Advice updated results please

[Pinkbarbie20]

Hi everyone I’m after some advice please. I have hashimotos and was experiencing flare type symptoms a couple weeks ago, my gp only tests tsh so I got a medichecks blood test as attached, the results were not the best but better then what I was expecting. I ordered myself some 25mcg levothyroxine to go on top of my 100mcg I already take as I thought the increase may get my ft3 up a bit more and my tsh down a bit, I was going to take the extra 25mcg every other day. When I rang the dr up to discuss my medichecks result he said he would order them again through the drs. These results are a week in between no meds taken before and blood draw same time but there a lot different, where do I go from here? I haven’t taken the extra 25mcg yet as I wanted to see what the results from my gp was. See attached. Also my blood count has an exclamation mark on one of them anyone know what this means please?

Dr results

Tsh 2.22 (0.55-4.78)

Ft4 17.2 (10.00-20.00)

Ft3 4.7 (3.5-6.5)

Ferritin 52 (10.00-291)

Medichecks results

Tsh 1.3 (0.26-4.2)

Ft4 16.2 (12-22)

Ft3 4.4 (3.1-6.8)

Tpo 418

Throglobin antibodies 265

[tattybogle]

Hi , the results are actually very similar, slight differences in results are to be expected.... there would even be slight differences on the same day if you tested half an hour earlier or later. (Also, notice that the lab ref range for the GP's TSH test is calibrated slightly higher than for medichecks ,so it is to be expected that a TSH result done using that test is a little higher)

However with TSH at 2.22 ,your GP should be willing to increase your dose of Levo by 12.5mcg or 25mcg, as your fT4/fT3/ TSH are all comfortably within range and so there is room to try an increased dose .... use the following references to support a request for an increase dose/lower TSH ;

(i'd suggest 12.5mcg increase at first rather than 25mcg. alternate 100 /125 daily ,or half a 25mcg tablet daily)

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healthunlocked.com/thyroidu.... /gps-told-keep-tsh-0.5-2pmol-l-hypothyroidism-causes-raised-cholesterol-thyroid-disease-effects-on-heart-and-cardiovascular-system. gponline.com/endocrinology-... "Replacement therapy with levothyroxine should be initiated in all patients to achieve a TSH level of 0.5-2.0pmol/L."

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sps.nhs.uk/wp-content/uploa... RMOC-Liothyronine-guidance-

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

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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 article from Thyroid UK email print it and highlight question 6 to show your doctor



 please email Dionne at

[e-mail]

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Also see this graph of most common TSH levels in healthy people..( TSH is most often around 1 . but once on Levo people often need it slightly under 1 to feel best.)

healthunlocked.com/thyroidu... tsh-levels-in-healthy-people-with-no-known-thyroid-disease

[Pinkbarbie20 in reply to tattybogle]

Thanks so much for the reply, with the tsh at 2.2 would an increase of levo make my ft4 go to high? My ft3 isn’t even half in range? I can’t speakTo my dr about the results until 3rd September so I am going to take the 25 every other day, the brand I have is mercury pharmacy but the 100 is accord does that matter? I will then retest in 8 weeks with vitamins as only ferritin had been tested.

[tattybogle in reply to Pinkbarbie20]

An increase in Levo would be expected to take fT4 a little higher than it is now (regardless of where TSH is). but hopefully 12.5mcg won't take it over range. .. it's impossible to predict what actually happens in individuals ....( obviously it should also lower TSH a little and hopefully it might increase fT3 result ) I find 12.5mcg is enough to make a difference to how i feel /function/ digestive system etc.

GP's often only bother testing TSH( and sometimes fT4) . I'm surprised your GP did an fT3 .. most won't /or lab won't run it even if they do ask for it.

GP will probably not be interested in what level an fT3 is. (unless its over the top and from a hyperthyroidism patient.

And they are only bothered about fT4 if it's over range, and many will still let you have it a smidge over range as long as the holy TSH is in range... They are taught to believe TSH is infallible !

So since they are mostly TSH focussed it makes more sense to use TSH to get what you want from them if you can ( and you can) .. even though WE know 'TSH alone' is not as informative as 'fT3/4 /TSH together'.. they often don't.

I wouldn't worry about the brand difference initially ... the one that is most known for giving some people problems is TEVA.

I'm ok using Mercury /Wockhard /Accord.. but i stay away from TEVA now as i eventually realised it left me feeling less good .. nothing specific like some people get .. just a bit 'bleargh' like someone stole my 'mojo'.

[Pinkbarbie20 in reply to tattybogle]

My gp who I normally see only tests tsh, but after feeling a bit crap I got the medichecks one done. I had a phone appt with the head dr at the surgery who would not accept the medichecks ones but he said he would do them all for me so I was surprised as well! I ordered myself some 25 so I’ll take one every other day starting tomorrow. This is the highest my tsh has ever been since starting meds. It was 0.96 in January and 1.47 before that, I didn’t know the frees tested. I try get it tested every few months at my drs.

[tattybogle in reply to Pinkbarbie20]

yes . funny that .. it seems one of the few ways to get them to do an fT3 is to do one yourself .. i wonder if they have a special code they put on to make the lab do it " do fT3 please, i want to contradict a patients private test result"

p.s From my experience it can take more than 5 weeks ... (more like 8-12) to know how you really feel on a new dose.. so you may not know if 112.5mcg is going to be an improvement in how you feel , when you speak to GP on 3rd sept .

[Pinkbarbie20 in reply to tattybogle]

I’ve managed toSelf source 25 do you think be ok to take every other day?

[tattybogle in reply to Pinkbarbie20]

plenty of people are fine taking eg. 100/125 alternate days. personally i prefer to split a tablet and take 112.5mcg ~ same each day...... just because i'll probably forget what day it is, if i alternate.