hello, a little advice please , these are my tsh and t4 levels. I also have slightly low iron and slightly high cholestoral. My gp has decided to treat me for underactive thyroid with 25 levothyroxine. Im a bit puzzled by this as the numbers dont look too bad , was anyone else treated similarly. Thank you
! Serum free T4 level
10.5 pmol/L range 11.00 - 21.20pmol/L
Serum TSH level 2.55mIU/L 0.27 - 4.20mIU/L
As your FT4 is below range it means you do need treatment. There is a more powerful thyroid hormone in your body FT3 it might be these levels are currently ok to compensate for low FT4. This might be why don’t have troublesome symptoms but the body can’t maintain that for long.
Was FT3 tested? Was TPO & TG antibodies tested as this will show if you have an autoimmune affecting your thyroid.
25mcg is lower than normal starting dose, are you over 60 or do you have heart issues?
You need to be retested 6-8 weeks of taking unchanged dose. It’s likely you need to increase dose.
High cholesterol will improve once adequately medicated.
Low nutrients common with hypothyroidism. Ferritin, folate vitamin D and B12 all need to be tested and be optimal for levo to work well. In range is not same as optimal.
Add results & ranges if these have been tested.
thank you for your answer, it was very imformative . I am 53 with no heart issues, These are the only tests that were done Values and Investigations (Latest Value)
! Full blood count - (CRS4002) - abnormal,for routine tel appt.
Total white cell count 7.3 X10^9/L 3.90 - 11.10X10^9/L
Red blood cell (RBC) count 4.62 x10^12/L 3.88 - 4.99x10^12/L
Haemoglobin estimation 124 g/L 118.00 - 148.00g/L
Haematocrit 38.8 % 36.00 - 46.00%
Mean corpuscular volume (MCV) 84 fL 82.00 - 98.00fL
! Mean corpusc. haemoglobin(MCH) 26.8 pg 27.30 - 32.60pg
! Thyroid function test - (CRS4002) - borderline,repeat 3 months.
! Serum free T4 level 10.5 pmol/L 11.00 - 21.20pmol/L
Serum TSH level 2.55 mIU/L 0.27 - 4.20mIU/L
! Serum lipids - (CRS4002) - CHOLESTEROL level does NOT give raised risk of Heart disease- starting a Statin not indicated
! Serum cholesterol 5.7 mmol/L 1.00 - 5.00mmol/L
Serum triglycerides 1.7 mmol/L 0.50 - 2.00mmol/L
Serum HDL cholesterol level 1.6 mmol/L
Reference Range: >1
! Serum LDL cholesterol level 3.3 mmol/L 1.00 - 3.00mmol/L
Total cholesterol:HDL ratio 3.56 ratio
Non HDL cholesterol level 4.1 mmol/L
Theres no ferritin (iron stores) or iron panel results. How does dr know your iron is low?
No FT3, antibodies or folate, B12 vitamin D.
Testing policy for FT3 & Vitamin D can be very restricted in NHS. Many of us arrange private testing to ensure full testing is done. It can be completed by finger prick sample and posted.
Here’s a list of companies with discount codes.
thyroiduk.org/help-and-supp...
Don’t think of levo as a drug - it’s a replacement hormone which your thyroid can’t procedure enough of and you need replacement.
It’s not unusual for the thyroid to decline very slowly, it might be that you just adapted to the symptoms you describe as they developed slowly. If those symptoms occurred over night you might not feel they are tolerable.
good point, no iron shown but gp said it to me on the phone , i will look into getting more tests privately. thank you
Hi busybusybee,
It sounds like you may have a GP that is knowledgeable about thyroid problems. Which is obviously a really good but a rare thing!
Many on this forum struggle to get help (myself included) so it does appear that your doctor is taking things seriously but slowly.
What are you symptoms and how do you feel?
hi yes, my gp is good , i have quite bad hair thinning, difficulty in losing weight, aches and pains, cold feet. All annoying but tolerable. I just dont feel that my test results were severe enough to need any treatment. I thought it was too soon to start levo
Hi busybusybee,
All the symptoms you describe can be attributed to an underactive thyroid so your GP is looking at treating your symptoms which is good.
Other more knowledgeable members of the forum will give you good advice.
I just dont feel that my test results were severe enough to need any treatment.
Excuse me for saying so, but that is because you don't understand how to interpret them.
Serum free T4 10.5 (11.00 - 21.20)
Serum TSH 2.55 (0.27 - 4.20)
A 'normal' (euthyroid) FT4 would be around mid-range. Yours is below range, so you can see it's not just a bit low, it's very low.
T4 is basically a storage hormone that needs to be converted to T3 before it does much. FT3 is the most important number, but it is rarely tested (?!). But in your case, it's not necessary to test it because it's obviously going to be low if the T4 is low.
A euthyroid TSH would be around 1, never over 2, and you are technically hypo when it gets to 3.
TSH - Thyroid Stimulating Hormone - is a pituitary hormone. It is produced when the pituitary senses that there is not enough thyroid hormone in the blood. The lower the thyroid hormone levels, the higher the TSH.
So, what we're seeing here is a TSH that does not adequately correspond to a low FT4 - it should be much higher than that with such a low FT4. So, that suggests that the problem is with the pituitary rather than the thyroid itself.
Further investigations should be carried out into pituitary function, because if one of its hormones is too low, others could be too, and that could affect other parts of the body. (Please excuse me, I'm talking to you as if you are a complete newby and know nothing about any of it. But there's no way I can know how much you know. 
)
There is nothing that can be done for a mal-functioning pituitary. All you can do is replace the hormones that are being affected. We cannot supplement TSH, so we have to supplement the low thyroid hormone, T4.
You cannot live without thyroid hormone, because it is needed by every single cell in your body. So, well-done to your doctor for spotting this problem, and possibly nipping it in the bud. I just hope he carries on and refers you to an endocrinologist for further testing.
Thank you, you are right i dont know anything about all this so thank you for the explanation. I am a bit worried that i might have a problem with the pituitary gland as i have not been refered to a specialist just put on 25 levo . I think i will have to contact the gp about this
Yes, I don't suppose your GP knows much about Central Hypo - i.e. when the problem is not with the thyroid, but the pituitary or the hypothalamus. So, you would have to put it to him gentley. Ask if he thinks it's a possibility, or something like that. We don't really know the extent of his knowledge, do we. But, it's possible that he doesn't really know the implications of having Central Hypo.
Bloods should be retested 6-8 weeks after each dose increase (or brand change in levothyroxine)
Always test thyroid levels early morning, ideally before 9am and last dose levothyroxine 24 hours before test
Which brand of levothyroxine have you started on
Many people find different brands are not interchangeable
Levothyroxine is an extremely fussy hormone and should always be taken on an empty stomach and then nothing apart from water for at least an hour after
Many people take Levothyroxine soon after waking, but it may be more convenient and perhaps more effective taken at bedtime
verywellhealth.com/best-tim...
No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.
Some like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away
(Time gap doesn't apply to Vitamin D mouth spray)
If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test
If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal
Standard starter dose of levothyroxine is 50mcg so starting on too small a dose can make you feel worse initially
You need vitamin D, B12, ferritin and thyroid antibodies tested at next test
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