After showing GP blood results from Blue Horizon , which clearly show undermedicated we discussed increase to 150mcg. She said she agreed but wanted NHS bloods done, she agreed if that still showed undermedicated she would then happily increase. Bloods done Monday morning, results back think Tuesday, TSH 5.3mu/L freeT4 19.8pmol/L. Couldn't get appointment, not even to talk on phone. Left message with surgery to ask she increases asap , took last of Thyroxine this am, didn't want to reorder on app as it would be wasteful when waiting for increase, explained this to them. Contacted them this am, they assured me message had been passed on and they would chase it. got call from this pm to tell me GP had done px and it was waiting for me in pharmacy.
Got there through rush hour traffic to be told no, it's still 125mcg. Told them to keep it and came home.
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Polo22
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With a FT4 near the top of the range and TSH above range, did the Dr not query this? T4 feeds back to TSH, so why isn't TSH responding by shutting down a little?
I think there's something wrong with TSH, but need the FT3 result to triangulate.
TSH 5.3 mU/L 0.27 - 4.20 Free T4 19.8 pmol/L 12.0 - 22.0 test done shortly after 9 am, last dose was about 8 am Sunday . had not ate before tests just water, Accord 100mcg, previously Actavis,,, Actavis always worked best for me. 25 mcg often different brands I know you told me Actavis doesn't come in 25 mcg. The woman in chemist was lovely, came over with a handful of different brands they had the Accord 100mcg and various brands in 25 mcg I told her I couldn't remember which was the one I had had last but that Actavis/Accord doesn't do 25mcg. I know you responded to a previous post of mine with all the info re brands but can't find it. Still waiting on T3 IFA and vit D results PTH 5.5 pmol/L 1.6 - 6.9 waiting on Vit D,
Looks like you could be a poor converter to T3. Your T4 is high in the range, not over, and your TSH is high and over range. This generally indicates you’re a poor converter. Did horizon tests do your T3 also. Was your T3 low? If so this is why you’ll be struggling.
Blue Horizon results from 10th May TSH 8.91 0.27 - 4.20 mU/L. T4 total 106.0 86 - 181 nmol/L. Free T4 17.2 12 - 22 pmol/L Free T3 3.11 3.1 - 6.8 pmol/L . Have a telephone consultation with practice at 10 am, don't know which Dr, was offered face to face but couldn't trust myself to not lose it completely. Last couple of weeks on top of everything else have been getting really agitated and angry but more than angry. Sheer unadulterated rage
Thanks , they haven't rang yet. They are probably drawing straws. It's my own fault I assumed they knew what they were doing. AAArrgghh just had the call, explained everything, she is refusing to increase. I again pointed out the results from both Blue Horizon and NHS indicate a problem, under medicated and maybe needing combination treatment. Her response was we have been advised by thyroid expert/specialist and proceeded to read out the as SlowDragon says generic comment , I said it was a standard response and reinforced I was still experiencing symptoms and insisted numbers proved action was needed. She is consulting with colleagues and will ring back. Is it too early for Gin
Guidelines on dose levothyroxine by weight is approx 1.6mcg levothyroxine per kilo per day
Can be useful for arguing for dose increase
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.
Thank You for all these links/info will read later. GP rang they have decided I can have the increase, 🤦♀️ I didn't rub her nose in it, need to pick which fights are worth energy and no point in burning bridges yet, but not going to let them walk all over me. You have all been a godsend
I do think you could benefit from adding Liothyronine T3. But you’ll probably need to go private only for that to happen any time soon. NHS will take forever. I went private only to secure my T3 and road to much better health and well-being.
You should have taken the script and argued with the doctor later on she could have given you another prescription. I will never understand why doctors won’t accept lab results from accredited labs for thyroid just seems stupid to me.
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