I’ve attached a copy of a recent medichecks blood test. This is the first time I’ve used them as I usually get tested by my gp but as they only test tsh & t4.
Last year (March) my gp agreed to an increase in levothyroxine from 50mcg to 75mcg as my tsh was 5.79 (range 0.34-5.6) only just over but I was feeling dreadful so they agreed to the increase
I’ve been feeling rough again lately (seems to always be at this time of year) and the medichecks results show increased antibodies,
Do you think the gp would do anything if I showed them these results - I’ve realised now there’s a lot more to having an under active thyroid than just taking levothyroxine
Thanks
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Jocarter
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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
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.
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.
Jocarter, once you are being treated with thyroxine your TSH should be less than 2 and for some people less than 1. After your last increase to 75mcgm levo you should have been tested again after 6-8 weeks not left for nearly a year!!! Yes, you need an increase to 100 mcgm and then another test after 6-8 weeks. Your GP is clearly only looking at the TSH and thinking you are in the range rather than taking note that you are not feeling well due to being undertreated. You also have very high antibody levels, so that's Hashimotos! No doubt you weren't tested for that by GP.
Have you tried a gluten free diet?
Slow dragon has posted some useful references to quote at the GP if they won't increase your medication. Good luck!
Another thing to mention- the top reference for TSH is far too high. I can’t imagine anyone who has a healthy, fully functioning thyroid would have a TSH as high as 5.6!
Blimey humanbean, my reply to that post was 2 months ago!!!I will just add that I had a TSH added to a blood test for a completely separate issue, way before my thyroid problems- I think it was the Lab who did it, I can’t imagine my GP actually asking for it. I was 69 at the time and my TSH was 0.75 Of course, I didn’t know that until I requested access to my blood tests about 3 years ago.
Considering that Levothyroxine is the third highest prescription in UK (or is it the world) every surgery should have at least one GP/Nurse who knows what they’re talking about, after all, most of them have a diabetic GP/Nurse. Perhaps it’s because it’s men who suffer more with diabetes and women with thyroid dysfunction- or am I being cynical 🤨
Ooh, I hadn't noticed the date. The OP has started a more recent thread and I must have looked up OP's posting history to get to this one without realising what I was doing.
At one point it was 5.62 (range was up to 5.6) and as i was feeling ill i called up and spoke to a locum - they said that they wouldn't increase my levothyroxine as it was only just out of range !! I wish i had known about this forum then !
I used to have similar conversations so I can empathise and sympathise. My TSH would be slightly over range but my Free T4 and Free T3 were both really low in range.
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