Apologies if this has been covered before.
I keep reading or being given conflicting directions as to blood tests.
- Time of day for test
- Taking Levothyroxine prior to test
At my GP’s the nurse (also hypothyroidic) told me it made no difference regarding time of day or taking your meds prior to test
Taking the above into account would a 2pm test and having taken meds before; would this affect the results to show “normal”? Despite no improvement in symptoms of hypo?
Rewg
When we give our suggestion for doing blood tests, this is based on patient experience and our knowledge of how timing of test, timing of last dose of thyroid meds and certain foods/drink can affect results. Doctors, nurses, phlebotomists know nothing of this (they tend to know nothing much about anything to do with thyroid disease). So the suggestions we make are given to give the most accurate measure of your thyroid status and we do suggest not to discuss with phlebotomist, etc, for precisely the reason you have given - they will contradict because they don't know.
Taking the above into account would a 2pm test and having taken meds before; would this affect the results to show “normal”? Despite no improvement in symptoms of hypo?
Yes, results would have been affected.
A 2pm test will give just about the lowest TSH of the day - see first graph here (scroll down):
thyroidpatients.ca/2020/07/...
Highest TSH is between midnight and about 4am, lowest TSH is about 12.30-3pm.
The highest TSH when it's possible to get a blood draw at the GP surgery is 9am. We say to aim for the highest possible TSH if you want to avoid a reduction in Levo or when looking for an increase in dose as most doctors tend to adjust dose by TSH only.
Taking your Levo before the test will give a false high FT4 result, Levo peaks in the blood 2-4 hours after ingestion then starts a gradual decline, so it depends on when last dose was taken.
Thank you for your response. I’m only at the start of being treated for hypothyroidism and diagnosed with Hashimotos shortly afterwards so learning the ropes as it were. Fortunately there is a forum to help with it. After my initial and further dealings with the gp I don’t feel that the information or knowledge they have available has been helpful.
Very few of GPs know very much about symptoms the patients may have.
We are supposed to be diagnosed when TSH reaches 10 (TSH = thyroid stimulating hormone). For me, my GP couldn't even understand when my TSH was 100 and phoned to tell me me I had no problems. I cried as I felt so very, unwell. I had also never heard the word 'hypothyroidism' either.
So after a 2pm blood test; my results are normal. Yet I am still showing the symptoms I had prior to starting TEVA 50mg levothyroxine. Extreme fatigue, feeling cold all the time, confusion, joint aches, numb hands and weight gain.
Response from GP; “your bloods have shown improvement from the 50mg Levi and a retest isn’t required for another 8 weeks. We can consult with an endocrinologist if you wish”…
Totally flummoxed by the attitude and complacency. I now feel that there is a distinct lack of competency regarding my doctors practice regarding treatment of hypothyroidism.
Confused as!
hi Rewg , Find out HOW 'normal' they really are for yourself .
You don't just want 'normal' (which is a massive range) ..
Thyroid levels are individual , like shoe sizes...... size 9 shoe is 'normal' for a blokes shoe size ,, but is bugger all use if you are a size 10 and a half ,, which is also 'normal'
...... you want 'optimal' , or else you won't have much chance of feeling better.
Ask GP's reception for a printout of those latest thyroid blood test results. ( not the comment / opinion of 'normal' ) you need to ask for TSH (Thyroid Stimulating Hormone) result and [lab range]
and (if done) fT4 (Free T4 / thyroxine) result and [lab range]
they will look like this eg . TSH 3.4 [0.4-4.5]
fT4 13.6 [12-22]
fT3 ~ very unlikely to have been done , but worth asking just in case they did.
you have a legal right to have them in UK, as long as GP has already seen them first .
They shouldn't be asking why you want them , but if they do ' for my own records' will suffice.
Yes , unfortunately the education that all GP's received on the subject of thyroid hormone treatment is extremely 'brief' ,... and not very realistic...... or accurate... or up to date .
What most of them know about how to treat hypothyroidism , can be written on the back of a postage stamp. ~ Levothyroxine / TSH in-range/ Job Done ~
Hate to tell you this , but actually that response from your GP is 'well above average'.
A retest after another 8 weeks on this dose is more than many would offer if TSH is now ' in range' .. and does show some understanding that results may take a long while to change , and may not match symptoms.... many people have been told to come back in 6 months or a year at this point.
and the offer to refer to Endo at this early stage shows more interest than most of us got .
How many weeks have you been taking 50mcg now ?
Depending on what your actual blood test results are, it may be correct to wait another couple of moths on this dose , or it may already be evident that you need more .
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p.s it is too soon for you to be able to tell if the following affects you yet, but bear it in mind, and keep a note of which brand you are given at each prescription, and how you feel on that make.( and remember , it may be about 10 days before you can tell if there is any difference in how you feel on a different brand ) :
Teva brand of Levo is a bit ' marmite ' ~ some of us have found we really do not like how this brand makes us feel (lousy ) , and now ask our chemist to put a note on computer for Teva to be avoided when filling our prescriptions .... but for a few patients , Teva is the one that make them feel best ( or they have it because it is lactose free )
Many GP's/ Chemists will raise an eyebrow or openly scoff if you suggest you can feel any difference between brands of Levo , but a recent MHRA safety update for pharmacists/ GP's does advise them that for patients who have difficulty when switching between makes ,or who have a problem on one make , to consider prescribing the specific make that is well tolerated by that patient.
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I’m at the start of my ninth week on 50mg Levo (TEXA).
I’m kind of getting the feeling a lot of gp’s see the results as what is within the British Standard Human categorisation.
yep ,, i don't think "thinking " is encouraged in the limited time allowed for the appointment nowadays .. they are just supposed to be able to see if a result is in range or not, and if it is ... move on to to the next patient.
T3 test and treatment 
6-8 weeks blood test after starting levo 
Latest test results following T3 treatment. Confused!
Thyroid blood test
Blood test question
