1st blood test after being diagnosed with Hypothyriod

[noteboo]

Good Morning!

Hope you all are well! I am approching my 8 weeks blood test post 50mg levo start. The GP emailed me a blood test request but only TSH is mentioned and no T4,TPO.. Is TSH enough to determine my new levels for levo? Thank you Xx

[SlowDragon Administrator]

Rarely, especially as your TSH wasn’t very high to start with

50mcg levothyroxine is only the standard starter dose

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)

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...

20% of Hashimoto's patients never have raised antibodies

healthunlocked.com/thyroidu...

Paul Robson on atrophied thyroid - especially if no TPO antibodies

paulrobinsonthyroid.com/cou...

[noteboo in reply to SlowDragon]

Thank you Slow Dragon, GP did a full test in regards to TPO and FT4 in august.. and then put me on starter dose of 50mcg. I feel so exhausted by noon.. Few weeks when i initially started levo did feel good and lost 4lb but now stagnant no matter what.. Is it worth calling gp to request the full panel test ?

TMI- i missed my periods as well (not pregnant) is this common when u start levo?

[SlowDragon Administrator in reply to noteboo]

Bloods should be retested 6-8 weeks after each dose increase....and repeated 2-3 times until well and stable once on high enough dose

Levothyroxine doesn’t “top up “ failing thyroid....it replaces it...hence reason why dose will almost certainly need increasing by 25mcg ...and then bloods retested 6-8 weeks later and then repeat this whole again and again until on full replacement dose

guidelines on dose levothyroxine by weight

Even if we frequently 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 results

[fuchsia-pink]

I have had some success in getting the full testing SlowDragon mentions by saying these are the tests recommended by Thyroid UK (although last time the hospital lab refused to do vit D despite the request coming from an endo). My GP said vit D is the hardest to get through.

If the GP won't do all of these, try at least for free T4 and antibodies on top of TSH. Any less is really too little to be of any help as TSH isn't even a thyroid hormone ...

Good luck x

[noteboo in reply to fuchsia-pink]

Thank you Fuchsia-pink ! I will push for it then.. Else no option but to get the private bloodworks done from the links provided by Slow Dragon and hope that GP acknowledges it..