16th dec, bloodtest t4 16.1 pmoll 11.0 26.0
Tsh level 1.80 mul. 0.27 _4.2
Also when I asked for a re blood test was suppose to check my vit d . But they only gave me the thyroid results . Because I was asking to up my dose of levothyroxine. But results I got , said dont need upping.
Related post: healthunlocked.com/thyroidu...
Sleepyachy
You are undermedicated, regardless of what your GP says.
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.
Your FT4 is only 34% through it's range.
You need an increase in your dose of Levo, 25mcg now and retest in 6-8 weeks.
To support your request for an increase, show your GP the following:
Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine (the professional magazine for doctors):
"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).*"
*He recently confirmed, during a public meeting, that this applies to Free T3 as well as Total T3.
You can obtain a copy of the article by emailing Dionne at
tukadmin@thyroiduk.org
print it and highlight question 6 to show your doctor.
If your GP is reluctant, see if he will agree to a trial of a higher dose, saying that if you have any indication of overmedication you will immediately reduce the dose - that worked for me years ago.
You are unlikely to lose weight until you are optimally medicated.
Thank you. I agree and definitely think need higher dose . I will email for a copy now .
So my is .80 over 1
Ft4 is only 33% through range
Helpful calculator for working out percentage through range
On just levothyroxine dose is increased slowly upwards in 25mcg steps until Ft4 is approx 60-70% through range and most important result is Ft3. Looking for Ft3 at minimum of 60% through range
See from previous post you are on 100mcg levothyroxine
Do you always get same brand of levothyroxine
Do you take levothyroxine waking or at bedtime
Guidelines on dose by weight is 1.6mcg levothyroxine per kilo
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...
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
bestpractice.bmj.com/topics...
Essential to regularly retest vitamin D, folate, ferritin and B12 at least annually
Vitamin D twice year if supplementing
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
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 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...
Also vitamin D available as separate test via MMH
Or alternative Vitamin D NHS postal kit
New 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...
Yeh same brand . Take in morning at least hour before food
Was last dose levothyroxine 24 hours before this test?
About . I waited and had blood test first thing morning then took levothyroxine after
Results
Results
The results are in
Results
Results
