Blood test

[Dozeydays]

Hello All,

I am having my blood taken first thing tmw to check my thyroid level. I am new to Levo. Should I take my thyroid med before blood draw?

[pennyannie]

Hello Dozeydays and welcome to the forum ;

In short - NO :

Fast before the blood tests, just take in water and take your dose of Levothyroxine after the blood draw :

Don't worry, T4 - Levothyroxine is a storage hormone and you will be fine :

Do you have a diagnosis of an auto immune thyroid disease ?

[Dozeydays in reply to pennyannie]

I've been told no to autoimmune thyroid disease. I am subclinical.

[pennyannie in reply to Dozeydays]

OK then, hopefully you'll get a TSH, T3 and T4 blood test :

If you can ask the nurse for ferritin, folate, B12 and vitamin D - that would be even better.

Keep us in the loop and always ask and keep copies of all your blood test results and ranges so you can monitor your progress and we can give you a second opinion on anything you are not sure about.

[Dozeydays in reply to pennyannie]

Thank you so much for all your help. 🙂

[SlowDragon Administrator in reply to Dozeydays]

Do you have actual results and ranges

You are legally entitled to printed copies of your blood test results and ranges.

The best way to get access to current and historic blood test results is to register for online access to your medical record and blood test results

UK GP practices are supposed to offer everyone online access for blood test results. Ring and ask if this is available and apply to do so if possible, if it is you may need "enhanced access" to see blood results.

Link re access

healthunlocked.com/thyroidu...

In reality many GP surgeries do not have blood test results online yet

Alternatively ring receptionist and request printed copies of results. Allow couple of days and then go and pick up.

Important to see exactly what has been tested and equally important what hasn’t been tested yet

NHS frequently only tests TPO antibodies

[SlowDragon Administrator]

No

Always test as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

How much levothyroxine are you currently taking

Bloods should be retested 6-8 weeks after each dose increase

Which brand of levothyroxine are you currently taking

Many people find different brands are not interchangeable

What vitamin supplements are you currently taking, if any

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also EXTREMELY important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially if you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies

About 90% of primary hypothyroidism is autoimmune thyroid disease

Ask GP to test vitamin levels and thyroid antibodies if not been tested yet

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .

Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins

List of private testing options

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Thriva Thyroid plus antibodies and vitamins By DIY fingerpick test

thriva.co/tests/thyroid-test

Thriva also offer just vitamin testing

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins and antibodies then 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...

monitormyhealth.org.uk/

NHS easy postal kit vitamin D test £29 via

vitamindtest.org.uk

[Dozeydays in reply to SlowDragon]

I have pushed the gp to provide Levo as I am having thyroid symptons of pins and needles, thinning hair/ hair breakage, Constipation, brittle nails, palpatation and tiredness. My journey so far was first a course of ramipril 2.5mg blood pressure tablets which seemed to help with the palpitations and 25 micrograms of wockhardt Levothyroxine which hasn't really made any difference. Oddly my blood pressure went up when I started taking Levo. My tsh serum blood results over the years has been anywhere between 3.37 to 7.26. Ferritin serum 79, vitamin b12 544 and foliate serum of 15.4. I was tested for thyroid autoimmune disease and it came back negative.

[Dozeydays in reply to SlowDragon]

Vitamins I take are: c, d3, fish oil, turmeric, melatonin, pine bark, rosemary

[SlowDragon Administrator in reply to Dozeydays]

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested.

Typically NHS only tests TPO antibodies

Ultrasound scan of thyroid can be helpful - £150 if NHS won’t

20% of Hashimoto's patients never have raised antibodies

healthunlocked.com/thyroidu...

Paul Robson on atrophied thyroid - especially if no TPO antibodies

paulrobinsonthyroid.com/cou...

Also EXTREMELY important to test vitamin D, folate, ferritin and B12

Ferritin looks ok

B12 too

No folate or vitamin D results?

Obviously 25mcg is only half the standard starter dose of levothyroxine if under 65 years old

Roughly what age are you?

Levothyroxine doesn’t top up failing thyroid, it replaces it, so it’s important to slowly increase dose levothyroxine upwards

guidelines on dose levothyroxine by weight

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...

[Dozeydays in reply to SlowDragon]

Thank you so much. Is there a list of consultants the group would recommend? I live in Kingston Upon Thames. My age is 56.

[SlowDragon Administrator in reply to Dozeydays]

First get full thyroid and vitamin testing

Come back with new post once you get results

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 ALWAYS under 2

When adequately treated, TSH will often be well below 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

[Dozeydays in reply to SlowDragon]

I have received my blood results and basically he only tested my tsh which is now 3.53 mu/l. Serum c reactive protein is down to 4.9 mg/l . No other test. As I am not below 2 on tsh I will push for increase on levo. I seriously doubt if gp will agree to other blood test so will pay for full thyroid blood test as you suggested and post back. I really do appreciate all your help on this journey. 🙂

[SlowDragon Administrator in reply to Dozeydays]

Assuming you get 25mcg dose increase in levothyroxine....don’t do private testing until 6-8 weeks minimum after dose increase in levothyroxine

Standard starter dose of levothyroxine is 50mcg ....unless over 65 years old

How long have you been left on just 25mcg levothyroxine

Insist on 25mcg dose increase in levothyroxine

[SlowDragon Administrator in reply to Dozeydays]

So at 56 years old you should have been started on 50mcg levothyroxine

Results show you need 25mcg dose increase in levothyroxine

Bloods should be retested 6-8 weeks after each dose increase or brand change in U.K.

