October Thyroid results

[Aniba]

Hi

Collected my thyroid results today, please can you help me understand them, I have learnt such a lot being on this forum and really appreciate your advice

Serum Free T4 level -12.6 pmol/L (12.0 -22.0)

Serum TSH Level - 12.2 mu/L (0.3 - 4.2)

What does the brackets mean exactly ?

I’m feeling spaced out today, and emotional can cry easily but not feeling depressed

Thank you

[PurpleNails Administrator]

The (brackets) are the normal range.

TSH above & FT4 very low in range.

Have you considered private testing to include FT3, nutrient & antibodies.

Did your GP give you a dose increase?

[Aniba in reply to PurpleNails]

Thank you

[Aniba in reply to PurpleNails]

Was prescribed 25MCG back in August but had side effects and came of them, therefore had another blood test in October then GP wrote to the Endocrinologist who recommended 25MCG again but in a split dose am/pmI

I have been on them nearly a month and seem to have tolerated it so far have appointment with Endocrinologist on Tuesday but I’m aware the dose is probably not high enough

[SlowDragon Administrator]

Looking at previous posts you are not currently taking any replacement thyroid hormones

Standard starter dose of levothyroxine is 50mcg

Bloods should be retested 6-8 weeks after each dose increase

Aim of levothyroxine is to increase the dose slowly upwards in 25mcg steps until TSH is under 2 as absolute maximum

Most people on levothyroxine will have TSH well under one when adequately treated

Ft4 will be in top third of range - on your ranges eg around 18-20

Ft3 at least 50-60% through range as minimum

Essential to regularly retest vitamin D, folate, ferritin and B12

Low vitamin levels extremely common when hypothyroid as you currently are

[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

About 90% of primary hypothyroidism is autoimmune thyroid disease

Ask GP to test vitamin levels and thyroid antibodies

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 .

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 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

Many people find Levothyroxine brands are not interchangeable.

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

Most easily available (and often most easily tolerated) are Mercury Pharma or Accord

Note Accord is also boxed as Almus via Boots, and Northstar 50mcg and 100mcg via Lloyds ....but beware 25mcg Northstar is Teva

List of different brands available in U.K.

thyroiduk.org/medications-f...

Teva poll

healthunlocked.com/thyroidu...

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.

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 decide to 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

[Aniba in reply to SlowDragon]

Thank you so much for the information its so informative, I have decided to have the advanced thyroid test, I have been taking Vitamin D for the last 4 years due to being deficient