help with interpreting bloods

[Cape-tonian1]

Hello all? Could anyone help me with my TSH results? I am currently in 50mg levothyroxine and I last results indicated my TSH serum level (XaELV) 6.92mu/l (0.35-5.0) which indicates above range. my Gp did have any issues with this and I had only just received the paper copy of my results not sure what this mean? Any thoughts would be highly appreciated. I am think of doing some private test? Any suggestions as to which ones to take? I had been experiencing extreme fatigue lately. I am taking b12 injections and last result indicated that this is above range … also VitD seemed fine.. thanks so much for your help

[tattybogle]

Hi , if TSH is 6.92mu/l (0.35-5.0) and this test was done after taking 50mcg every day for at least 6 weeks , then it means you need the dose of Levothyroxine increasing .

GP is incorrect to say it is OK at this level .

They should be increasing Levo dose gradually (25mcg increase) and then retesting after further 6 weeks , and repeating this until TSH is at the very least 'in range' .. but preferably around 1 , and symptoms have resolved.

With TSH 6.92 it is not surprising you still feel awful.

Contact GP and request a dose increase to 75mcg , and a retest after 6 /8 weeks.

[Cape-tonian1 in reply to tattybogle]

Thanks so much for responding will get back to GP ASAP

[SeasideSusie Remembering]

Cape-tonian1

last results indicated my TSH serum level (XaELV) 6.92mu/l (0.35-5.0) which indicates above range. my Gp did have any issues with this

Do you mean that your GP did not have any issues with this over range result? If so then your GP is as sadistic as he is ignorant of how to treat hypothyroidism.

How long have you been on 50mcg Levo? Is this a recent diagnosis and you were started on 50mcg, or have you been diagnosed and on this dose for a long time?

The aim of a treated Hypo patient on Levo only, generally, is for TSH to be 1 or below with FT4 and FT3 in the upper part of their reference ranges, if that is where you feel well.

So the first thing to do is bring that TSH down and to do that you need an increase in your dose of Levo, 25mcg immediately, retest in 6-8 weeks, keep repeating until your TSH is down to 1 or below and then you need to look at your FT4 and FT3 levels.

Just testing TSH and adjusting dose by that alone is inadequate, TSH does not tell us our thyroid status, it's a pituitary hormone which signals the thyroid to make thyroid hormone. When the pituitary detects there's not enough thyroid hormone the TSH is high. If your FT4 was measured now it would be low in range.

If your GP is unfamiliar what TSH level to aim for then show him the following which clearly states it should be below 2.5 or even 2

From GP Notebook

gpnotebook.com/simplepage.c...

Target level for TSH during thyroxine therapy

Fine tuning of the dose could be necessary in some patients

* aim of levothyroxine treatment is to make the patient feel better, and the dose should be adjusted to maintain the level of thyroid stimulating hormone within the lower half of the reference range, around 0.4 to 2.5 mU/l. If the patient feels perfectly well with a level in the upper half of the reference range, then adjustment is unnecessary

From GP online

gponline.com/endocrinology-...

Under the section

Cardiovascular changes in hypothyroidism

Replacement therapy with levothyroxine should be initiated in all patients to achieve a TSH level of 0.5-2.0pmol/L.

I am think of doing some private test? Any suggestions as to which ones to take?

I would get the full thyroid/vitamin panel as optimal nutrient levels are essential for us Hypos.

The two most popular ones here are:

Medichecks ADVANCED THYROID FUNCTION medichecks.com/products/adv...

Check this page for details of any discounts: thyroiduk.org/getting-a-dia...

They are showing a special discount at the moment of 20% at the top of their web page although I don't know how long that is going to be available

or

Blue Horizon Thyroid PREMIUM GOLD bluehorizonbloodtests.co.uk...

Check this page for discount code thyroiduk.org/getting-a-dia...

Both tests include the full thyroid and vitamin panel. They are basically the same test with just a few small differences:

Blue Horizon includes Total T4 (can be useful but not essential). Medichecks doesn't include this test.

B12 - Blue Horizon does Total B12 which measures bound and unbound (active) B12 but doesn't give a separate result for each. Medichecks does Active B12.

Total B12 shows the total B12 in the blood. Active B12 shows what's available to be taken up by the cells. You can have a reasonable level of Total B12 but a poor level of Active B12. (Personally, I would go for the Active B12 test.)

Blue Horizon include magnesium but this is an unreliable test so don't let this sway your decision, it also tests cortisol but that's a random cortisol test and to make any sense of it you'd need to do it fasting before 9am I believe.

Both can be done by fingerprick and if you've not done one before and would like some tips on how to do it please ask and I will post them.

Don't bother having their doctor's comments, it delays getting the results and you get a better interpretation of them from members here.

Always advised here, when having thyroid tests:

* Blood draw no later than 9am. This is because TSH is highest early morning and lowers throughout the day. If looking for a diagnosis of hypothyroidism, an increase in dose of Levo or to avoid a reduction then we need the highest possible TSH

* Nothing to eat or drink except water before the blood draw. This is because eating can lower TSH and coffee can affect TSH.

* If taking thyroid hormone replacement, last dose of Levo should be 24 hours before blood draw, [if taking NDT or T3 then last dose should be 8-12 hours before blood draw. Adjust timing the day before if necessary.] This avoids measuring hormone levels at their peak after ingestion of hormone replacement. Take your thyroid meds after the blood draw. Taking your dose too close to the blood draw will give false high results, leaving any longer gap will give false low results.

* If you take Biotin or a B Complex containing Biotin (B7), leave this off for 7 days before any blood test. This is because if Biotin is used in the testing procedure it can give false results (most labs use biotin).

These are patient to patient tips which we don't discuss with phlebotomists or doctors.

[Cape-tonian1 in reply to SeasideSusie]

Thanks so much, yes I meant GP did not

[SlowDragon Administrator]

50mcg is only a starter dose of levothyroxine

Dose is increased slowly upwards in 25mcg steps

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

Likely to need several further increases in levothyroxine over coming months

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...

Which brand of levothyroxine are you currently taking

Many people find different brands are not interchangeable

Bloods should ALWAYS be tested as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

Have you had vitamin D, folate, ferritin and B12 levels tested or thyroid antibodies

If not request that these are tested NOW, or test privately

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

List of private testing options

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

NHS easy postal kit vitamin D test £29 via

vitamindtest.org.uk

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

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

bluehorizonbloodtests.co.uk...

Thriva Thyroid plus antibodies and vitamins By DIY fingerpick test

thriva.co/tests/thyroid-test

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/

[Cape-tonian1 in reply to SlowDragon]

Awesome this has been so helpful thank you