I have just had an appointment with a GP for other reasons than my Thyroid so I thought id kill two birds with one stone and ask for a reply from Endocronoligist my GP had emailed 3 weeks ago about my Thyroid symptoms! diagnosed in March 2021 with hypothyroid.... apparently," nothing wrong with her Subclinical hypothyroid and her symptoms are probably menopausal" and you must not prescribe T3 for her!
T3 never checked!
sorry if this is gobbledygook I'm just venting! been informed they will not check for T3 and T4 not done on my last blood test on July 21!
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Doris11
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But due one for next week! Which will be 6 wks after my dose increase to 75mcgs ! unfortunately no say in what bloods are being done because I got practically encouraged out the door ☹️
OK , that's as it should be. It takes 6 weeks to get a representative TSH reading after a change in dose , and realistically it often takes more like 8 -12 weeks to settle into how that dose will actually make you feel.
It is quite likely you will still need further increase(s) up from 75mcg dose , but don't assume that 'how you feel now' is 'how 75mcg feels' .. it's a bit too soon to know for sure. Hypothyroid symptoms develop gradually and unfortunately they only get better gradually even when you ARE on the best dose for you. .. so be patient.
I wouldn't worry about getting fT4 /3 done until you see the outcome of this next NHS test and GP's response .. hopefully they will increase dose if needed, and even if they are not keen, there is plenty of evidence to put under their nose that relates to aiming to get TSH between 0.5 -2 , also NICE guidance based on expected replacement dose of Levo in mcg /Kg body weight (1.6mcg /Kg ) .....so the lack of ft4 /3 test won't make much difference to GP's follow up yet.. it becomes more necessary as leverage if /when your TSH is in danger of going below range.
What you can do is make sure next NHS test is early in AM , preferably before 9am.
Re-schedule blood draw if necessary.. and dont take that mornings Levo until after the blood test.
This will give highest TSH reading, and the fT4 will avoid the high peak which occurs a few hours after tablet is taken. Taking results in this way will be more useful for getting dose increased than knowing your fT4 will be at this point., so don't worry if they don't do fT4 .. the lab may not do fT4 even if it is asked for ,as long as TSH is 'in range'.
put your effort into understanding how to get GP to increase based on TSH.. that is really all they are interested in at this point.
So like thousands upon thousands of U.K. patients you need to get FULL thyroid and vitamins tested privately as first step
How long have you been on 75mcg levothyroxine
That’s only one step up from starter dose
Which brand of levothyroxine are you currently taking
Many people find different brands are not interchangeable
How much approx do you weigh in kilo
Guidelines on dose levothyroxine by weight is approx 1.6mcg levothyroxine per kilo of your weight
Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine
Have you got actual results and ranges on your most recent test
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 with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)
EXTREMELY Common GP will only test TSH, which is completely inadequate
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)
Is this how you do your tests?
Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins
If TPO or TG thyroid antibodies are high this is usually due to Hashimoto’s (commonly known in UK as autoimmune thyroid disease).
About 90% of all primary hypothyroidism in Uk is due to Hashimoto’s. Low vitamin levels are particularly common with Hashimoto’s. Gluten intolerance is often a hidden issue too
It typically take 6-12 months to slowly increase levothyroxine dose upwards in 25mcg steps until adequately treated
You can’t rush hormones
Approx how old are you?
guidelines on dose levothyroxine by weight
Even if we very 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
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.
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.
Thank you 🙏 I find it difficult to copy and paste from my GP app 🤦♀️ My last TSH was on July 5th and it was 1.55mu/l Range 0.27 - 4.20 No T4 checked! My last T4 was in March 21 when I was diagnosed.
I think I will go private! Bloods! I have to make an appointment for blood test via GPS so will get an early one and omit my dose for 24hrs! And see£what happens then
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I give up, what can I do?
Should I give up?
Giving up on medication and seeing the Doctor - I can not rely on either!
I give up😠
