Thyroid Test Normal?

[CarleneRyan]

I have had under active thyroid for years. Dose was cut from 100 to 50 mcg several years back. Lately been feeling very tired and tingling in hands and feet and just feel thyroid dose needs adjusting. Had bloods to test for thyroid and to eliminate various other things all came back normal. My thyroid level was 1.9 is there any further test they can do to see if thyroid is working well.

[greygoose]

Sounds like they only tested TSH. The TSH on its own doesn't tell you much. What you need are FT4 and FT3, and antibodies if you've never had them tested.

Also a good idea to get your nutrients tested: vit D, vit B12, folate and ferritin. They are likely to be low, adding to your symptoms.

Why did they slash your dose like that? That was a massive reduction.

[CarleneRyan in reply to greygoose]

Hi Greygoose, thanks for your response. They slashed the dose because I went hyperthyroid by a little margin. I am going to ask for a full thyroid test, if not forthcoming I will get a private one done and B12 & D vitamin test. Thank you CarleneRyan

[greygoose in reply to CarleneRyan]

Well, you might have been slightly over-medicated, but you couldn't have gone hyperthyroid, because that's a physical impossibility. But, what was it suggested you were over-medicated? Was it just a TSH below range? Or an over-range FT4? In any case, you should never agree to a reduction in dose without the FT3 being tested. Because you're only over-medicated if your FT3 is over-range. And, your dose certainly should not have been reduced by 50 mcg whatever your results. Time to take your GP in hand, me thinks!

[CarleneRyan in reply to greygoose]

Yes agree they said too high a dose! Do not know whether it was TSH range or FT4 I totally agree will be speaking to doctor next week and if no joy will get private tests. Thank you for your response Carlene

[greygoose in reply to CarleneRyan]

You're welcome.

[shaws Administrator]

Did you do the following when getting test:-

Tests should be at the very earliest, fasting (you can drink water) and allow a gap of 24 hours between your last dose of hormones and the test and take it afterwards? If not the results will be skewed.

Reducing a patients dose by half is a bit drastic it should be increased/decreased by 25mcg each time.

[CarleneRyan in reply to shaws]

Hi Shaws thank you for response. No I took thyroxine first thing in morning prior to tests so could have skewed it. It was drastic and I know it needs increasing. We all know our bodies. Carlene

[shaws Administrator in reply to CarleneRyan]

Next time, make your appointment several weeks ahead so that you can get the earliest appointment, don't take thyroid hormones until after blood draw and hopefully your numbers will enable an increase in dose. Thyroid hormone tablets should be taken with one full glass of water and wait an hour before eating.

Many doctors seem to only take notice of the TSH and if is too low, the assumption is that we're on too high a dose, so it is reduced and then we are symptomatic again.

[CarleneRyan in reply to shaws]

Thank you awaiting private test kit. This will test.for vitamin deficiencies too. Be interesting to finally have a complete overview. Carlene

[Marz]

Tingling in hands and feet can be LOW B12 and can be a serious problem if not corrected.

Dose of T4 should NOT be reduced by 50mcg - only 25mcg. You are only over medicated when the FT3 is over range - rarely tested in the NHS .

Are you able to have Private Testing done to ensure you have the correct testing and nutrients. See link below and scroll through Menu.

thyroiduk.org

[CarleneRyan in reply to Marz]

Hi Marz I will get a private test for thyroid and B12 and D vitamin levels for sure. Tingling I know can be a sign of low B12. Thanks for responding Carlene

[SlowDragon Administrator]

Just testing TSH is completely inadequate

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...

[CarleneRyan in reply to SlowDragon]

Hi SlowDragon thank you for your really comprehensive responses. I will probably go private to have tests done both with thyroid and vitamin levels as know B12 deficiency can result in pins and needles. I started all those years ago on 50 mcg and was gradually upped to 100 mcg. Also I had taken my thyroxine prior to tests which were in the morning. So could have skewed things too. Thanks again for detailed explanation and NICE & BMJ guidelines. Carlene

[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/insist GP to test vitamin levels

Pins and needles is frequently low B12

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)

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

Thriva also offer just vitamin testing

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...

[SlowDragon Administrator]

Come back with new post once you get full results

[CarleneRyan in reply to SlowDragon]

I certainly will thank you Carlene