TSH

[Megymoo]

Just a little confused I had my thyroid levels checked with my doctor the results came back that my TSH level has gone down in 3 months from 6.8 to 3.9. I done a private test the same day and time 3 months ago at 6.5 and they said that they have gone up to 6.9. My doctor has said that my prescription of 50 levothyroxine is fine

[SeasideSusie Remembering]

Megymoo

Not quite following that (probably me, not you 😊)

Can you clarify the dates and times you had each test, can you list the result, reference range (something like 0.27-4.20) and the amount of Levo taken at the time of the test eg.

6.6.21 - 50mcg Levo - NHS test

TSH: result (range)

6.9.21 - 50mcg Levo - Private test

TSH: result (range)

Whatever your current TSH level is - either 3.9 or 6.9 or anywhere in between, you are undermedicated. The aim of a 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.

Low TSH is borne out by the following which you can discuss with your GP:

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.

So that says TSH of 2 as an absolute maximum but can be lower if you need it to be.

Also, Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine (the professional publication 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 this article from ThyroidUK:

[e-mail]

print it and highlight Question 6 to show your GP.

Always advised here, when having thyroid tests, to get an accurate measure of your levels and to be able to compare them each time:

* 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.

Also, do take your Levo on an empty stomach, one hour before or two hours after food, with a glass of water only, no tea, coffee, milk, etc, and water only for an hour either side, so that absorption will not be affected? Take any other medication and supplements 2 hours away from Levo, some need 4 hours.

Do you always get the same brand of Levo each time?

[Megymoo in reply to SeasideSusie]

The results from my doctor was 3.9 TSH and he said for me to keep taking 50mcg for another year

Results

[SeasideSusie Remembering in reply to Megymoo]

Megymoo

You are undermedicated as I explained above. The symptoms you have mentioned in reply to Tattybogle confirm this as well as your high TSH. You need to discuss with your GP using the evidence I have given you.

[PurpleNails Administrator]

Labs results can vary slightly and reference ranges can make results appear different when they actually closely correlate.

The time the test is taken & medication taken can also show a significantly fluctuation. An early morning test after fasting before taking medication is going to have a very different result to taking test in afternoon after food & recent dose.

The aim when taking levo is for TSH to be in the lower part of the reference range, eg 1. The FT4 should be in top part of range. Wasn’t FT4 tested?

So a TSH of 3.9 is too high.

50mcg a starter dose, do still have symptoms? Ask for an increase in 25mcg steps and retest after 6 weeks or a dose change.

[tattybogle]

Do you mean you have had a recent NHS test and private test with blood for both taken on same day/time.. and one says TSH 3.9 and the other says TSH 6.9 ?If so that is a bit odd.

but ..either way .. even if the 3.9 is correct ... that doesn't mean "50mcg is fine" (unless you feel well)

With TSH at 3.9 there is plenty of room to increase dose of Levo if required

[Megymoo in reply to tattybogle]

I feel terrible I have been depressed, can’t shift any weight even though I watch what I eat and I exercise nearly ever day, but the doctor has said he will run another Thyroid function test in 12 months

[tattybogle in reply to Megymoo]

Contact GP again and ask for an increase in levo dose to 75mcg , based on your TSH of 3.9 being higher than is advised in this article in GPonline . (which recommends getting TSH to between 0.5 and 2 it's written by cardiologist and endocrinologist registrars)

the link to it is in this post.

healthunlocked.com/thyroidu....

[SlowDragon Administrator]

See different GP

Request 25mcg dose increase in Levothyroxine to 75mcg per day

Blood should be retested 6/8 weeks after EACH DOSE CHANGE or brand change in Levothyroxine

Which brand Levothyroxine are you currently taking

The aim of Levothyroxine is to increase the dose slowly upwards in 25mcg steps until symptoms improve

Typical dose Levothyroxine eventually required is approx 1.6mcg per kilo of your weight

How much do you weigh in kilo

Essential to regularly retest vitamin D, folate, ferritin and B12 too

As been left very under medicated likely low vitamin levels

TSH should ALWAYS be under 2 when on Levothyroxine

Most people when adequately treated will have TSH under one

Most important results are always FT3 followed by Ft4

[Megymoo in reply to SlowDragon]

Hi the brand of Levothyroxine I am on is TEVA Uk. I currently weight 11stone exactly I have never been this heavy. My dose of Levothyroxine is 50mcg a day and I feel awful.

[SlowDragon Administrator in reply to Megymoo]

Teva brand upsets many people unless lactose intolerant

Have you ever been on different brand

Teva is only brand that makes 75mcg tablets

Suggest you try Mercury Pharma brand at next prescription

Get GP to increase dose to 75mcg daily as 50mcg and 25mcg tablets

Retest in 6-8 weeks

Likely to need further increases in dose over coming months

Meanwhile getting vitamin levels tested and supplement to bring to optimal levels can help improve symptoms

[Megymoo in reply to SlowDragon]

No that is the only brand that I have been offered my doctor is phoning me on Friday as I have told the receptionist that I don’t feel any better going from 25mcg to 50mcg. I will ask him to put me on a higher dose and to change to Mercury Pharma brand many thanks again

[SlowDragon Administrator in reply to Megymoo]

Guidelines are clear on Levothyroxine TSH should ALWAYS be under 2

Print out guidelines on this and on dose Levothyroxine by weight

Be prepared to stand your ground if necessary

But With such TSH over 3 GP should readily agree to dose increase

Ask pharmacy which brands Levothyroxine they have available

Refuse Teva brand

Accord brand is also well tolerated but only makes 50mcg or 100mcg tablets

Accord is boxed as Almus via Boots or Northstar via Lloyds

Wockhart make 25mcg only

Beware Northstar 25mcg is Teva

[SlowDragon Administrator in reply to Megymoo]

11stone is 70 kilo

70 kilo suggests that likely to eventually need 112mcg Levothyroxine per day

We can normally only tolerate increasing dose in 25mcg steps upwards

Always retest as early as possible in morning before eating or drinking anything apart from water and last dose Levothyroxine 24 hours before test

[Megymoo in reply to SlowDragon]

Test results

Results

[SlowDragon Administrator in reply to Megymoo]

So TPO is high

Confirms autoimmune thyroid disease also called hashimoto’s

About 90% of primary hypothyroidism is autoimmune thyroid disease

Low vitamin levels are extremely common with autoimmune thyroid disease

Request coeliac blood test via GP BEFORE considering trial on strictly gluten free diet

[SlowDragon Administrator]

Suggest you read all the replies on this post

50mcg is only starter dose

healthunlocked.com/thyroidu...

[SlowDragon Administrator]

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

Are you currently taking any vitamin supplements?

If yes - what EXACTLY

[Megymoo in reply to SlowDragon]

Not taking any supplements

[SlowDragon Administrator in reply to Megymoo]

Request GP tests vitamin D, folate, ferritin and B12 plus coeliac blood test

This is recommended by guidelines