Hi all, just got my results back from the surgery's new g.p. He was confused as to why these bloods haven't been taken for a long while and booked me straight in. Anyways, here's the results. Can anyone give me any ideas as to what they mean? I've gotta do the daily phonecall thing to try to get an appointment ASAP but in the meantime.........
New GP: Hi all, just got my results back from the... - Thyroid UK
New GP
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Lizangellus
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SlowDragonAdministrator
Looking at last post on Thyroid forum a year ago you were only on 75mcg levothyroxine
That’s only one step up from starter dose
Your results now show you are very under medicated
The aim of levothyroxine is to increase the dose slowly upwards in 25mcg steps until TSH is ALWAYS under 2
Most people when adequately treated will have TSH around or under one and Ft4 in top 1/4 of range
So GP should increase dose levothyroxine by 25mcg
Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine
Which brand of levothyroxine are you currently taking
What vitamin supplements are you currently taking
Folate and ferritin borderline deficient
Request vitamin D test
Being under medicated for thyroid results in low vitamin levels
Just to add to SlowDragons response. Do you supplement B12?
I have prescription b12 injections every 3 months by g.p/nurse
Hi Slowdragon. I'm still only prescribed the same 75mcg of Teva uk levothyroxine. My usual g.p was unavailable for my last appointment so I saw the new one at my surgery and he was quite unhappy at the length of time between blood testing due to a seemingly worsening of symptoms. I was given 3 months of folic acid and iron approx 9 months ago but no other blood tests until last Friday. I'm currently off work sick as I just feel dreadful all the time so when I requested a sick note, the new g.p ordered the tests
You have been left woefully under medicated
First step is to get dose levothyroxine increased to 100mcg
Approx how much do you weigh in kilo
Guidelines on eventual dose levothyroxine by weight is approx 1.6mcg per kilo per day
Low vitamin levels need improving too
It’s going to take several weeks to begin to improve having been left under medicated for so long
On levothyroxine we MUST have GOOD vitamin levels
What’s your diet like, are you vegetarian or vegan?
Thanks for all your help Slowdragon. I weigh approx 76.4 kg
Also, I'm not officially vegan or vegetarian but I don't like dairy products other than used as part of a recipe and I only eat chicken or fish, no pork or red meat
Lack of red meat won’t be helping with iron deficiency
Sounds like you might be lactose intolerant
In which case stick with Teva ……or try Aristo….but aristo only comes in 100mcg tablets
You might/likely end up on more than 100mcg
76.4. X 1.6 = 122mcg per day
So you might need 125mcg 7 x week
Or possibly 125mcg 6 x week and 100mcg one day week
But we can only increase by maximum of 25mcg levothyroxine at any one time
Increase dose to 100mcg and Retest in 6-8 weeks
I'm so confused now. Just got off the phone with my regular g.p. Had a phone appointment to discuss the blood results. She is insisting everything has came back fine. There are no abnormal results? She said thyroid and parathyroid are fine. Iron folate and vitamin levels are all fine. And nothing has been uncovered. I don't understand what she is seeing. Her only suggestion is to maybe repeat some of them in the new year if I'm not feeling better by then.
What the date on these tests
A TSH of 7 is NOT fine
Is this most recent result
Similarly dates of ferritin testing etc
Ferritin of 30 requires treatment
And other tests suggest you have anaemia
All the tests were taken on Nov 15th
So that TSH result of 7.1 is definitely test result from Nov 15th
If your regular GP thinks a TSH of 7 is ok she needs to retire or go back to medical school.
On levothyroxine TSH should ALWAYS be under 2
Ferritin under 30 confirms iron deficiency
Iron is below range - iron deficiency
Transferrin above range - iron deficiency
I've double checked on the NHS app, definitely from the blood taken on 15th.