Request GP test vitamin D, folate, ferritin and B12 plus thyroid antibodies

[Dozeydays in reply to SlowDragon]

Hi SlowDragon,

Firstly, thank you so much for all your advice and help. I am so very grateful

😘.

After my doctor only tested my tsh which recorded 3.53 mu/l and serum c reactive protein of 4.9 mg/l, I did as suggested and pushed to increase dose by 25 mcg. I also went and had the medicheck full thyroid test prior to dose increase so I had some comparative makers. See below for results. The GP suggested I have 25 mcg one day and 50 mcg the other day and to repeat this sequence for eight weeks. My blood will be tested after this period by GP and I will once again do a full medicheck thyroid test. Questions: 1.) Do you think the alternative dosing is correct? 2.) Do you think I should have my thyroid scanned as CRP HS is above normal? 3.) It seems my full thyroid check is on track - do you agree?

Best regards,

DozeyDays

CRP HS 6.4 above normal

Ferritin 108 ug/l

Folate Serum 9.3 ug/l

Vitamin B12 - active 84 pmol/l

Vitamin D 84 nmol/l

TSH 1.99 miu/l

Free T3 - 4.4 pmol/l

Free Thyroxine 16.6 pmol/l

Thyroglobulin Antibodies <10 iu/ml

Thyroid Peroxidase <9 iu/ml

The writeup results said -

Your CRP level is high. This may indicate increased inflammation and/or infection within the body. If you are experiencing pain, fever or other symptoms that suggest infection or inflammation then I recommend that you discuss this further with your GP at your earliest convenience.

The type of CRP test that you have had is one which can also indicate future risk of cardiovascular disease. I recommend repeating this test in 6-8 weeks to see whether it remains above 3. If it does then I recommend that you take a more aggressive approach to managing other cardiovascular risk factors such as blood pressure, cholesterol, diet, smoking and exercise levels.

You have healthy levels of iron, magnesium, folate, vitamin B12 and vitamin D.

Finally I am pleased to report that all your results for your thyroid profile are within the normal ranges. Your thyroid hormones are normal as are your thyroid antibodies revealing no evidence of autoimmune thyroid disease.

Hi SlowDragon,

Firstly, thank you so much for all your advice and help. I am so very grateful

😘.

After my doctor only tested my tsh which recorded 3.53 mu/l and serum c reactive protein of 4.9 mg/l, I did as suggested and pushed to increase dose by 25 mcg. I also went and had the medicheck full thyroid test prior to dose increase so I had some comparative makers. See below for results. The GP suggested I have 25 mcg one day and 50 mcg the other day and to repeat this sequence for eight weeks. My blood will be tested after this period by GP and I will once again do a full medicheck thyroid test. Questions: 1.) Do you think the alternative dosing is correct? 2.) Do you think I should have my thyroid scanned as CRP HS is above normal? 3.) It seems my full thyroid check is on track - do you agree?

Best regards,

DozeyDays

CRP HS 6.4 above normal

Ferritin 108 ug/l

Folate Serum 9.3 ug/l

Vitamin B12 - active 84 pmol/l

Vitamin D 84 nmol/l

TSH 1.99 miu/l

Free T3 - 4.4 pmol/l

Free Thyroxine 16.6 pmol/l

Thyroglobulin Antibodies <10 iu/ml

Thyroid Peroxidase <9 iu/ml

The writeup results said -

Your CRP level is high. This may indicate increased inflammation and/or infection within the body. If you are experiencing pain, fever or other symptoms that suggest infection or inflammation then I recommend that you discuss this further with your GP at your earliest convenience.

The type of CRP test that you have had is one which can also indicate future risk of cardiovascular disease. I recommend repeating this test in 6-8 weeks to see whether it remains above 3. If it does then I recommend that you take a more aggressive approach to managing other cardiovascular risk factors such as blood pressure, cholesterol, diet, smoking and exercise levels.

You have healthy levels of iron, magnesium, folate, vitamin B12 and vitamin D.

Finally I am pleased to report that all your results for your thyroid profile are within the normal ranges. Your thyroid hormones are normal as are your thyroid antibodies revealing no evidence of autoimmune thyroid disease.

[SlowDragon Administrator in reply to Dozeydays]

You likely have room for full 25mcg dose increase, but go with the 12.5mcg dose increase for now

Testing again in 6-8 weeks

Remember to stop taking any supplements that contain biotin a week before all blood tests

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

Do test 24 hours after the lower dose.....