Test results

[Freyabo]

Hi I’ve had UAT for 3 years now ! Just had blood results back and still fell rubbish ! Can anybody tell me if these are ok

[Lalatoot]

No they are not okay.

You are needing an increase in levo.

Your ft4 and Ft3 are low in range.

When on levo tsh should be around 1 or lower as a rough guide with ft4 and Ft3 over halfway through their ranges.

[Freyabo in reply to Lalatoot]

Thankyou for replying ! I’m not sure what to do as feel so rubbish but dr just saying they are normal

[Lalatoot in reply to Freyabo]

Yes they are normal for somebody but not for you.

Anywhere in the range is normal. You need to find where in the normal range you feel well. Tell your gp. You would be normal if your ft4 was 9 and you would be normal if it was 19. 13 is in range but it is not the optimal normal for you.

[Freyabo in reply to Lalatoot]

Thankyou x

[FancyPants54 in reply to Lalatoot]

That's a really good way to explaining it. Pointing out that you would be normal at 9 and normal at 19, yet you feel rubbish at 13 and you want to increase your medication.

Thyroxine is so cheap I have no idea why they are so mean with it.

[Freyabo in reply to Lalatoot]

Thankyou for replying ! I’ve been on 75mg for the last 3 years . I just got told normal range today and that was that ! I’m so frustrated though as I know il not feeling well

[SlowDragon Administrator in reply to Freyabo]

guidelines on dose levothyroxine by weight

Even if we don’t start on full replacement dose, most people need to increase levothyroxine 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...

Come back with new post once you get vitamin results

Bloods should be retested 6-8 weeks after GP increases dose levothyroxine up to 100mcg

Come back with new post when you get next results

[Freyabo in reply to SlowDragon]

My dr says results are normal so I’m not getting them increasesd ? It’s so frustrating

[Freyabo in reply to Freyabo]

Also my vitamin d has always been low but I’m taking supplements x

[SlowDragon Administrator in reply to Freyabo]

How much vitamin D are you currently taking

What were most recent results?

[Freyabo in reply to SlowDragon]

Vitamin d nmol/L

[Freyabo in reply to Freyabo]

Vitamin d 40 nmol/L

[SlowDragon Administrator in reply to Freyabo]

So vitamin D is still low

How much vitamin D are you currently taking?

Low vitamin D obviously needs improving and GP should prescribe 1600iu everyday for 6 months

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 to bring levels to

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...

[SlowDragon Administrator in reply to Freyabo]

What are most recent b12, folate and ferritin results

[SlowDragon Administrator in reply to Freyabo]

Did you get folate, ferritin and B12 tested ?

[SeasideSusie Remembering]

Freyabo

No they're no OK, you are undermedicated and need an increase in your dose of Levo, 25mcg now and retest in 6-8 weeks. The aim of a treated hypo patient on Levo, generally, is for TSH to be 1 or lower with FT4 and FT3 in the upper part of their ranges if that is where you feel well, so you may need a further increase after the initial one.

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine (the professional 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

[e-mail]

print it and highlight question 6 to show your doctor.

Also use the following information from a Leeds NHS hospital, I can't see how a doctor can argue with this coming from the NHS:

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

Scroll down to the box

Thyroxine Replacement Therapy in Primary Hypothyroidism

TSH Level .................. This Indicates

0.2 - 2.0 miu/L .......... Sufficient Replacement

> 2.0 miu/L ............ Likely under Replacement

[Freyabo in reply to SeasideSusie]

Thankyou x

[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

Do you have high 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)

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 vitamins including folate (private blood draw required)

medichecks.com/products/thy...

Thriva Thyroid plus antibodies and vitamins By DIY fingerpick test

thriva.co/tests/thyroid-test

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off if go on thyroid uk for code

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

monitormyhealth.org.uk/thyr...

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

medichecks.com/products/nut...

Medichecks often have special offers, if order on Thursdays