Can someone help me make sense of my blood results please.? I was diagnosed with hypothyroidism in March 2020. I started Levo 25mg mid May. I’ve been kept on this dose ever since and have not felt any better (symptoms are migraines/ headaches/ tiredness and fatigue/ dry skin).
(The following blood test was taken in the afternoon after I’d taken my daily dose of levo ..)
28/1/2021
TSH = 0.85 (0.4-4.5)
T4 = 10.9 (9-19)
Serum folate = 9.7 (3.1-20.5)
B12 491 (187-883)
Serum ferritin 83 (5-204)
I’m concerned that my T4 has barely improved and maybe this is the reason my symptoms are still there - previous bloods 5 years ago show my T4 at 16 so guessing this is normal for me.
The GP at the surgery has told me everything is fine and my bloods are normal and there is no pathological cause for my symptoms (insinuating it’s in my head I guess or mental health!) Im just exhausted all the time and haven’t experienced headaches for many many years until I had hypothyroidism! I was referred to Endocrinology last year but have heard nothing - guessing it’s due to Covid.
I was taking my Levo at bedtime so switched it to first thing in morning as didn’t realise I should have been doing this all along, and began having bad headaches daily all of sudden - so after 2 weeks of this I gave up and just stopped taking it (this was 2 weeks ago). I’ve stopped as I want to get some private blood tests done and want to see what my baseline levels are without medication.
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EmmaFlowerPower
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A 25 microgram dose often has little effect. Enough for your own thyroid hormone production to drop a bit, but not enough to get your thyroid hormone level up.
Towards bottom of FT4 range despite having taken your tablet within a few hours. Suggests it is rather low.
Hi Helvella. Thanks you so much for your response. I’ve just woke up I’m on a run of nights so I will be looking at all them links you’ve sent when I get chance - really grateful for the info.
I notice this comment on your profile with your results"Worked out half life and think will be out my system after 5/6 so going to get a private blood test then."
If you are meaning 5/6 DAYS, then that will probably not be long enough to see where your TSH(thyroid stimulating hormone) is.
TSH may continue to rise over weeks.
And this will then have an effect on your own T4 and T3 levels.
i'm not quite sure how long i'd really leave it to get a true base line, but certainly at least 3 weeks i would have thought , and probably longer...more like 6 weeks ?
It's a shame they didn't increase dose after your results on 25 were in , there was room to do so according to your blood results at that time, (even though the latest ones will be preventing an increase because the TSH will be considered 'low enough')
It's not surprising you didn't feel any better and your fT4 didn't rise much , since 25mcg is so tiny. That dose often makes people feel worse, not better ,but it is sometimes necessary to introduce Levo gradually. But should be raised as quickly as tolerated.
Unfortunately your TSH has gone so low and got in the way of them increasing dose.
I agree with helvella , the fT4 result after taking Levo that morning does indicate that your hormone level is pretty low still.
Was there a reason given for them starting you on only 25mcg ? , the usual starting dose is 50mcg unless over 65 or with heart problems.
Hi Tatybogle! Yes I’ve just edited my profile and meant 5/6 weeks, I keep getting tempted to just order the test kit now but I will wait it out until then as otherwise seems a bit pointless. They started me on 25 as I was reluctant to believe I had hypothyroidism as my test result on in Dec 19 showed TSH at 0.02 and T4 at 16 so I couldn’t get my head around why it would change so suddenly - I’d started a strict keto diet and although was having plenty of calories I was in ketosis much of the time so thought this may have caused a transient change to my bloods. I stopped the diet and my bloods improved a little but not much, and I felt exhausted, so GP started me off on 25 guessing in the view it could have been sub clinical, however due to Covid I don’t get a choice when GP gets back to me now and haven’t had the opportunity to discuss anything with him since.
It typically takes TSH six weeks to respond to any dose change....hence bloods should be tested 6-8 weeks after each dose change or brand change in levothyroxine
Standard starter dose of levothyroxine is 50mcg and dose is increased upwards in 25mcg steps until Ft4 is in top third of range and Ft3 is at least 50% through range
Starting and being left on too small a dose is counterproductive. It lowers your TSH, and your own thyroid output reduces significantly
Levothyroxine doesn’t “top up” failing thyroid but replaces it
Blood tests should ALWAYS be 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 regularly retest vitamin D, folate, ferritin and B12. Frequently necessary to supplement to maintain optimal vitamin levels
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
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.
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.
Blood tests should ALWAYS be done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test
I hadn’t realised this at the time. I was also taking the Levo for a long time with folic acid and have read that this can slow the absorption.
Important to regularly retest vitamin D, folate, ferritin and B12. Frequently necessary to supplement to maintain optimal vitamin levels
My VitD was 97 (so good I believe) was last checked in July but I was out in the sun loads. Obviously now don’t get much and on top of that I work shifts so I probably get less VitD than the average person. I also have scalp psoriasis which flares up in winter so I guess I’m low in it during these months. I’ve tried to supplement with D3 from H&B 2 years in a row. First time tried 2000iu and last year I tried 400iu and even then I was getting a side effects, worsening tiredness and scare joint pain in both knees, and throbbing kidney pain, so I stopped it as for some strange reason it must not agree with me.
I’ve also tried using floravital recently for the B Vitamins to see if that helped, however even at the lowest quantities of these it severely constipates me. I have no idea why I’m so sensitive to this either.
I was tested for coeliac (I don’t get gut symptoms normally) but the GP wanted to rule is out as was regularly complaining of fatigue - and this was negative.
I will check out your links when I get chance as I’m on a run of nights at min, really appreciate the the time you have taken to reply.
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