Blood test results

[Littlebuddha]

Following in from previous chats, I have now received a print out of my recent blood test. I don't understand any of it!!! Could you please comment and advice accordingly 🙏 TIA

[SeasideSusie Remembering]

I think you've been told your thyroid results are normal.

The aim of a treated Hypo patient on Levo, generally, is for TSH to be 1 or below with FT4 and FT3 in the upper parts of their reference ranges.

Your TSH is very close to the top of the range, this is far too high.

Your FT4 has just scraped into the bottom of the range and this is way, way too low.

FT3 is doing it's best to keep going but eventually this will fall.

You desperately need an increase in your Levo, an extra 25mcg now, retest in 6-8 weeks, another increase of 25mcg, another retest 6-8 weeks later, repeat until your levels are where they need to be for you to feel well.

Use the following to support your request for an increase:

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

[e-mail]

print it and highlight question 6 to show your doctor.

and this which shows target level for TSH should be between 0.4 and 2.5

gpnotebook.com/simplepage.c...

You already know about your pre-diabetes so I expect you're addressing that.

B12 is dreadful at 124 (115-1000). This can indicate B12 deficiency and maybe Pernicious Anaemia. Ask your GP to test for these.

Do you have any signs of B12 deficiency – check here:

b12deficiency.info/signs-an...

b12d.org/submit/document?id=46

If you do then list them to discuss with your GP and ask for testing for B12 deficiency and Pernicious Anaemia. Do not take any B12 supplements or folic acid/folate/B Complex supplements before further testing of B12 as this will mask signs of B12 deficiency and skew results.

[Littlebuddha in reply to SeasideSusie]

Hey there Seaside Susie, thank you for all this advice and information......I'm so grateful for this site and to admin for taking the time out to respond 🙏😊🌟

[SlowDragon Administrator]

Previous post shows you are currently only on 25mcg levothyroxine

Is that correct?

Results show you are EXTREMELY under medicated

Ft4 result is right at bottom of range at 7.9 (7-21)

TSH is too high for someone on levothyroxine

When adequately treated Ft4 should be at least around 17-20

See GP for immediate 25mcg dose increase in levothyroxine up to 50mcg

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

Likely to need several further increases in levothyroxine

Folate and B12 are both low

B12 under 500 is often too low

B12 under 200 is definitely low

Your B12 at 124 is right at bottom of range

GP should test for Pernicious Anaemia before starting any B12 supplements or B12 injections

Low B12 is likely due to being under medicated for thyroid and should improve as dose levothyroxine increases

However ideally need to rule out Pernicious Anaemia before starting on B12 supplements

Ask GP to test vitamin D and if never had thyroid antibodies tested you need thyroid antibodies tested too

When dose levothyroxine is increased to 50mcg make sure to get same brand of levothyroxine as previously

Come back with new post once you have seen GP

[Littlebuddha in reply to SlowDragon]

Thank you Slow Dragon, yes that is correct, 25 mcg once a day. I think you asked me which levothyroxine I was prescribed, the only name I can see on the box is TEVN is that the brand. Thank you so much for the information and advice 😊

[Littlebuddha in reply to Littlebuddha]

Ps I've referred back to my previous posts and your reply regarding the brand and see that it is TEVA 🙃

[SlowDragon Administrator in reply to Littlebuddha]

Suggest you try different brand then,....as Teva does upset many many people

Perhaps Mercury Pharma or Accord are most widely available and tolerated

Mercury Pharma make 25mcg, 50mcg and 100mcg tablets

Accord only make 50mcg and 100mcg

[tattybogle]

TSH 4.4 [0.35-4.7] 'normal' .... barely , It is too high. The most normal TSH for healthy people is under 2 and closer to 1. This is what your GP should be aiming for , not 'just barely within the range'The TSH is a 'signal' hormone to ask for more thyroid hormones to be produced by the thyroid or, if you have hypothyroidism, to be prescribed by your Doctor.

fT4 7.9 [7.8-21] 'normal'... again , only barely in range . It is too low. ( Note the lab comment under TSH result saying fT4 will be within or slightly ABOVE the reference interval .... this is because they do accept that some people on Levo do need slightly over range fT4 to be well)

It is so bad that if your fT4 was just 0.2 lower, then your current state would still be diagnosed as 'sub clinical hypothyroid' and the results would mean the patient needed to be started on Levo.

fT3 4.6 [3.8-6] This is actually not too bad , but that is probably because your body is desperately compensating for the dreadfully low fT4 by making more fT3 .

