I've looked this up on the internet and come away more confused than when I started!
I've been on a trial of Levo (25mg a day) for subclinical hypothyroidism and just had my bloods done. I'd only been on it for about a fortnight or so when they were tested and it's gone from being high (TSH anything from 6-10; it jumps about but is always on the high side) to what looks like normal to me.
My TSH is 2.9 and the Free T4 is 16. I'm in the UK. There's notes saying "For individuals on thyroxine with euthyroid TSH the reference range for FT4 is 14 - 28". Mine is within these parameters, so does this mean I am euthyroid, and is that a bad thing, or do they put this note on as standard when you are on levo and have bloods done?
Do these results mean the thyroxine is working and all is good?
I'm talking to the doc about them on Wednesday so I'd love a heads-up in case she is going to spring something on me.
Also, if these are working would it be worth shoving the dose up to 50mg to see if it gets even better? It seems like a very low dose and I'm wondering if the doc will keep me on that now, since everything looks okay.
As you can tell, I have no idea what I am doing here.....
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Chancery
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I suggest its real meaning is someone with perfectly acceptable thyroid hormone levels and no thyroid disorder.
But as soon as someone has a thyroid problem, I'd throw the term out of the window. You have the situation in which, to achieve the same levels of TSH, FT4 and FT3 as you probably used to have, is next to impossible. You can only approximate that state.
Unfortunately the term is widely used in medicine.
Standard starter dose of levothyroxine is 50mcg unless over 60 years old …
Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine
Testing after 2 weeks is far too soon
Have you had thyroid antibodies, vitamin D, folate and ferritin
See you are on B12 already
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
Low vitamin levels are extremely common, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)
Low vitamin levels common as we get older too …..or on vegetarian/vegan diets
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
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
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.
A TSH of 2.9 is not euthyroid. It's within the stupid range, but most of that range is far from euthyroid. A euthyroid TSH - i.e. the TSH of someone with no thyroid problems - would be around 1, never over 2, and you're hypo when it reaches 3. So, you are under-medicated. Which isn't surprising on only 25 mcg levo.
That FT4 range is incredibly wide - don't think I've ever seen one that wide. Normally something like 12-22, even narrower. That would mean that mid-range - which is euthyroid - would be around 21. So, you can see your FT4 is much too low.
Do these results mean the thyroxine is working and all is good?
Levo is a hormone - the thyroid hormone T4 - so it can't not work. It's not like aspirin, or some other drug. It does what it can - i.e. builds up a store ready to be converted into T3 when the body needs it. But, you have to take enough of it for it to make you well. So, yes, you do need an increase in dose - probably several increases at six week intervals.
If your doctor wants to keep you on 25 mcg, then he has no idea what he's doing, either! The point of thyroid hormone replacement is to bring the TSH down to 1 or under, and the FT4 and FT3 up into the top third of the range, or wherever you need it to feel well.
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Any thoughts on Free T4 going down a bit please? What does this mean, if anything? Thank you!
