TSH 15.8 T4 6.3

[Pipsy82]

Hi I just had the results of tsh 15.8 and t4 6.3 can I please have some advice as how best to treat this.

I have been prescribed 50mcg levothyroxine

I am aware that thyroid is very complex and that there are many recommendations.

Hair loss and tiredness (weight gain, I think I eat for the energy) are my main symptoms

[SeasideSusie Remembering]

Pipsy82

Your GP is doing exactly what is correct. He has prescribed the right starter dose of Levo, you should be retested in 6 weeks to check your levels, you should be given an increase of 25mcg and retested 6-8 weeks later. This should be repeated until your levels are where they need to be for you to feel well. It's not a quick fix, it can take a few months of testing/increasing to get to your optimal dose.

The aim of a treated Hypo patient on Levo only, generally, is for TSH to be 1 or below with FT4 and FT3 in the upper part of their reference ranges, if that is where you feel well.

Feel free to come back with new results when retested and members will comment, but please always include the reference ranges for your tests as these vary from lab to lab.

Many GPs only test TSH but this is inadequate and doesn't give a full picture. TSH is not a thyroid hormone, it's a signal from the pituitary to the thyroid. The thyroid hormones are FT4 and FT3 and these are the tests that tell you your thyroid status, unfortunately most doctors don't know this.

Always advised here, when having thyroid tests:

* Blood draw no later than 9am. This is because TSH is highest early morning and lowers throughout the day. If looking for a diagnosis of hypothyroidism, an increase in dose of Levo or to avoid a reduction then we need the highest possible TSH

* Nothing to eat or drink except water before the blood draw. This is because eating can lower TSH and coffee can affect TSH.

* Last dose of Levo 24 hours before the test, take that day's dose after the blood draw. This is because if you take your Levo before the blood draw the test will measure the dose just taken and show a false high. If you leave longer than 24 hours the result will show a false low.

* If you take Biotin or a B Complex containing Biotin (B7), leave this off for 7 days before any blood test. This is because if Biotin is used in the testing procedure it can give false results (most labs use biotin).

These are patient to patient tips which we don't discuss with phlebotomists or doctors.

Also, take your Levo on an empty stomach, one hour before or two hours after food, with a glass of water only, no tea, coffee, milk, etc, and water only for an hour either side, as absorption will be affected. Take any other medication and supplements 2 hours away from Levo, some need 4 hours.

We Hypos often have low nutrient levels, and optimal levels are needed for thyroid hormone to work properly. Low nutrient levels often give symptoms similar to hypothyroidism (eg low ferritin causes fatigue). It would be a good idea to test

Vit D

B12

Folate

Ferritin

You could suggest to your GP next time you consult with them that you have taken advice from the charity ThyroidUK (don't mention the forum, they don't like that) and they have advised you about testing nutrients so would he please arrange for them to be done. If your GP wont do them then we have recommended private labs where you can get them done with a fingerprick blood test.

[Pipsy82 in reply to SeasideSusie]

Thank you 😊

[fuchsia-pink]

Welcome to the forum

You poor thing, must feel dreadful with such a high TSH. You have been given a "starter" dose of levo: take this every day, morning or evening as you prefer, just with water and with nothing else to eat or drink for an hour afterwards or two hours before. Have your bloods re-tested in 6 - 8 weeks to see if you need a dose increase (very likely). Have an early morning blood test, fasting, and leave 24 hours from your previous dose of levo.

Ideally, you will also have full blood testing at some point - that means TSH, free T4, free T3, thyroid antibodies and key nutrients - ferritin, folate, vit D and B12, as your levo works best when these are good. I have had some success with my GP by saying these are the tests recommended by Thyroid UK.

Always get your actual blood result and lab ranges (these vary from lab to lab). Don't be fobbed off with guff like "in range", "normal" or "getting there" - you are aiming for "optimal"

While we are all different, ideally, you are aiming for TSH to be less than 2, prob less than 1, and free T4 and free T3 to be 2/3 through range.

If you're not too familiar with thyroid things, please have a good rootle around the main Thyroid UK site and helvella 's excellent glossary (in the "pinned posts").

Good luck x

[Pipsy82 in reply to fuchsia-pink]

Thank you 😊

[SlowDragon Administrator]

Ask GP to test vitamin D, folate, ferritin and B12 at next blood test

Also important to get thyroid antibodies tested to see if cause of your hypothyroidism is autoimmune thyroid disease. About 90% of primary hypothyroidism is autoimmune thyroid disease (hashimoto’s) so it’s pretty likely