Help with results

[Newtothyroid1]

I need help! I’m new to this condition and I do not know what these numbers mean can anyone help. I feel my doctor is not really helpful. If anyone can explain that would be great. My previous result from the hospital said my thyroid function was 5.7miu/l and required a small about of medication can anyone explain if it’s improved or not?? Thanks in advance

[SlowDragon Administrator]

Welcome to the forum

So you had a nodule removed, was this a hemi thyroidectomy?

Or have you had whole thyroid removed

How much levothyroxine are you currently taking

How long at this dose

Which brand of levothyroxine

Many people find different brands are not interchangeable

How do you feel?

Just testing TSH and Ft4 is completely inadequate, but usually all GP will test

[Newtothyroid1 in reply to SlowDragon]

Hi I have had half my thyroid removed and take 50mng of levothroxine.

If tired all the time and have pain in my heels.

I have gained so much weight as well I have no confidence.

Thanks for your reply

[SlowDragon Administrator in reply to Newtothyroid1]

So you need 25mcg dose increase in levothyroxine

Bloods should be retested 6-8 weeks later …..remember to ALWAYS test as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

Which brand of levothyroxine are you currently taking

Heel pain (plantar fasciitis) is extremely common when under medicated

Approx how much do you weigh in kilo

Likely to need further increase 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...

Suggest you print out these guidelines and politely, but firmly request 25mcg dose increase in levothyroxine

Unfortunately many GP’s are clueless about how to manage hypothyroidism

Once we are on levothyroxine, the feedback mechanism of TSH is broken and we almost ALWAYS need to be on full replacement dose

Essential to test vitamin levels too

Being under medicated for thyroid results in low stomach acid, poor nutrient absorption and low vitamin levels as direct result

Low vitamin D in particular linked to plantar fasciitis too

How long have you been left on only starter dose of 50mcg levothyroxine

[SlowDragon Administrator]

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

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested.

Very important to test vitamin D, folate, ferritin and B12 at least annually

Have you had vitamin levels tested yet?

Low vitamin levels are extremely common, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)

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 and last dose levothyroxine 24 hours before test

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

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

List of private testing options

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

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...

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/

NHS easy postal kit vitamin D test £29 via

vitamindtest.org.uk

If TPO or TG thyroid antibodies are high this is usually due to Hashimoto’s (commonly known in UK as autoimmune thyroid disease). Ord’s is autoimmune without goitre.

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

Link about thyroid blood tests

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

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

List of hypothyroid symptoms

thyroiduk.org/if-you-are-un...

Levothyroxine doesn’t “top up “ failing thyroid…..it replaces your own thyroid output…..so virtually all thyroid patients need to increase dose levothyroxine slowly upwards in 25mcg steps (retesting 6-8 weeks after each dose increase) until on roughly full replacement dose

Typically TSH will be around or under one. Ft4 near top of range, and Ft3 at least 50-60% through range

All four vitamins need to be optimal as well

[pennyannie]

Hello Newtothyroid and welcome,

You are not alone with all this and will always find help and support from forum members as most of us been through a similar situation, learnt how to help ourselves, and then come back on the help others, and it is all a bit daunting in the beginning.

A fully functioning working thyroid would be supporting you on a daily basis with trace elements of T1, T2 and calcitonin plus a measure of T3 at around 10 mcg plus a measure of T4 at around 100 mcg.

T4 - synthetic Levothyroxine is a storage hormone and needs to be converted by your body into T3 the active hormone that the body runs on.

In order for T4 to work in your body and convert well to T3 you do need to maintain an optimal core strength of ferritin, folate, B12 and vitamin D - so blood tests for these should be run along with a TSH, T3 and T4. along with inflammation and thyroid antibodies.

We will then be more able to explain everything to you when you start a new post with all these results and ranges.

If your doctor can't run this full thyroid blood panel for you there are companies listed on the Thyroid UK website who are the charity who support this forum and some private companies even offer a nurse home visit which I find, takes off a layer of stress.

