Help with Latest Results

[Albaangel]

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?

[SlowDragon Administrator]

Well your Ft3 shows you’re under medicated

But GP will only look at low TSH and want to reduce dose

Ft4 is 68% through range

Ft3 only 16% through range

Helpful calculator for working out percentage through range

chorobytarczycy.eu/kalkulator

So you have extremely poor conversion of Ft4 to Ft3

Poor kidney function linked to low Ft3

ncbi.nlm.nih.gov/pmc/articl...

You need dose increase in levothyroxine, but GP only likely to want to reduce

Email Thyroid UK for list of recommend thyroid specialist endocrinologists...

NHS and Private

[e-mail]

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

[SlowDragon Administrator]

guidelines on dose levothyroxine by weight

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

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...

[Albaangel in reply to SlowDragon]

Thanks very much for your informative reply,.

I will ask to be increased to 75, as my T3 is low should I also ask for T3?

[SlowDragon Administrator in reply to Albaangel]

I doubt very much that GP will agree to increase because TSH is low

Likely necessary to see a recommended endocrinologist

Yes looking like you might need addition of T3 prescribed alongside levothyroxine. This has to be initiated by endocrinologist. GP can not prescribe

Email Thyroid UK for list of recommend thyroid specialist endocrinologists...NHS and Private

[e-mail]

Before considering adding T3 we need all four vitamins optimal and frequently necessary to be strictly gluten free too

Bloating suggests poor gut function, low stomach acid and possibly gluten intolerance

[Albaangel in reply to SlowDragon]

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

Platelet Count 140-400 - 444x10^9/1, 394x10^9/1, 377x10^9/1

Total White Cell Count 4.0 - 10.0 - 6.1x10^9/1, 6.6x10^9/1, 4.1x10^9/1

Neutrophil Count 1.5-7.0 - 3.3x10^9/1, 2.8x10^9/1, 2.1x10^9/1

Eosinophil Count 0.1-0.5 - 0.11x10^9/1, 0.23x10^9/1, 0.07x10^9/1

Basophil Count 0.01-0.10 - 0.05x10^9/1, 0.11x10^9/1, 0.10x10^9/1

Lymphocyte Count 1.0-4.0 - 2.x10^9/1, 3.0x10^9/1, 1.2x10^9/1

Monocyte Count 0.2-0.8 - 0.5x10^9/1, 0.5x10^9/1, 0.4x10^9/1

Large unstained cells 0.05-0.50 - 0.08x10^9/1

Serum Albumin g/L 35-50 - 41

Serum Alkaline Phosphatase U/L 30-130 - 94

Serum ALT Level U/L 9-55 5-55* Serum Alanine aminotransferase Level - 17*

Serum GT Level U/L 4-35, 8-33*, =Serum Gamma-glutamyl Level - *24

Serum Total Bilirubin Level umol/L 0-20 - 11

AST Aspartate transam (SGOT) 10-45 - 18

Serum Sodium mmol/L 133-146 - 137, 140

Serum Potassium mmol/L 3.5-5.3 - 4.5

Serum Chloride mmol/L95-108 - 101, 104

Serum Bicarb 22-29 - 28

Serum Urea Level mmol/L 2.5-7.8 - 3.4, 3.7

Serum Creatinine umol/L 50-100 45-84* - *87

GFR Calcted abrvited MDRD ml/min/1.73 60-40 =GFR calculated aabrv MDRD -

57, >60

Serum Amylase U/L 28-100 - 80

Serum C Reactive Protein Level mg/L 0-4 - 2

CA125 Level kU/L 0-35 - 14

[SlowDragon Administrator in reply to Albaangel]

GFR Calcted abrvited MDRD ml/min/1.73 60-40 =GFR calculated aabrv MDRD -

57, >60

Low GFR levels linked to low Ft3

Ask for referral to recommended endocrinologist or see one privately

Roughly where in the U.K. are you?

[Albaangel in reply to SlowDragon]

Will tell the Dr I require to see an Endo, NE Scotland.

[SlowDragon Administrator in reply to Albaangel]

SCOTTISH PARLIAMENT

healthunlocked.com/thyroidu....

scottishparliament.tv/meeti...

There’s at least one endocrinologist in Scotland on recommended list from Thyroid U.K.

[Albaangel in reply to SlowDragon]

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.

[SlowDragon Administrator in reply to Albaangel]

Low Ft3 can cause osteoporosis (as can high Ft3)

Osteoporosis

thyroidpatients.ca/2018/07/...

See replies by Diogenes

healthunlocked.com/thyroidu...

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

academic.oup.com/jcem/artic...

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.