testing including folate - DIY finger prick test

medichecks.com/products/nut...

Medichecks often have special offers, if order on Thursdays

These results don’t show over medication. Ft3 is only mid way through range

[Beads in reply to SlowDragon]

I'm waiting on the vitamin results, that sample was posted yesterday as well. They were tested in May and last December, but B12 and folate had dropped quite a lot between samples, likely due to eliminating gluten, including marmite, which meant that I wasn't getting as much Bs in my diet. I've been supplementing with about half a dose of B complex and want to see if I've stopped the decline of my Bs.

Yes to test conditions.

1.6 x roughly 60kg (about 62kg at the moment, I need to shift the few kg that accumulated before levo) is roughly 100µg, so going by that it's probably about the right dose.

Yep, FT3 is about halfway, you know that's not over medicated, I know that's not over medicated, unfortunately the doc will ignore that and concentrate on the TSH being too low. However my FT3 was about at the same level when my TSH was high and my FT4 below range, so I'm hoping if I drop my dose very slightly I'll be able to up my conversion a bit (not going to tell the doc though). I'm my own science experiment!

[SlowDragon Administrator in reply to Beads]

Sainsbury’s “marmite” is gluten free...Asda own brand possibly is too

Coeliac UK membership gives access to full list GP foods

[Beads in reply to SlowDragon]

Ooooooo!!! You may have just made my day, or even year!

[Beads in reply to Beads]

Yay!!! SlowDragon, I love you!

"However, some supermarket-own brands of yeast extract are gluten free, so if you’re missing Marmite, you’ll be pleased to know that Asda Yeast Extract, Meridian yeast Extract, Morrison’s Yeast Extract and Sainsbury’s Reduced Salt Yeast Extract are all listed in the Coeliac UK app as gluten free."

[SlowDragon Administrator]

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.

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.

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...