First results for T4. Are they OK?

[Shoey1]

Hi,

I've just had a thyroid panel done via GP as requested by midwife and have results . I also had bloods done privately earlier this week and will be seeing the consultant on Monday to discuss, so I'm just trying to understand where I should be so that I can ask the right questions at Monday's appointment. The private bloods are more thorough, GP said they couldn't do vitamin D and there was no antibody test either.

As follows:

Thank you for doing blood test today and a thyroid function test shows free T4 is 15.3 (11 - 22) and TSH is 0.22 (0.49 - 5.23) and I understand you are currently on 75 µg of thyroxine as per consultant endocrinologist so this result is okay.

Folic acid is normal at above 20 and anything above 5 is good and vitamin B12 is 526 (211 - 911) and ferritin is normal at 50 (10 - 291).

So the blood test results appear normal.

Thanks for any advice

[fuchsia-pink]

free T4 is 15.3 (11 - 22)

so it's "in range" - but only 30% through range and that's really not good enough - I'm guessing you don't feel great with free T4 this low If so, that's not really "ok" ...

I'd push for two things: first, a dose increase and second a free T3 test. Because when T4 is low, it's more than likely that free T3 is low - and possibly more feeble than free T4. You really want both frees to be nice and high in range - at least 2/3 through - so at least DOUBLE where you are now.

Good luck with the endo x

[Shoey1 in reply to fuchsia-pink]

Thanks so much for replying. I think there should be a free T3 in the tests I did privately, so I need to get my head round what to look for...I'm totally new to this and it's all a bit confusing, especially in my current state of fatigue! I'm not feeling great but not sure how much is thyroid and how much first trimester, new to both!

[SlowDragon Administrator]

Was this test done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

Important to test Vitamin D too

As you are pregnant it’s important Ft4 doesn’t drop too low

But endocrinologist won’t want TSH too low either

Also look at increasing iron rich foods in diet to boost ferritin levels to at least around 70

[Shoey1 in reply to SlowDragon]

Hi slow dragon,

This test was done before 9am this morning, last levo 8am yesterday and no food or drink bar water.

The ones for the endocrinologist, same except couldn't get an appointment until 10am. Endocrinologist ordered vit d and, I think ft3 as well as antibodies test.

I was also wondering about ferritin, looked low to me but I'm fairly clueless atm. I'll try with the foods...getting anything down at all has been a win in the last few weeks. I am taking a prenatal vitamin but it's obviously not enough.

What should I be aiming for with fT4 & fT3 with that range as an example? It's all Greek to me right now, I really need to read more but have so little focus at the moment.

Thanks so much for your help.

[SlowDragon Administrator in reply to Shoey1]

Well ideally you would have

TSH between 0.5-1.0

Ft4 and Ft3 at least 60% through range

But often TSH will drop too low long before you get levothyroxine dose high enough to get Ft4 and Ft3 optimal

Being pregnant they won’t want TSH too low

[Shoey1 in reply to SlowDragon]

Would that mean a decrease in the levothyroxine? How would I get right levels of ft3 &ft4 without the TSH going lower?

[SlowDragon Administrator in reply to Shoey1]

That’s the thyroid conundrum

Most medics dose by TSH, leaving patients under medicated

You might push endo to increase levothyroxine dose slightly....perhaps 100mcg 3 x week and 75mcg 4 x week

What brand levothyroxine are you currently taking

Many people find different brands are not interchangeable

[Shoey1 in reply to SlowDragon]

It appears to be 2 different brands, the 50mcg says Teva, the 25mcg wockhardt. Is this bad? I just took what the pharmacist passed me.

[SlowDragon Administrator in reply to Shoey1]

Did you start on Teva?

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

But for some people (usually if lactose intolerant, Teva is by far the best option)

Teva, Aristo and Glenmark are the only lactose free tablets

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

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, 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

[Shoey1 in reply to SlowDragon]

Thank you so much. I did start on Teva, with the 50mg dose. I felt great the first month I took it and the decline started once I took the hormones for ivf, which I believe can interact. I don't think I'm lactose intolerant so that shouldn't be a problem for me.

[SlowDragon Administrator in reply to Shoey1]

Personally I would try different brand at next prescription (if not before)

Wockhart only make 25mcg

Mercury Pharma make 25mcg, 50mcg and 100mcg