I have been taking thyroxine for over 20 years( I’m 44 now) and requested blood check with GP as I’ve been feeling cold, lethargic and exhausted. I’ve also had a change in my menstrual cycle and been having my periods every 3 weeks.
TSH 30.1 (0.55-4.78)
Serum Free T4 18.8 (9.5-22.7)
Ferritin 7 (10-291)
GP has started me on ferrous fumurate twice a day and wants to review thyroid bloods in 6months and said no action is required.
Does this sound right? TSH for me has always been 1-2.
I spoke to him and asked for referral/ further checks but he said it wasn’t needed!
I’m looking to book in to see an endocrinologist privately and would be grateful for any advice/ anything I should be Aware of before attending.
I’m new to this forum and would like to thank in advance. I wasn’t even aware before about having blood tests early etc
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Pp1978
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Presumably you do remember to take levothyroxine everyday without fail. Always take levothyroxine on empty stomach and then nothing apart from water for at least an hour after
Iron, vitamin D, magnesium, calcium, HRT or PPI all need to be minimum 4 hours away from levothyroxine
Which brand of levothyroxine are you currently taking
Do you take levothyroxine waking or bedtime
Make an appointment with different GP
Request retesting of thyroid levels including Ft4 and Ft3
Always test thyroid levels early morning, ideally before 9am and last dose levothyroxine 24 hours before test
First thing to check is that first test high TSH was correct
It’s possible to have interference with test
Also request vitamin D, folate, B12 tested at same test
Thank you so much for your reply. I always take thyroxine first thing in the morning with glass of water and minimum 45 mins before eating breakfast. I’ve been taking iron/ vitamins at lunchtime and dinner
I recall TSH being 18 a year ago but then went down when repeated.
The brand I take is mercury pharma?
Thank you for advising me about the Other tests as I will request this when I see the endocrinologist
Suspect you do need dose increase in levothyroxine
Essential to test Ft4 and Ft3
Obviously ferritin is a big problem at moment too
If under medicated then vitamin D, folate and B12 are likely low as well
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
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.
I weigh 52kg and currently on 100mcg. Last year I was taking 100mcg during th week and 125mcg on weekends. I really do appreciate your advice. I’m so fed up of feeling tired all the time and when the GP was dismissive of the results, I felt like it was all in my head.
I have now got a clear idea of what tests I need to ask for.
I think this is what I need to look into more detail. I take the vitabiotics vitamin D and the immunace vitamins. I feel this is where I need to improve and didn’t realise the effect It had on the thyroid.
Too little of what we do need, frequently cheaper poorly absorbed ingredients and most contain iodine not recommended for anyone with autoimmune thyroid disease
I’ve also had a change in my menstrual cycle and been having my periods every 3 weeks.
Ferritin 7 (10-291)
Many years ago (in my teens) I had very heavy periods beginning every 16 days and lasting for about a week. It turned out that I was anaemic. Taking iron supplements (and presumably reducing the severity of my anaemia) had the effect of reducing the blood loss I put up with and increased the time between them.
Unfortunately for me, doctors have always thought that ferritin levels only need to be just in range to be "normal". I have spent most of my adult life feeling as if I am permanently low in iron, and my ferritin has chugged along the bottom of the range. I had to fix my own iron and ferritin levels in the end, by buying my own iron supplements and paying for my own testing.
I am constantly having to change, as the medicines are reformulated. See thyroid reformulation in France. For some people, but not all, the addition of mannitol as an excipient neutralises the drug involved. Eltroxin worked well for me for a long time. Now not.
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