Advice on latest results please. After my last MC results October 2020 I raised the dose to 50 (2 x 25 Wockhardt), the pharmacy struggled to get Wockhardt so started Accord 50 end of Jan 21, latest test was taken on Sat at 9:30am last thyroxine 24 hrs prior.
Currently taking BetterYou VitD 3000 and Florisene (for hairloss) both stopped 1 week before test.
Age 61, 8 stone and 5ft 2". Still have the brain fog, sleep probs, hairloss and bloating etc
Had FBC a week ago (12:30pm) and was informed by Dr to up my fluid intake as my kidney function was low, would this have effected my latest MC thyroid test?
Advice on best way forward and should I ask for T3?
Written by
Albaangel
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You need dose increase in levothyroxine, but GP only likely to want to reduce
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The aim of levothyroxine is to increase dose upwards in 25mcg steps until TSH is under 2
When adequately treated, TSH will often be well under one.
Most important results are ALWAYS Ft3 followed by Ft4. When adequately treated Ft4 is usually in top third of range and Ft3 at least 60% through range (regardless of how low TSH is)
Extremely important to have optimal vitamin levels too as this helps reduce symptoms and improve how levothyroxine works
8 stone = 50 kilo x 1.6 = 80mcg daily likely dose you might need
80 x 7 = 560mcg per week
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 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.
Thanks SD, these were my FBC results I have added the last 3 years results if they were done, latest results in bold, I will be retested next week after a couple of weeks of increasing my fluid intake on Dr orders!!!
FBC Feb-21 Aug-20 Dec-19
Haemoglobin Estimation g/l 120-160 - 149, 141,128
Red Blood cell (RBC) count 4.0-5.0 - 5.3x10^12/1, 4.8x10^12/1, 4.4x10^12/1
Haematocrit PVC l/l 0.37-0.47 - 0.47, 0.44, 0.39
Mean Corpuscular vol (MCV) fl 82-99 - 89, 92, 89
Mean Corpusc. haemoglobin (MCH) pg 27-32 - 28, 29, 29
As you mentioned the Dr said my TSH was too low and would not prescribe, I asked about T3, again was told its in range, I mentioned the percentage through range which fell on deaf ears, kept saying TSH was dangerously low. I requested to see an Endo as I did not agree with what the they were saying, they are going to arrange an appointment. My appointment was actually for a sore rib, I have to get an xray as they are not sure if I have cracked a rib or my bones are thinning, another reason they will not up my dose of Levo. I have some extra 50 Accord as I get a 8 week supply, I will self medicate on 75 and inform the Dr when I run out and do another test in 8 weeks. They also totally dismissed the T3/Low Kidney Function link.
the best paper on this that I have seen indicates that a TSH of 0.03-0.5 is best on therapy. Above that is insufficient and below MAY or MAY NOT indicate slight overdosing
Interestingly, patients with a serum TSH below the reference range, but not suppressed (0.04–0.4 mU/liter), had no increased risk of cardiovascular disease, dysrhythmias, or fractures. It is unfortunate that we did not have access to serum free T4 concentrations in these patients to ascertain whether they were above or within the laboratory reference range. However, our data indicate that it may be safe for patients to be on a dose of T4 that results in a low serum TSH concentration, as long as it is not suppressed at less than 0.03 mU/liter. Many patients report that they prefer such T4 doses (9, 10). Figure 2 indicates that the best outcomes appear to be associated with having a TSH within the lower end of the reference range.
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Confused with latest thyroid results, advice please.
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