Test results

[rabeya_2008]

Hello can anyone advise if I am on right dose. GP test results below.

TSH-0.04

T4-18.1

Taking Levo 100mg last 6 months after 75. GP told me to reduce 82.5mg

Thanks

[SeasideSusie Remembering]

rabeya_2008

We can't interpret your results without the reference ranges that come with them, ranges vary from lab to lab. Please add the ranges so that members can comment.

[rabeya_2008 in reply to SeasideSusie]

TSH> 0.4-4.1

T4> 11-21

[SeasideSusie Remembering in reply to rabeya_2008]

rabeya_2008

TSH-0.04 (0.4-4.1)

T4-18.1 (11-21)

Has your GP said why he wants you to reduce your dose? Presumably because TSH is below range.

How do you feel?

TSH is not a good indicator of thyroid status. It is not a thyroid hormone, it's a pituitary hormone. It's useful for diagnosis of hypothyroidism but once on Levo it's the thyroid hormones that count. The thyroid hormones are FT4 and FT3 and these are the results which are important and which should be used to determine your dose, along with how you feel.

Your FT4 is 71% through range which is a pretty good place to be. The aim of a treated Hypo patient on Levo, generally, is for TSH to be 1 or below with FT4 and FT3 in the upper part of their reference ranges.

Your GP is making the mistake that so many do, only looking at TSH. You can see that your FT4 is nicely within range.

If you feel well on 100mcg and don't want to reduce your dose then refuse and ask your GP to test FT3 as well as FT4 and TSH. If FT3 is over range then that suggests overmedication, not TSH. You can use the following information to support this:

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.

[rabeya_2008 in reply to SeasideSusie]

I take your point.

Symptom wise I am fine on 100mg but my cholesterol level raised significantly while I am on higher dose, do not know if there is any connection or not! though I eat low carb low fat diet.

GP advised to reduce to 82.5mg for 3 months and then get retested all and see the results to review further.

Thanks

[SeasideSusie Remembering in reply to rabeya_2008]

rabeya_2008

Raised cholesterol is actually a symptom of hypothyroidism.

We all need good fats in our diet, low fat diets aren't good.

It's up to you if you reduce your dose but your results definitely do not warrant it without testing your FT3 and it's very unlikely that will be over range with the FT4 level you have.

[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)

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...

What vitamin supplements are you currently taking?

As SeasideSusie says high cholesterol is linked to still being hypothyroid

nhs.uk/conditions/statins/c...

If you have an underactive thyroid (hypothyroidism), treatment may be delayed until this problem is treated. This is because having an underactive thyroid can lead to an increased cholesterol level, and treating hypothyroidism may cause your cholesterol level to decrease, without the need for statins. Statins are also more likely to cause muscle damage in people with an underactive thyroid.

Many people find Levothyroxine brands are not interchangeable.

Do you always get same brand?

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...

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...

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)

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