My Thyroid story started 2012, when I found a lump on my neck, I had fine-needle aspiration biopsy for goitre which was normal. As other family members have underactive thyroids the Dr suggested I should be tested yearly, most tests have come back borderline.
At every yearly test, I mentioned to the Dr I have the usual symptoms for underactive thyroid but kept being told its borderline/normal. After my yearly test in 2015 my doctor put me on 50mg Levo, after 4 months I was retested, the Dr stopped them as my results had went the other way!! In 2016 my goitre had grown larger, I was referred to Endo who gave me another FNA, which was normal, the Endo suggested if I wanted, I could go on 25mg Levothyroxine, it was up to me!! I didn’t want to start taking tablets unless it was necessary because I knew once you are on Thyroxine its for life, I never started a course as he didn’t seem too concerned. Every test since then I have been informed all is normal/borderline.
End of 2019 I felt the symptoms were getting worse, brain fog, tiredness, dry skin, hair loss, hoarseness etc, went back to Dr to ask for the 25mg that the Endo suggested, I have been on 25mg Levothyroxine since February 2020, The pharmacy changed to TEVA after a couple of months which I couldn’t take as I had reaction and had to change back to Wockhardt. I was also put on Folic Acid for 3 months as one blood test came back saying it was low, had another test after the 3 months and was told it was ok and to keep eating my greens.
I thought it would help to have a private blood test done, and have attached the results. I am more confused, as it has came back stating all my results are normal, does this mean I’m on the correct dose of Thyroxine or should I stop taking it?
I still have the same symptoms, brain fog, lethargic, hoarseness, dry skin, hairloss etc
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Albaangel
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Your TSH should be 1 or lower and your T4 and T3 should be in the upper third of the range. You definitely need an increase of 25mcg which you should continue to do until you feel well. Also your vitamin levels need to be optimal for the Levothyroxine to work. You need to test B12, Iron and Ferritin, Vitamin D and Folate. Just to add if your ferritin is too low that can cause hair loss. I think your ferritin should be over 80 for hair growth. Just to add 25mcg is not even a starter dose 50mcg is.
Clearly you need 25mcg dose increase in levothyroxine
Bloods should be retested 6-8 weeks after each dose increase
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
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
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
Thankyou for your reply. I do feel myself I need to up the doze to see if it helps. I was taking D3 and Nourkin (for hairloss) but stopped these 1 week before my test. I currently take my Levo in the morning and wait at least an hour before I have any Tea, I have also just started on Omeprazole which I usually take in the afternoon.
Albaangel, 'I am more confused, as it has came back stating all my results are normal,'
Please type out the actual numbers for this private thyroid blood test so that members here can comment on these, rather than an arbitrary description of 'normal'. What might be normal for one person isn't necessarily so for another. We are individuals, with individual thyroid hormone requirements.
Thankyou for your reply, Numbers are at the top of my post. I asked for a Dr overview for my Thyroid Check UltraVit with Folate Blood Test from Medichecks the reply was
"Your thyroid stimulating hormone is in the normal range which suggests that your levothyroxine dose is correct.
I am also pleased to report that your vitamins B9, B12 and D are all at normal healthy levels. Your ferritin level is also normal indicating healthy iron stores"
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
Interestingly, patients with a serum TSH below the reference range, but not suppressed (0.04–0.4 mU/liter), had no increased risk of cardiovascular disease, dysrhythmias, or fractures. It is unfortunate that we did not have access to serum free T4 concentrations in these patients to ascertain whether they were above or within the laboratory reference range. However, our data indicate that it may be safe for patients to be on a dose of T4 that results in a low serum TSH concentration, as long as it is not suppressed at less than 0.03 mU/liter. Many patients report that they prefer such T4 doses (9, 10). Figure 2 indicates that the best outcomes appear to be associated with having a TSH within the lower end of the reference range.
Apologies, for some reason the pic of your test results wasn't showing for me when I wrote the above. It is now though
If you still have symptoms, then your results are not 'normal' for you. An increase in levothyroxine dose should be the next step, with a retest about 6 weeks after.
You just might find the article below (and the full paper which you can access) interesting and/or useful.
The normal range: it is not normal and it is not a range
1. Martin Brunel Whyte
2. Philip Kelly
Abstract
The NHS ‘Choose Wisely’ campaign places greater emphasis on the clinician-patient dialogue. Patients are often in receipt of their laboratory data and want to know whether they are normal. But what is meant by normal? Comparator data, to a measured value, are colloquially known as the ‘normal range’. It is often assumed that a result outside this limit signals disease and a result within health. However, this range is correctly termed the ‘reference interval’. The clinical risk from a measured value is continuous, not binary. The reference interval provides a point of reference against which to interpret an individual’s results—rather than defining normality itself. This article discusses the theory of normality—and describes that it is relative and situational. The concept of normality being not an absolute state influenced the development of the reference interval. We conclude with suggestions to optimise the use and interpretation of the reference interval, thereby facilitating greater patient understanding.
Yes, good article. Should be compulsory reading for all medics, and after they've read it, be made to write out (with a quill pen and indian ink) one hundred times 'The reference interval provides a point of reference against which to interpret an individual’s results—rather than defining normality itself. '
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