Please advise with blood results

[PJP1]

My gp has sent the latest blood test results so would really appreciate your help - as blood test was at 13:30 took the 100 thyroxine the previous night at 23:00 and my vitamin d spray at 9:00 on the morning the results are TSH 3.24 - T415.7 - T3 4.3 - B12 >1500 - ferritin 141 - folate 16.7 Unfortunately vitamin D was missed on this blood test but June’20 the level was 159 - thank you for looking 😊

[SeasideSusie Remembering]

PJP1

TSH is obviously too high for a treated Hypo patient on Levo, most patients feel best when it's 1 or below. However, we can't interpret your FT4 and FT3 without the reference ranges. Can you please add them. If you don't have them then ask for a print out of your results from the receptionist, the ranges will be on there. Don't accept verbal results/ranges as mistakes can be made, always get a print out for accuracy.

Do you take any supplements? Your B12 is high, maybe you have injections? Ferritin seems good, as does folate but that depends on the range. Vit D was fine in June but of course it was summer when we can make Vit D naturally from the sun, we can't make Vit D in the winter so our level tends to drop.

[PJP1 in reply to SeasideSusie]

Thank you for replying - the ref range is TSH 0.34 - 5.60 - T3 4.30 - 6.80 & T4 7.70 - 15.10 - I have also been using a B12 oral spray which I’m happy to stop using as in June’20 my level was 214 - ferritin 11.00 - 307.00 - folate 3.80 - 25.00 - would appreciate any update😊

[SlowDragon Administrator in reply to PJP1]

Are you sure the range on Ft4 is

T4 7.70 - 15.10

That’s very unusual range

[PJP1 in reply to SlowDragon]

Hopefully you’ll be able to read it - this is what surgery emailed me 😊

Levels

[SlowDragon Administrator]

Had you done test as recommended....as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test.....no doubt TSH would have been even higher

See/contact GP and request 25mcg dose increase in levothyroxine

Do you always get same brand of levothyroxine at each prescription

Which brand

[PJP1 in reply to SlowDragon]

Thank you for your reply - I was given the appointment for my diabetic review at 13:30 with the confirmation that my bloods would also be taken then with no offer of any other time when I asked for advice about taking my last thyroxine I made (obviously) the wrong choice by taking it the night before but felt under pressure to attend as it’s almost impossible to contact our surgery very often taking 20-40 mins on hold before being timed out - I apologise for this but thought as there was over 12 hours between timings it was the best option - I hadn’t eaten anything but I did have water and a coffee in the morning - do you believe that I should still request an increase? TIA

[SlowDragon Administrator in reply to PJP1]

Absolutely definitely

On levothyroxine TSH should ALWAYS be under 2

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

 please email Dionne at

[e-mail]

[PJP1 in reply to SlowDragon]

Thank you very much for your patience - I’ll print off the suggested items and attempt to convince the doctor to up my dose - his argument has always been I don’t need as much as I’ve got older however my freezing cold hands with weight gain, nails splitting down the nail and dry skin disagree 😊