Help interpreting private blood test results

[Jules0001]

Following my last post (link below), I spoke to my doctor who confirmed that my vitamin D level was “inadequate” at 42nmol/L (range 30-50nmol/L is considered inadequate in some people) so I’ve started to take a supplement. He said I should start to feel better in 6-8 weeks…

We also spoke about my TSH levels but because these are in the “normal” range (October 2021 - result 3.25mlU/L (ref ranges 0.30-3.94 mlU/L) he basically refused to conduct any further tests. So, I paid to have these done privately. I would really appreciate some guidance on what this all means…

Thyroid function tests @ 18 Nov:

TSH - 3.85 (ref ranges 0.27-4.20 mU/L)

T4 total - 76.3 (ref ranges 66-181 nmol/L)

Free T4 - 13.8 (ref ranges 12.0- 22.0 pmol/L )

Free T3 - 3.88 ref ranges 3.1-6.8 pmol/L)

Immunology:

Anti-Thyroidperoxidase abs - H135 (ref range <34 IU/mL)

Anti-Thyroglobulin - 37 (ref range <115 IU/mL)

I also had my magnesium and cortisol tested and these are the results:

Magnesium - 0.83 (ref range 0.7-1.0 mol/L)

Cortisol (Random) 242.0 (ref range 6am - 10am 166 - 507 nmol/L)

I had the tests done via Blue Horizon and asked for doctors comments - which were:

The thyroid function is currently normal. The positive thyroid antibody result, however, increases the possibility of your having or ultimately developing autoimmune thyroid disease, such as Hashimoto's thyroiditis or Grave's disease.

Previous post:

healthunlocked.com/thyroidu...

[fuchsia-pink]

Well you must feel dreadful. You are on a "starter" dose of levo, which should be increased until TSH is always less than 2, probably less than 1, free T4 and free T3 are nice and high in range - AND you feel properly well

Your TSH is obv too high. Free T4 is a feeble 18% through range an free T3 isn't much better at 21% through range. You are likely to need these at least 67% through range ...

I'd try and ask again for a dose increase.

Hopefully someone - SlowDragon ? - will pop up with a link you can show him

Good luck x

[Jules0001 in reply to fuchsia-pink]

Thank you for responding so quickly! I will ask again…

[SlowDragon Administrator]

See different GP and politely insist on 25mcg dose increase in levothyroxine as indicated by guidelines

On levothyroxine dose levothyroxine should be increased slowly upwards in 25mcg steps until TSH is ALWAYS under 2

Most people when adequately treated will have TSH around or under one

TSH should be under 2 as an absolute maximum when on levothyroxine

gponline.com/endocrinology-...

Replacement therapy with levothyroxine should be initiated in all patients to achieve a TSH level of 0.5-2.0pmol/L.

NHS England Liothyronine guidelines July 2019 clearly state on page 13 that TSH should be between 0.4-1.5 when OPTIMALLY treated with just Levothyroxine

Note that it says test should be in morning BEFORE taking levothyroxine

Also to test vitamin D, folate, B12 and ferritin

sps.nhs.uk/wp-content/uploa...

Graph showing TSH in healthy population

web.archive.org/web/2004060...

Aim is to bring a TSH under 2.5

UK guidance suggests aiming for a TSH of 0.5–2.5

gp-update.co.uk/SM4/Mutable...

[Jules0001 in reply to SlowDragon]

Thank you for your reply! Lots to read and helpful info to support my request for an increase in dose.

[SlowDragon Administrator]

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

Don’t bother having Doctors comments from Blue horizon or Medichecks ….as demonstrated…if they were aware you’re on levothyroxine they should have explained you are under medicated

[Jules0001 in reply to SlowDragon]

Thank you for all the info! I had to wait longer for the results because I’d asked for doctors comments - I did feel they were cut and pasted as a generic reply rather than a comment on my actual results. I’ll know not to do that again!