Puzzled by latest blood test results

[BethH77]

Hi. I am currently on 50mcmg of Levothyroxine.

I have been taking a vit D spray and had a B12 injection in Sept too.

However, my latest results show everything is worse than before! My CRP inflammation marker is up by 1.2 and my Ferritin is lower by 34 too! My TSH is worse than ever and my FT3 has declined by 0.7 too and Free thyroxine by 0.3.

My GP did a TSH/T4 test but said it was 'in range'.....

Any advice gratefully received.

Thanks

[SlowDragon Administrator]

Can you make an appointment with different GP at practice

50mcg levothyroxine is only a starter dose

Take copy of these results to consultation/email it to them if phone consultation

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

Request 25mcg dose increase in levothyroxine

Bloods should be retested 6-8 weeks after any dose change or brand change in levothyroxine

Which brand of levothyroxine are you currently taking

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...

Vitamin D, folate and B12 are all too low

Ask GP to test B12 and folate

Also to retest CRP as was high on medichecks test

[BethH77 in reply to SlowDragon]

They started me on 25....and were very reluctant as said I was "only" subclinical. I had to really push for an increase to 50 too as their TSH check showed I was top limit, so 'in range' to them. The last check they did showed I was in range but was a lunch time test as couldn't get me an early appt. This check was first thing and shows a significant imcreade in TSH levels.I am on Mercury I think...

I bought the B12 injection myself and then had covid and a bad back so just wasn't able to keep them up as I should. Again, GP wouldn't do anything as said ok....

I am taking a VitD spray of 4000 I think.....will check.

[SlowDragon Administrator in reply to BethH77]

Take these private results to your GP appointment

along with all official guidelines that show your TSH is far too high for someone on levothyroxine

Meanwhile Email Thyroid UK for list of recommended thyroid specialist endocrinologists

...NHS and Private

[e-mail]

[BethH77 in reply to SlowDragon]

Thank you, may try private as I took all my Thyroid UK documents, results in with me last time and she wouldn't even look at them! She doesn't believe TSH needs to be below 2, just under the top range!! So frustrating.

If I get my Levo dose right, do you think my T3 will increase?

[SlowDragon Administrator in reply to BethH77]

Very likely to yes

Can you see different GP

NHS guidelines are clear…..if patient has symptoms dose should be increased

[SlowDragon Administrator in reply to BethH77]

gp-update.co.uk/Latest-Upda...

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.

[SlowDragon Administrator]

If you had B12 injection in September, why have you not had any more

Typically B12 injections are every 2-3 months

How much vitamin D are you currently taking

What was vitamin D level before starting supplements

[SlowDragon Administrator]

Levothyroxine doesn’t “top up “ failing thyroid….it replaces it

Standard starter dose of levothyroxine is 50mcg, but dose is increased slowly upwards in 25mcg steps over several months until symptoms improve and typically TSH is always under 2….and often lower than that

guidelines on dose levothyroxine by weight

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