The fact that you have been left on just 25mcg Levo with these results , and told they are normal and there is no need to increase your dose , despite the fact that you do not yet feel well , and have told them so ,is frankly appalling.

[tattybogle in reply to tattybogle]

p.s In case you haven't seen it already , see this graph showing the commonest TSH values in healthy people without a thyroid problem, Virtually no-body has anywhere near 4.

healthunlocked.com/thyroidu...

Ask your GP to follow the guidelines and aim to get your TSH neared to 1 , like 'really normal' people have. or ask them for a clear reason why not .

[tattybogle in reply to tattybogle]

p.p.s The reason for your username being 'itsallshit ' becomes clear now ..... it will be, with result's like those ....

Improved lab results should make a big difference to how you feel.

Hopefully you can get a new name soon

[Littlebuddha in reply to tattybogle]

Hahaha, thank you, at the time thats how I felt and it was the first thing that came into my head! 🥴

[SlowDragon Administrator]

How old are you?

High HBA1C is pre diabetes......but likely to improve as levothyroxine dose increases

But if you currently eat high carbohydrate diet, cutting carbs should help significantly reduce result

Your GP has little or no understanding of how to treat hypothyroidism

Standard starter dose of levothyroxine is 50mcg (unless over 65 years old) and dose is increased upwards in 25mcg steps as fast as tolerated

guidelines on dose levothyroxine by weight

Even if we frequently 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...

To say your B12 was normal was ludicrous.....yes it’s within range ....but only just

[Littlebuddha in reply to SlowDragon]

I will be 64 on 1 April.

[SlowDragon Administrator in reply to Littlebuddha]

So you possibly should have been started on 25mcg levothyroxine

But dose still needs to increase upwards in 25mcg steps until adequately treated

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

Levothyroxine doesn’t “top up” failing thyroid, it replaces it. So almost everyone on levothyroxine will need to increase dose slowly upwards until on at least 1.6mcg per kilo of your weight as per guidelines

Roughly how much do you weigh in kilo?

[Littlebuddha in reply to SlowDragon]

Now thats a leading question ........ive no idea, all I know is I'm well overweight ......I don't do kilos, im still in lbs and ozs, but I reckon I weigh about 13.5 stone ....even when I lost weight and was in a size 10, I still weighed over 10 stone!!!

[SlowDragon Administrator in reply to Littlebuddha]

So assuming you weigh 13 stone that’s 82.5 kilo

thecalculatorsite.com/conve...

1.6 x 82.5 = 132mcg as the likely dose you will need per day of levothyroxine

132 x 7 = 924mcg per week

125mcg x 5 days a week and 150mcg 2 days a week

So you can see you’re likely to need several further increases in dose

We have to increase dose upwards in 25mcg steps

Essential to get all four vitamins at OPTIMAL levels too as this helps levothyroxine work well

Vitamin D at least around 80nmol and around 100nmol maybe better

Likely to find vitamin D is EXTREMELY low

Serum B12 at least over 500

Obviously your B12 is currently EXTREMELY low

Definitely will need either B12 injections or daily B12 supplements......but GP should test for Pernicious Anaemia before starting any B12

Folate and ferritin at least half way through range

[SlowDragon Administrator]

So make an appointment with GP

Request 25mcg dose increase in levothyroxine

Plus Testing of vitamin D and thyroid antibodies

Thyroid levels will need retesting 6-8 weeks time

[Littlebuddha in reply to SlowDragon]

Will do and once again, thank you 😊