Arrange an early as possible a blood test, fast over night just taking in water and take your T4 after the blood draw and stop any supplements a week beforehand so we can see exactly what your body is holding onto.

Some people can get by on T4 only ; some people find at some point in time that they need the addition of a little T3 - synthetic Liothyronine making a T3/T4 combo : some people can't tolerate T4 and take T3 only : and some people take Natural Desiccated Thyroid.

The thyroid is the body's engine and a major gland responsible for full body synchronisation including your physical, mental, emotional, psychological and spiritual well being, your inner central heating system and your metabolism.

Personally speaking I think if there has been a medical intervention and the thyroid part or fully removed, or there has been RAI ablation that both T3 and T4 should be on the patient's prescription for if, and likely when, both these vital hormones will need to be taken to restore health and well being and give you back your " you ",

I don't know what this 5.7 means - it sounds like a T3 reading, but seen in isolation - who knows ?

Your TSH looks a little high to me and your T4 is just around 50 % through the range and we generally feel better when ourT4 is up in the top quadrant.

Generally the higher in the range your T4 sits the higher in the range will be your T3 - and it is where in the range your T3 sits that gives you your wellness.

Too low a level of T3 for you and you will have symptoms of hypothyroidism just as too high a level of T3 to you and you may experience symptoms of hyperthyroidism.

If you go into the Thyroid UK website there is a detailed list of both hypo and hyper symptoms and it does get confusing as some symptoms can be experienced when suffering with either condition as bot hyper and hypo are the extreme ends of same T3 stick and your wellness is your T3 level somewhere within this range.

So a dose increase in T4 will lower your TSH and should increase your T4 :

How long ago was your surgery and are you still under endocrinology ?

[Newtothyroid1 in reply to pennyannie]

Thank you for replying it means a lot. My surgery was in June so I’m under my GP now.So I feel lost if I’m honest and when I ask for my result it was given in the form of a print out It meant nothing to me.

Thanks again

[pennyannie in reply to Newtothyroid1]

We all start off knowing next to nothing :

I think it will be in your best interests to first get the full thyroid blood panel actioned and then start a new post with the results and ranges and then you will be offered constructive advice on your next best step back to better health.

Otherwise first start with an appointment with your doctor and discuss your symptoms and ask for an increase in your T4 medication and ask for your ferritin, folate, B12 and vitamin D to be tested and get the results as you may well be in the NHS ranges but not high enough for someone with half a thyroid taking T4 medication.

You are legally entitled to copies of and access to your medical records and if you don't already have on-line access it's in your best interest to get this set up with your surgery.

Otherwise you need to ask the receptionist for copies of all your blood test results and ranges from pre and post surgery.

The print out you're posted above is a blood test reading of your TSH and T4 :

The TSH is saying your level is 2.20 in a range of 0.27 - 4.20 - so in range :

The T4 is saying your level is at 17 in a range of 12 - 22.00 - so in range :

The reading on the form recommends that T4 should be in the upper part of the reference range so suggesting a dose increase - so your doctor should be increasing your T4 medication by 25mcg Levothyroxine and re-test in another 6-8 weeks time to see if your symptoms have improved and your T4 level increased.

I believe you need to run with a low TSH because of the cancer diagnosis and your TSH needs to come down the range and your T4 up the range both of which will happen when you have a dose increase in your Levothyroxine.

When not well and likely suffering with that brain fog I know it's difficult to take in and understand all this information.

Just start reading the posts on here of other people in a similar situation.

It is a bit of jigsaw puzzle but it does all sink in and once you get a couple of corners sorted everything will become clear and the jigsaw take shape and the picture and way forward more easily seen.

[Newtothyroid1 in reply to pennyannie]

Thank you for your advice, it’s very difficult to understand.

[SarahJane1471 in reply to Newtothyroid1]

I knew nothing until I came to this forum and began to educate myself. I didn’t even pass biology at school 🤷‍♀️But I have managed to get my head around it all from the very knowledgeable people on here.