It was your regular GP that left you inadequately treated in first place ….suggest you make another appointment with new GP
Phone back and request a different GP looks at these results. say that this GP has obviously missed that fact that the TSH is over range , and also missed the lab comment below the TSH result clearly flagging up that the most likely reason is that your dose of Levo is insufficient.
and so you wish to have a second opinion from a different GP , and you'd like this looked into urgently because you are currently so unwell you are off work.
Many people find Levothyroxine brands are not interchangeable.
Many patients do NOT get on well with Teva brand of Levothyroxine.
But for some people (usually if lactose intolerant, Teva is by far the best option)
Teva, or Aristo (100mcg only) are the only lactose free tablets
Have you only ever had Teva brand?
Are you lactose intolerant?
Teva contains mannitol as a filler, which seems to be possible cause of problems. Teva is the only brand that makes 75mcg tablet.
Most easily available (and often most easily tolerated) are Mercury Pharma or Accord
Mercury Pharma make 25mcg, 50mcg and 100mcg tablets
Accord only make 50mcg and 100mcg tablets
Accord is also boxed as Almus via Boots, and Northstar 50mcg and 100mcg via Lloyds ....but Accord doesn’t make 25mcg tablets
beware 25mcg Northstar is Teva
List of different brands available in U.K.
thyroiduk.org/if-you-are-hy...
Posts that mention Teva
healthunlocked.com/search/p...
Teva poll
healthunlocked.com/thyroidu...
Once you find a brand that suits you, best to make sure to only get that one at each prescription.
Watch out for brand change when dose is increased or at repeat prescription.
New guidelines for GP if you find it difficult/impossible to change brands
gov.uk/drug-safety-update/l...
If a patient reports persistent symptoms when switching between different levothyroxine tablet formulations, consider consistently prescribing a specific product known to be well tolerated by the patient. If symptoms or poor control of thyroid function persist (despite adhering to a specific product), consider prescribing levothyroxine in an oral solution formulation.
academic.oup.com/jcem/artic...
Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).
Levothyroxine is an extremely fussy hormone and should always be taken on an empty stomach and then nothing apart from water for at least an hour after
Many people take Levothyroxine soon after waking, but it may be more convenient and perhaps more effective taken at bedtime
verywellhealth.com/best-tim...
No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.
Some like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away
(Time gap doesn't apply to Vitamin D mouth spray)
If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test
If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal
SlowDragonAdministrator
Ferritin at 30
cks.nice.org.uk/topics/anae...
In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency
Look at increasing iron rich foods in diet
Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption
List of iron rich foods
Links about iron and ferritin
irondisorders.org/too-littl...
davidg170.sg-host.com/wp-co...
Great in-depth article on low ferritin
oatext.com/iron-deficiency-...
drhedberg.com/ferritin-hypo...
This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.
Thyroid disease is as much about optimising vitamins as thyroid hormones
healthunlocked.com/thyroidu...
restartmed.com/hypothyroidi...
Transferrin levels and iron levels both abnormal confirms iron deficiency
GP likely to prescribe iron supplements
Suggest you read the many posts and replies by humanbean on iron and ferritin
SlowDragonAdministrator
Vitamin D was far too low on post from 8 months ago
healthunlocked.com/fibromya...
How much vitamin D are you prescribed?
GP should have prescribed 1600iu everyday for 6 months
NHS Guidelines on dose vitamin D required
ouh.nhs.uk/osteoporosis/use...
GP will often only prescribe to bring vitamin D levels to 50nmol. Some areas will prescribe to bring levels to 75nmol or even 80nmol
leedsformulary.nhs.uk/docs/...
GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)
mm.wirral.nhs.uk/document_u...
But improving to around 80nmol or 100nmol by self supplementing may be better
pubmed.ncbi.nlm.nih.gov/218...
vitamindsociety.org/pdf/Vit...
Once you Improve level, very likely you will need on going maintenance dose to keep it there.
Test twice yearly via NHS private testing service when supplementing
Vitamin D mouth spray by Better You is very effective as it avoids poor gut function. There’s a version made that also contains vitamin K2 Mk7
amazon.co.uk/BetterYou-Dlux...
