Undertreated with Levothyroxine: TSH 8.57 (.30-... - Thyroid UK

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Undertreated with Levothyroxine

Luuca profile image
5 Replies

TSH 8.57 (.30-5.50)

FreeT4 16.1 pmol/l (11.5-22.7

No T3

Vit D ,B12 calcium within normal range

No ferritin reading FBC ok

On levothyroxine 100mg Having reduced from 125 mg

In April T3 was 3.1

Feel terrible muscle wasting and pain lots of symptoms of hypothyroidism since reduction but also before Gp doesn’t listen or understand

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Luuca profile image
Luuca
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SeasideSusie profile image
SeasideSusieRemembering

Luuca

Well no wonder you feel terrible with a TSH of 8.57, that indicates hypothyroidism, and your FT4 is only 41% through it's range. 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 range.

Did you do your test as we always advise:

* 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.

What were your results when on 125mcg Levo and why was the dose reduced?

Vit D ,B12 calcium within normal range

What are the results, reference ranges and units of measurement for Vit D and B12? Just being "within normal range" doesn't necessarily mean they're at optimal levels, and that's what we need for thyroid hormone to work properly.

It's important to test ferritin because some experts say that the optimal level for thyroid function is 90-110ug/L.

Luuca profile image
Luuca in reply to SeasideSusie

Thank you for your replies. I followed the rules about taking bloods but folate ferritin wasn’t taken. 22.10.2021

Serum adjusted calcium was 2.41mmol/l (2.13-2.63)

Serum calcium 2.55

B12 783ng/l (233-1132)

Serum vit D 88nmol/l (50-125)

When I was taking Levothyroxine 125mg September 2020

my TSH .24

Free T4 19.2 (11.5-22.7)

After reducing to 100mg Levothyroxine

1.4.2021

TSH 2.84

Free T3 3.1pmol/l((3.1-7.0)

FreeT4 15.7pmol/l(11.5-22.7)

The Gp thought that was ok

Since then gone downhill Cholesterol has increased and I have episodes of bradycardia , skin is dreadful Sleeping is poor and as an additional factor managed to have a triple ankle fracture at the beginning of October

SeasideSusie profile image
SeasideSusieRemembering in reply to Luuca

Luuca

When I was taking Levothyroxine 125mg September 2020

my TSH .24

Free T4 19.2 (11.5-22.7)

Why was your dose reduced? There was no need, even if your TSH is below range (you haven't given the range) your FT4 is 68.75% through range so not even top of range. Your dose should not have been reduced unless FT3 tested and found to be over range.

After reducing to 100mg Levothyroxine

1.4.2021

TSH 2.84

Free T3 3.1pmol/l((3.1-7.0)

FreeT4 15.7pmol/l(11.5-22.7)

The Gp thought that was ok

No way was that OK. TSH should always be below 2, lower if necessary - see

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.

and your FT4 was only 37.5% through range with FT3 right at the bottom of the range.

B12 783ng/l (233-1132)

Serum vit D 88nmol/l (50-125)

B12 is OK but Vit D is recommended to be 100-150nmol/L according to the Vit D Society and Grassroots Health, with a recent blog post on Grassroots Health recommending at least 125nmol/L.

SlowDragon profile image
SlowDragonAdministrator

On levothyroxine TSH should ALWAYS Be under 2

When adequately treated most people will have TSH around or under one

Ft3 at least 50% through range

Please add actual results and ranges for vitamin D, folate, ferritin and B12

See/contact GP surgery and get 25mcg dose increase in levothyroxine

Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine

Do you always get same brand levothyroxine at each prescription

Do you have autoimmune thyroid disease also called Hashimoto’s diagnosed by high thyroid antibodies

If not already on strictly gluten free diet, get GP to do coeliac blood test BEFORE considering trial on strictly gluten free diet

shaws profile image
shawsAdministrator

Few doctors are skilled in treating their patients who're hypothyroid.

Mine told me that T3 converts to T4! My response 'No doctor that's incorrect T4 should convert to T3. He is in his late 60's so I wouldn't have like to consult with him - as it is I had to diagnose myself when the GP phoned to tell me he had the results of my blood tests and I had no problems. I cried but thankfully I had requested a blood test form to be left at the Reception as I had been out of England for a few weeks.

I went straight to hospital got a blood test and within a couple of hours the main GP phoned to ask who gave me the blood test form. I said "I did". She said come and get a prescription you have hypothyroidism (I hadn't a clue what that was but I soon learned thanks to Thyroiduk and there was no forum then).

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