Help re results .. thank you.

[Karan49]

Hello can someone read my results please and advise?

I take 75mg of Levo I am also diabetic so take metformin. I am tired all the time, not depressed, get hot sweats and I am on hrt also.

Plasma tsh level 1.87. Mu/L 0.30 _ 4.20 mu/ l

T4 11.7 Pool/L 9.00 -19.oo Pom/L

T4 3.1 Pmol/ L. 2.60 - 5.70pmol/l

Sorry for any mistakes all figures correct typing on phone

I haven’t had vitamins etc checked

Thanks

[SlowDragon Administrator]

Ft4 is only 27% through range

Ft3 only 13% through range

Helpful calculator for working out percentage through range

chorobytarczycy.eu/kalkulator

So clearly you are in dire need of 25mcg dose increase in levothyroxine

Bloods should be retested 6-8 weeks after each dose increase (or brand change) in levothyroxine

Metaformin can significantly reduce B12

independentnurse.co.uk/clin...

Absolutely essential to regularly retest vitamin D, folate and ferritin too

Insist that GP test all four vitamins ASAP

Or test privately

What vitamin supplements are you currently taking

Are you type one diabetic or type 2?

[Karan49 in reply to SlowDragon]

Thank you so much. Type 2

[SlowDragon Administrator in reply to Karan49]

guidelines on dose levothyroxine by weight

Even if we 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, or near 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.

Also here

cks.nice.org.uk/topics/hypo...

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...

Increase in dose usually has to only be in 25mcg steps....retesting 6-8 weeks after each dose increase

Important to stick to same brand levothyroxine

[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

Do you have Hashimoto’s?

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 antibodies and vitamins

medichecks.com/products/adv...

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 down to £26.10 if go on thyroid uk for code

thyroiduk.org/getting-a-dia...

monitormyhealth.org.uk/

Also vitamin D available as separate test via MMH

Or alternative Vitamin D NHS postal kit

vitamindtest.org.uk

[Karan49 in reply to SlowDragon]

But b12 is 614 range 180.0 _900. Ng/l Iron 17.6 range 11.00 _30.00

Folate 10.6 range 3.00 _20.00

Ferritin 49.8 range 10.00 -200 microg/L

I do not know if I have hashimotos..

[SlowDragon Administrator in reply to Karan49]

You are legally entitled to printed copies of your blood test results and ranges.

The best way to get access to current and historic blood test results is to register for online access to your medical record and blood test results

UK GP practices are supposed to offer everyone online access for blood test results. Ring and ask if this is available and apply to do so if possible, if it is you may need "enhanced access" to see blood results.

Link re access

healthunlocked.com/thyroidu...

In reality many GP surgeries do not have blood test results online yet

Alternatively ring receptionist and request printed copies of results. Allow couple of days and then go and pick up.

Important to see exactly what has been tested and equally important what hasn’t been tested yet

See if ever had thyroid antibodies tested

If not .....get tested

Are you currently taking any B12 or folate

No vitamin D tested

Will need to improve low ferritin

Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption

List of iron rich foods

dailyiron.net

Links about iron and ferritin

irondisorders.org/too-littl...

davidg170.sg-host.com/wp-co...

Great in-depth article on low ferritin

oatext.com/iron-deficiency-...

drhedberg.com/ferritin-hypo...

This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

restartmed.com/hypothyroidi...

Post discussing just how long it can take to raise low ferritin

healthunlocked.com/thyroidu...

Never supplement iron without doing full iron panel test for anaemia first

Post discussing why important to do full iron panel test

healthunlocked.com/thyroidu...

Thyroid disease is as much about optimising vitamins as thyroid hormones

[SlowDragon Administrator in reply to Karan49]

Come back with new post once you get thyroid antibodies results and vitamin D

[SlowDragon Administrator]

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]

TSH should at least be between 0.5-2.0

For many people even TSH at 0.5 is too high

Most important result is always Ft3 result

gponline.com/endocrinology-...

Replacement therapy with levothyroxine should be initiated in all patients to achieve a TSH level of 0.5-2.0pmol/L.

[grumpyold]

I have Hashi's and type 2 diabetes (and a few other things besides) and, like you, take metformin.One thing you need to be aware of (because most doctors aren't!) is that metformin can make your TSH appear suppressed. It works along the hypothalamus/pituitary axis and skews the result.

Consequently, I have no end of arguments with the ignorant GPs at my surgery who keep telling me to reduce my T4 because my TSH varies between 0.01 and 0.005 (0.035-3.5.) I have to really spell it out to anyone taking my blood at the surgery why it is even more imperative to get FT3 tested because of the metformin effect. AND the nurse MUST put the reason on the form for the lab, so the lab doesn't over-ride/ignore the instruction.

[Karan49 in reply to grumpyold]

Thank you.. c an you advise how I go about talking to my GP about this. I have spoken to him about my symptoms and he always go back to saying Get your diabetes in order and everything else will follow! I would love them to just get more educated in what drugs contra indicate with each other.. especially since Type 2 is on the increase. Regards

[grumpyold in reply to Karan49]

It's so difficult getting a medic to listen, isn't it? There are 4 doctors at the practice I go to and only one of them is not completely closed-minded and robotic. If he ever left, I would be stuffed.

I usually get all the info to back up what I am trying to say off the internet, print it off and take it with me when I have an appointment, so I can quote chapter and verse and avoid getting flustered or tongue tied. The one good doctor reads it and we make informed decisions based on that.

I realise I am fortunate to have that one good doctor. I, too, have been at the mercy of the ignorant majority in the past and it was a battle we can do without, on top of everything else!