It’s trial and error what dose we need, with autoimmune thyroid disease we frequently need higher dose than average
Vitamin D and thyroid disease
grassrootshealth.net/blog/t...
I was prescribed a 6 week loading dose of vit d 8 months ago. Nothing since and no further testing other than last Fridays mixed bunch
You should have been advised to self supplement vitamin D as an ongoing daily supplement
Many/most hypothyroid patients need to supplement continuously to maintain optimal vitamin levels
It’s trial and error what dose suits each person
Suggest you get vitamin D test now
See what level is …come back with new post once you get results
Likely to need at least 2000iu daily, possibly higher dose
NHS only tests and treats vitamin deficiencies
It’s down to us to self supplement to maintain OPTIMAL vitamin levels
SlowDragonAdministrator
As per post a year ago
healthunlocked.com/thyroidu...
You need thyroid antibodies tested to see if cause of your hypothyroidism is autoimmune thyroid disease also called Hashimoto’s
Highly likely it is
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...
Technically it’s Hashimoto's (with goitre) or Ord’s thyroiditis (no goitre).
Both variants are autoimmune and more commonly just called Hashimoto’s
Hashimoto's frequently affects the gut and leads to low stomach acid and then low vitamin levels
Low vitamin levels affect Thyroid hormone working
Poor gut function with Hashimoto’s can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common.
According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but a further 80% find gluten free diet helps, sometimes significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)
Changing to a strictly gluten free diet may help reduce symptoms, help gut heal
Before considering trial on gluten free diet get coeliac blood test done FIRST just to rule it out
Ask GP to run coeliac blood test
lloydspharmacy.com/products...
If you test positive for coeliac, will need to remain on gluten rich diet until endoscopy (officially 6 weeks wait)
If result is negative can consider trialing strictly gluten free diet for 3-6 months. Likely to see benefits. Can take many months for brain fog to lift.
If no obvious improvement, reintroduce gluten see if symptoms get worse.
chriskresser.com/the-gluten...
amymyersmd.com/2018/04/3-re...
thyroidpharmacist.com/artic...
drknews.com/changing-your-d...
restartmed.com/hashimotos-g...
Non Coeliac Gluten sensitivity (NCGS) and autoimmune disease
ncbi.nlm.nih.gov/pubmed/296...
The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported
ncbi.nlm.nih.gov/pubmed/300...
The obtained results suggest that the gluten-free diet may bring clinical benefits to women with autoimmune thyroid disease
nuclmed.gr/wp/wp-content/up...
In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned
restartmed.com/hashimotos-g...
Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.
Hi Lizangellus,
Gosh, you must be feeling dreadful. 😞
I'm just going to add that your Haemoglobin Concentration of 118g/L alone (although 'in range') confirms Anaemia per Nice guidelines.
"Anaemia is defined as a haemoglobin (Hb) level two standard deviations below the normal for age and sex:
In non-pregnant women aged over 15 years — Hb below 120 g/L."
And here is further info re treatment and monitoring (1st section, bullet point 2nd from bottom in blue) which you might find useful. ie They shouldn't just prescribe a short course of Iron to bring you up a bit and then send you away.
I bet the new GP had to walk around after seeing the test results and reading your file, and kick the furniture/cat/receptionist as you have been well and truly let down by the practice. It is hopeful that this new GP is on the ball, will up your dose and you will feel half human again soon.
Hug.
Hello again all. After much to-ing and fro-ing, I managed to get SOME bloods repeated yesterday. Much to the annoyance of the senior G.P. Here are the new results
Text
have they still not increased your dose yet ? assuming senior GP can read ... the comments re. 'inadequate dose 'under this TSH test tell her/him what needs to be done .... increase Levo .
Unfortunately not. I'm still on 75 mcg. The results came back yesterday morning, I checked them online. Haven't heard anything from the g.p since the tests were agreed
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