Hi can anyone advise on my last results please, tested December, currently on levo 75 dose.
TSH 2.77
T4 14.7
Thyroid antibodies 377
(My last T3 test was 12 months ago 3.5)
Just wondered if I was on correct dosage and if the T3 was normal? Gp never tells me anything. I know I’m Hashimotos. Feel tired all the time and gaining weight on a healthy diet. Thanks everyone
TSH is still a bit high, ideally should be closer to 1 on levo. No ranges given for T4 so hard to say. Please add these figures.I don’t think a year old result is valid now.
Please add ranges on these results (figures in brackets after each result)
Results look like you’re under medicated, but need ranges to definitely confirm
On levothyroxine TSH should be under2
Ft4 looks low
Obviously high thyroid antibodies confirms autoimmune thyroid disease also called Hashimoto’s
Essential to test vitamin D, folate, ferritin and B12 at least annually
What vitamin supplements are you currently taking
Are you on strictly gluten free diet
Hi I’m partially gluten free, Ferritin level 157, Vit D 2.22 no idea on B12. My TSH 2.77 range is 0.35-4.94) and T4 14.7 range is 9.00-19.00. I don’t take vitamin supplements just Vit D spray.
Saw a professor of endo who said to not bother with gluten free diet, seemed quite dismissive but I read it’s common to not be given the right advice from them. Just curious if I was on enough Levo or should I get tested again and see where I am at. Thanks
Ft4 is only 57% through range
Can you clarify vitamin D result.....
How much vitamin D are you supplementing
Suggest you get TSH, Ft4 and Ft3 tested
All thyroid tests should be done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test
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...
B12 and folate need testing.....ask GP for test
And trial of increase in levothyroxine
Perhaps 75mcg and 100mcg alternate days initially
Retest after 6 -8 weeks
Thank you for the advice. I’ve a few figures for Vit D. Serum calcium 2.22 calcium adjusted 2.24 serum album 40 Serum 25-HO 120.7. I use the Vit d 1000 spray once per day.
So vitamin D is good at 120nmol
Being partially gluten free isn’t going to work (if being gluten free is going to work. If that makes sense?). If you are sensitive to gluten, even a tiny amount will cause problems. It’s unlikely you’d see any improvements if you’re still having gluten-y foods from time to time.
It’s well worth going full-on gluten free for 3 months or so, just to see if it helps. If it doesn’t, then you’ll know it doesn’t and can get back to not restricting your diet any more.
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 eventually 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
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...
Aim is to bring a TSH under 2.5
UK guidance suggests aiming for a TSH of 0.5–2.5
gp-update.co.uk/SM4/Mutable...
Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,
"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)."
(That’s Ft3 at 58% minimum through range)
You can obtain a copy of the articles from Thyroid UK email print it and highlight question 6 to show your doctor
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tukadmin@thyroiduk.org
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