Blood test results

[Ullallah-6]

I’ve learned from this site that these blood tests are needed. Any help welcome from anyone knowledgeable. I had a total thyroidectomy in march. Still not feeling great. Very low energy. I’m on 100 mg Levothyroxine.

[Lalatoot]

Did you get tsh and ft4 results? These will help to interpret your Ft3 result to see if you need a higher levo dose or have poor conversion.

[Ullallah-6 in reply to Lalatoot]

tsh 0.06 mU/L

ft4 26.1

Should i be worried about high B12?

Thank you...

[SlowDragon Administrator]

Please add TSH and Ft4

Ft3 looks likely rather too low

But without Ft4 result it’s impossible to say wether this is just because not on high enough dose levothyroxine(Ft4 would be low) .....or if Ft4 is high ...it’s poor conversion

Vitamins look fine

[Ullallah-6 in reply to SlowDragon]

tsh 0.06 mU/L

ft4 26.1

Should i be worried about high B12?

Thank you...

[SlowDragon Administrator in reply to Ullallah-6]

What’s the range on Ft4?

How long have you been on 100mcg

Do you always get same brand of levothyroxine

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?

What vitamin supplements are you currently taking?

[Ullallah-6 in reply to SlowDragon]

I don’t understand the range of ft4? On form it says Free T4 26.1 pmol/L and normal range is 12-22 lmol/L

I was on Accord 100mg Levothyroxine straight after surgery on march 24th. I felt it was a good dose as i felt well in myself. Then 6 weeks later i was told to cut to 75mg which I immediately knew didn’t feel good. (My consultant doesn’t care!) Then on 15 July RAR oncologist raised it back up to 100mg and I immediately felt better. That didn’t last too long though and wondered if it was to do with brand change as chemist began sending me Teva. I have now told them to only give me accord or northstar which I believe to be exactly the same ingredients. I’ve only just stopped Teva. Regarding blood tests, they haven’t been fasting ones.

[SlowDragon Administrator in reply to Ullallah-6]

Many people find Levothyroxine brands are not interchangeable.

Once you find a brand that suits you, best to make sure to only get that one at each prescription.

Watch out for brand change when dose is increased or at repeat prescription.

Many patients do NOT get on well with Teva brand of Levothyroxine. Teva contains mannitol as a filler, which seems to be possible cause of problems. Teva is the only brand that makes 75mcg tablet. So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half

Teva, Aristo and Glenmark are the only lactose free tablets

healthunlocked.com/thyroidu...

Teva poll

healthunlocked.com/thyroidu...

academic.oup.com/jcem/artic...

Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).

Levothyroxine is an extremely fussy hormone and should always be taken on an empty stomach and then nothing apart from water for at least an hour after

Many people take Levothyroxine soon after waking, but it may be more convenient and perhaps more effective taken at bedtime

verywellhealth.com/best-tim...

If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test

If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal

No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap. Some like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away

(Time gap doesn't apply to Vitamin D mouth spray)

[helvella Administrator Thyroid UK in reply to Ullallah-6]

Northstar 50 and 100 microgram tablets are, indeed, Accord (new name for Actavis).

But, just in case it becomes relevant, 25 microgram Northstar are actually Teva product.

[SlowDragon Administrator in reply to Ullallah-6]

It will take minimum of perhaps 8-12 weeks for levels to settle after dose was inappropriately reduced

How long before blood test was last dose levothyroxine?

Currently Ft4 is slightly over range

But Ft3 is only 37% through range at moment

Helpful calculator for working out percentage through range

chorobytarczycy.eu/kalkulator

Suggest you hold tight and wait for levels to settle and get bloods retested in 10-12 weeks after stopping Teva brand

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...

guidelines on dose levothyroxine by weight

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...

Rare to need less than guidelines, some patients need higher doses

[SlowDragon Administrator in reply to Ullallah-6]

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

"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)."

(That’s FT3 at 58% minimum through range)

You can obtain a copy of the articles from Thyroid UK email print it and highlight question 6 to show your doctor

 please email Dionne at

[e-mail]

[Angel_of_the_North in reply to Ullallah-6]

It means that you have poor conversion of T4 to T3 as you need over range FT4 to get quite a low level of T3 (needs to be at least 5).

[SlowDragon Administrator]

When is vitamin D result due in?

Previous post you said

most days 1000 VitD3.

1000iu vitamin D may not be enough to maintain optimal level

What was reason for TT ?

[Ullallah-6 in reply to SlowDragon]

Vit D Result due today. I had thyroid cancer.

[SlowDragon Administrator in reply to Ullallah-6]

If you had Graves’ disease or Hashimoto’s frequently gluten free diet helps or is essential

[Ullallah-6 in reply to SlowDragon]

No Graves or Hashimoto's... Cancerous nodules

[SlowDragon Administrator in reply to Ullallah-6]

Yes ...so probably not necessary to try strictly gluten free diet.

[Batty1 in reply to Ullallah-6]

Besides energy are you having any other issues?

[Ullallah-6 in reply to Batty1]

Brain not always in gear. Memory not good. Losing/misplacing things

[SlowDragon Administrator in reply to Ullallah-6]

Brain needs good ft3 levels

[Ullallah-6]

Results in... Test name: 1 25 (OH) 2 Vitamin D3 results have just come in as 104 pmol/L. The range shows as 48-192. I’m taking 1000μg most days. (I sometimes miss a day). Is this enough?

[SlowDragon Administrator in reply to Ullallah-6]

Yes likely fine