My TSH level has gone from 1.52 - June 21 to 7.04 - 26/11/21. Should I be concerned?

[TinaZim]

Increased TSH

[SeasideSusie Remembering]

TinaZim

Your other post tells us that you have Hashi's. Fluctuations of results are common with Hashi's as it causes swings from hypo to hyper and back again.

Just testing TSH is not enough, you also need FT4 and FT3 which are the actual thyroid hormones, TSH is just a signal from the pituitary.

When doing thyroid tests we always advise:

* Blood draw no later than 9am. This is because TSH is highest early morning and lowers throughout the day. If looking for a diagnosis of hypothyroidism, an increase in dose of Levo or to avoid a reduction then we need the highest possible TSH

* Nothing to eat or drink except water before the blood draw. This is because eating can lower TSH and coffee can affect TSH.

* If taking thyroid hormone replacement, last dose of Levo should be 24 hours before blood draw, if taking NDT or T3 then last dose should be 8-12 hours before blood draw. Adjust timing the day before if necessary. This avoids measuring hormone levels at their peak after ingestion of hormone replacement. Take your thyroid meds after the blood draw. Taking your dose too close to the blood draw will give false high results, leaving any longer gap will give false low results.

* If you take Biotin or a B Complex containing Biotin (B7), leave this off for 7 days before any blood test. This is because if Biotin is used in the testing procedure it can give false results (most labs use biotin).

These are patient to patient tips which we don't discuss with phlebotomists or doctors.

Is this how you do your tests?

[SlowDragon Administrator]

Are you currently taking any thyroid replacement hormones

If yes, how much

What vitamin supplements are you currently taking

Was test done as early as possible in morning before eating or drinking anything other than water (and if taking…..last dose levothyroxine 24 hours before test)

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 once year minimum

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

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)

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...

[TinaZim in reply to SlowDragon]

Thanks SlowDragon, Yes the test was taken fasting first thing in the morning and Leveroxine was taken 15 hours previously. I take 100 mg's of Leveroxine every evening. I am taking high doses of Vitamin D from the doctor. I also take magnesium supplements, B6 and B12 daily.

[SlowDragon Administrator in reply to TinaZim]

Which brand of levothyroxine

Do you always get same brand levothyroxine at each prescription

See/contact GP for 25mcg dose increase in levothyroxine and bloods should be retested 6-8 weeks after any dose change or brand change in levothyroxine

How long have you been on 100mcg levothyroxine

Low vitamin levels are extremely common when under medicated

Low vitamin levels tend to lower TSH, so once you started improving low vitamin levels, not surprising that TSH has increased

[SlowDragon Administrator]

Approx how much do you weigh in kilo

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

[SlowDragon Administrator]

As you have Hashimoto’s have you had coeliac blood test done yet

Or are you already on strictly gluten free diet

If not had coeliac test, request that’s done BEFORE considering trial on strictly gluten free diet

TSH should be under 2 as an absolute maximum when on levothyroxine. Many people when adequately treated will have TSH around or under one

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...