Previous Test Results

[TinaBa]

I recently posted my results 8 weeks ago but all over the place. I just want to know what I need to tell my doctor about the test results as I will have to fight to the death to get anything. I know I need a 25mcg increase in Thyroxine but he's going to need proof and the test results have all come back normal!

[tattybogle]

Direct your GP to the GPonline page linked to in this post; healthunlocked.com/thyroidu.... it tells them to get TSH between 0.5 and 2 , and explains the benefits.

Your TSH is higher than 2. so an increase in dose will lower it , and as long as it stay's within range GP should not have a problem , unless the increase takes your fT4 or fT3 over range, and it is highly improbable that a small 25mcg extra will do that since your current fT4 is only about 30% through the range, and your fT3 is only about 25% through range.

GP's are taught to worry about risks to heart and bones if TSH goes too low , which most of us understand is not always as much of a worry as they think it is ... but even if it was true, even GP's are taught there are no increased risks as long as TSH/fT4/3 stay within the reference ranges.. so if your GP is not willing to increase your dose with those results he needs to explain why not... what is his concern ?

[TinaBa in reply to tattybogle]

Thank you so much. This is the most confusing illness ever! He keeps telling me it's menopause and is willing to put me on HRT which is something I refuse to go on and then gets angry and says he can't help me as my TSH is in range...very frustrating!

[tattybogle in reply to tattybogle]

Also this one ,which i copied from a reply by SeasideSusie to another post;

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine (the professional magazine for doctors):

"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).*"

*He recently confirmed, during a public meeting, that this applies to Free T3 as well as Total T3.

You can obtain a copy of the article by emailing Dionne at

[e-mail]

print it and highlight question 6 to show your doctor.

P.s if i remember correctly , Dr Toft was the Queens physician when she's in Scotland.. so if he's good enough for the Queen....

**edit , just checked ... yes, he was ... en.wikipedia.org/wiki/Antho... **

[greygoose]

No, they've all come back in the so-called 'normal' range. Maybe send your doctor a copy of this article:

The normal range: it is not normal and it is not a range

1. Martin Brunel Whyte

2. Philip Kelly

Abstract

The NHS ‘Choose Wisely’ campaign places greater emphasis on the clinician-patient dialogue. Patients are often in receipt of their laboratory data and want to know whether they are normal. But what is meant by normal? Comparator data, to a measured value, are colloquially known as the ‘normal range’. It is often assumed that a result outside this limit signals disease and a result within health. However, this range is correctly termed the ‘reference interval’. The clinical risk from a measured value is continuous, not binary. The reference interval provides a point of reference against which to interpret an individual’s results—rather than defining normality itself. This article discusses the theory of normality—and describes that it is relative and situational. The concept of normality being not an absolute state influenced the development of the reference interval. We conclude with suggestions to optimise the use and interpretation of the reference interval, thereby facilitating greater patient understanding.

dx.doi.org/10.1136/postgrad...

A normal - euthyroid - TSH is around 1, never more than 2. A TSH over 3 is hypo. So, you are still hypo. Not surprising you still have hypo symptoms, then.

[TinaBa in reply to greygoose]

Thank you so much. Hair pulling out stuff! 🤪

[greygoose in reply to TinaBa]

You're welcome.

[tattybogle]

You could also show him this graph to re-educate him about what is 'normal' ; healthunlocked.com/thyroidu...

You can clearly see that many more 'normal' healthy people have a TSH of around 1 or 2 , or even below 1, than have a TSH of 3.3 .... so if his aim is to treat your thyroid until it's at 'normal ' levels, first he really needs to understand what 'Normal Levels' are for most people.

It's probably not entirely his fault.. bless 'im

he's probably never seen this information , they just don't show it to them at medical school, they give them about an hour on the whole subject (if they're lucky) and tell them that low TSH means hyperthyroidism, and they are very frightened of being held responsible for over treating patients.

[SlowDragon Administrator]

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.

New 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...

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]

[SlowDragon Administrator]

How much levothyroxine are you currently taking Do you always get same brand of levothyroxine

Was test 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)

How much do you weigh in kilo approx

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...

[TinaBa]

I managed to get my extra 25mcg of Thyroxine which has made me so happy 😀

My sleep, libido, hunger pains even after I've eaten a big meal and weight gain is awful so was wondering will this extra little pill will help with this and is it better to split the dose between morning/evening?

Thank you all so much for your expert replies I'm so greatful to you all.