Latest blood results

[skinner44]

7 week's ago I had my Thyroxine increased from 50mcg to 75. I have just received my latest blood results TSH 1.7 (0.27-4.5) T4 17.6 (11-23) T3 4.44 (3.1-6.8). Are these now going in the right direction previous results 28/9/2021 TSH 3.5 T4 16.1 T3 not tested. My latest results are nearly what I was before my partial thyroidectomy.

[SlowDragon Administrator]

Was test done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

Do you always get same brand levothyroxine at each prescription

Which brand?

Ft4 is 55% through range Ft3 only 35% through range

Helpful calculator for working out percentage through range

chorobytarczycy.eu/kalkulator

When were vitamin D, folate, ferritin and B12 last tested

What vitamin supplements are you currently taking

[skinner44 in reply to SlowDragon]

Bloods done 1st thing before meds and anything to eat or drink. I'm on Accord get same brand everytime and cut a 50 with them not doing a 25. Vit D etc were last done 28th September, I take Vit D I have always had to take it this time of year.

[SlowDragon Administrator in reply to skinner44]

Previous post shows dire B12, folate and ferritin

healthunlocked.com/thyroidu...

Presumably you have been supplementing a daily B12 and separate B complex daily

Presumably GP prescribed iron supplements ?

If not, they should have

And should be working on very low ferritin by increasing iron rich foods in diet

Aiming for Serum B12 at least over 500

Folate and ferritin at least half way through range

Vitamin D at least around 80nmol and around 100nmol maybe better

[JAmanda]

I’d want a further increase to get levels high in range and tsh lower, but if you have no symptoms then stay where you are.

[skinner44 in reply to JAmanda]

Have the odd symptom now and again but nothing like I had before. Get tired after exercise but think that's because I need to realise I can't do what I previously did.

[SlowDragon Administrator in reply to skinner44]

Most people when adequately treated will have Ft3 at least over 50-60% through range and usually Ft4 needs to b3 a little higher

How much do you weigh in kilo

Guidelines on dose levothyroxine by weight is approx 1.6mcg per kilo per day

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

[pennyannie]

Hello Skinner :

Considering you do have blood tests for TSH, T3 and T4 prior to thyroid surgery I think that should be at least the goal you aim to achieve post surgery.

A fully functioning working thyroid would be supporting you daily 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.

T3 is said to be around 4 times more powerful than T4 and T3 is the active hormone that the body needs to runs on, and not T4 as this is a storage hormone that your body needs to be able to convert into T3., with the average person needing to find/convert utilise around 50 T3 daily, just to function, let alone exercise as this will use up your energy quicker.

Conversion of T4 into T3 can be compromised by low vitamins and minerals, and looking back, I see you have already been well advised on all this and conversion can also be compromised by inflammation, any physiological stress ( emotional or physical ) dieting, depression nd ageing, so more difficult area to take some control over but worth mentioning.

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

It is essential that you are dosed on your T3 and T4 levels and not your TSH which is quite likely in primary care, as it is where your T3 is in the range that gives you back your wellness and your " you " :

Ideally when on T4 monotherapy this will require you T4 to be up somewhere up in the top quadrant of its range as this should in theory convert to a high good level of T3 working out at about a 1/4 ratio T3 to T4 :

Personally I just think it makes common sense that both T3 and T4 be on the patient's prescription when there has been a medical intervention with either thyroid surgery or RAI ablation as having all/part of your own natural production of T3, you will likely struggle to regain your former health and well being on T4 only.

Some people can get by on T4 only, some people find that after some time the T4 doesn't seem as effective as it once was, and need to addition of a little T3 making a T3/T4 combo, some people can't tolerate T4 and need to take T3 only wilst others prefer to take Natural Desiccated Thyroid.

Sadly currently in primary care doctors have no treatment options to offer, but T4 and if this doesn't fully restore your health you may need to consider a referral to an endocrinologist who is " known " to be supportive of alternative thyroid hormone replacements which were all freely available on the NHS some 20 years ago, and still are widely prescribed in most other countries throughout the world.