Due for Thyroid test shortly

[sbadd]

So im due to retest my thyroid this week, last test oct last year, definitely shows improvement on 75mcg levo which was my initial dose id been on for years, previous results were on lower doses and slowly increased as meds were stopped for 3 weeks in July 2019 (long story) taken me this long just to get back to 75mcg , now that next test will be just short of 4 months since last im guessing will show more accurate point of where im at, was a bit concerned as to my last T3 result though, any thoughts

[SlowDragon Administrator]

Results suggest you are under medicated and need dose increase in levothyroxine

Which brand of levothyroxine are you currently taking

Do you always get same brand

TSH should be under 2

Ft4 is only 60% through range

Ft3 only 37% through range

Helpful calculator for working out percentage through range

chorobytarczycy.eu/kalkulator

When were vitamin D, folate, ferritin and B12 last tested

What vitamin supplements are you currently taking

Do you have Hashimoto’s

Are you on strictly gluten free diet

Make sure to get test done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

If taking any biotin supplements remember to stop these a week before ALL BLOOD TESTS

[sbadd in reply to SlowDragon]

Yes hashimotis, im in Australia so brand I take here is EUTROXSIG, always take same brand, last vitamin levels were i say ok at the time, suspect dose increase needed but currently been put into 5 day lockdown so will post new results once able to get test.

[sbadd in reply to SlowDragon]

Update had thyroid retested results are

Tsh 4.1 range 0.40 -4.00

T4 15 range 10-20

T3 4.5 range 3.5 - 6.5

At this stage doct does not want to up meds but to retest in another 8 weeks, not happy, been on this dose now for around 6 months so surely that's an accurate result. Tsh creeping up again.

[SlowDragon Administrator in reply to sbadd]

Clearly under medicated

You also need vitamin D, folate, ferritin and B12 tested

See different GP

If GP still won’t increase dose see a recommended endocrinologist

Email Thyroid UK for list of recommend thyroid specialist endocrinologists...NHS and Private

[e-mail]

The aim of levothyroxine is to increase dose upwards in 25mcg steps until TSH is under 2

When adequately treated, TSH will often be well under one.

Most important results are ALWAYS Ft3 followed by Ft4. When adequately treated Ft4 is usually in top third of range and Ft3 at least 60% through range (regardless of how low TSH is)

Extremely important to have optimal vitamin levels too as this helps reduce symptoms and improve how levothyroxine works

TSH should be under 2 as an absolute maximum when on levothyroxine

gponline.com/endocrinology-...

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

NHS England Liothyronine guidelines July 2019 clearly state on page 13 that TSH should be between 0.4-1.5 when OPTIMALLY treated with just Levothyroxine

Note that it says test should be in morning BEFORE taking levothyroxine

Also to test vitamin D, folate, B12 and ferritin

sps.nhs.uk/wp-content/uploa...

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.

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...

[sbadd in reply to SlowDragon]

Yes im confused as was on this dose for last 11 or so years without a problem until terrible time 2018 through whole 2019 , I don't actually think my thyroid was the problem but was at wits end so agreed to stop for 3 weeks and restart, taken me till now to be on original dose, I think he's worried if he increases I will get symptoms back that I endured, I don't think what happened was thyroid related at all, he is a good doct, so I guess I decide whether to wait out 8 weeks and if still high will insist on increase which I'm sure he will agree 2, thankyou for your advice, my b12 and d are due for retest aswell so will get this done.

[sbadd in reply to SlowDragon]

Have also just checked last b12 test, done july 2020 was 398 range 150-750Folate was 40.6

range under 5.0 deficient

Above 5.0 normal

There was also a note on there that biotin can falsely increase folate, however I don't take this and never have?

[SlowDragon Administrator in reply to sbadd]

Suggest you get vitamin D, folate , ferritin and B12 retested NOW

BEFORE starting on any B vitamins

B12 under 500 is too low

supplementing a good quality daily vitamin B complex, one with folate in (not folic acid) may be beneficial.

This can help keep all B vitamins in balance and will help improve B12 levels too

Difference between folate and folic acid

chriskresser.com/folate-vs-...

B vitamins best taken after breakfast

Igennus Super B is good quality and cheap vitamin B complex. Contains folate. Full dose is two tablets per day. Many/most people may only need one tablet per day. Certainly only start on one per day (or even half tablet per day for first couple of weeks)

Or Thorne Basic B is another option that contain folate, but is large capsule

IMPORTANT.....If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

Low B12 symptoms

b12deficiency.info/signs-an...

With B12 result below 500, recommended to be taking a B12 supplement as well as a B Complex (to balance all the B vitamins) initially for first 2-4 months, then once your serum B12 is over 500 (or Active B12 level has reached 70), stop the B12 and just carry on with the B Complex.

B12 sublingual lozenges

amazon.co.uk/Jarrow-Methylc...

cytoplan.co.uk/shop-by-prod...

healthunlocked.com/thyroidu...

healthline.com/nutrition/me...

[sbadd in reply to SlowDragon]

Thankyou will get these all tested before starting any supplements