Help with results please

[Mymble]

Hi - I wondered if anyone could help me interpret my results over the last the 8 months, please. I have an appt with my consultant. This is a haem not an endo. I have a chronic blood cancer and the treatment can trash your thyroid -hence why it’s monitored:

TSH Range(0.3-4.2) T4 range (9-19)

Nov 21 - TSH 10.36, T4 14.7

Feb 22 - TSH 10.73, T4 13.6

Jun 22 - TSH 6.91, T4 12.8

I’m a bit confused about why my TSH has reduced so much. I’m not on any treatment for my thyroid as yet and this was going to be discussed at my appointment. Blood was taken in the afternoon.

Many thanks in advance for any insights.

[greygoose]

Blood was taken in the afternoon

And the other blood draws were in the morning? Depends pretty much on the actual time, but that could be why your TSH has reduced. TSH is highest early morning, and drops through the morning until it's at its lowest around midday. Then, it starts to rise again. So that is why the blood draw should always be around the same time of day for all test, otherwise, you cannot compare them.

But, in any case, you are hypo - you're hypo when your TSH reaches 3. And, on your last test, your FT4 has also gone down. Surely they should have started thyroid hormone replacement in November last year. You must be feeling terrible with such numbers!

[Mymble in reply to greygoose]

Thanks so much for your quick response. Yes -I’m feeling very lethargic slow and sort of lacking in mental acuity!! And I’m gaining weight in a way I just can’t control. I think the reason I’m not being treated is because so far this has been looked at by haematologists (and a different one every time) In February, I made the mistake of asking a question - if my thyroid is still producing in range T4 even though it’s having to work harder to do it ( their description of the situation), why do I need treatment. The answer was ‘good point - let’s leave it for now and review next time’ It’s only after coming to this forum that I realised this was the response of someone who probably knew not much more than me about hypothyroidism! So at my appointment today I was going to suggest starting treatment and was a bit worried that the reduced level of TSH would be an obstacle to this. But, yes, other blood draws were in the morning so I will make that point. Thank you so much.

[greygoose in reply to Mymble]

You're very welcome. Good luck!

[Mymble in reply to greygoose]

Just thought I’d update you following my haem appt. As I feared, the reduction in my TSH together with my ‘in range’ T4 resulted in the view that I am subclinical and probably don’t need treatment. They had also tested my thyroid peroxidase ab levels and these were 257. I don’t have the lab range as I can’t see this result in my portal until tomorrow afternoon but was told that the upper level is 35. The haem did not know what was a level to be concerned about but after I pushed back with symptoms, the information about testing for TSH with blood taken in the morning they did agree to put an enquiry through to the endos. I think this might be the start of a bit of a saga . . .

[greygoose in reply to Mymble]

Oh dear, why do they think asking endos is the right thing to do? Most endos know less than they do!

Didn't you tell them what the high antibody level means? The top of the range is usually around 35, so yours are pretty high, and mean you have Autoimmune Thyroiditis, which means that your TSH, and everything else, is going to fluctuate. But, the dropping TSH does not mean that you're improving on your own. And the opinion of those in the know is that subclinical hypothyroidism should be treated. I think diogenes has posted papers on that subject, so have a look on his profile and see if you can find something useful.

Thank you for bringing me up to date.

[SlowDragon Administrator]

Always test thyroid levels early morning, ideally before 9am

ESSENTIAL to test vitamin D, folate, ferritin and B12 levels too

Being hypothyroid frequently causes low stomach acid, this leads to poor nutrient absorption and low vitamin levels as direct result

Important to maintain GOOD vitamin levels, frequently that means supplementing

What vitamin supplements are you currently taking

Have you had vitamin levels tested?

Standard starter dose levothyroxine is 50mcg (unless over 60 years old,….then starting on 25mcg)

Dose levothyroxine is increased slowly upwards in 25mcg steps over several months. Bloods should be retested 6-8 weeks after each dose increase, aiming for TSH below 2 and Ft4 and Ft3 at least 50-60% through range and all four vitamins optimal

[Mymble in reply to SlowDragon]

Thank you for the information and advice. Just had an appointment with my Haem who thought there was no need to do anything yet as I am ‘sub clinical’ . I did push back a bit so they are going to push a query through to the endos. Also, they tested my Thyroid peroxidase ab and that came out at 257. No idea what the lab range is because I can’t see the result for myself in the portal until tomorrow afternoon but when I asked what the upper range was they said it was 35. Guess I’ll just have to wait and see what happens, but thanks for replying, I really appreciate it.

[SlowDragon Administrator in reply to Mymble]

So high thyroid antibodies confirms autoimmune thyroid disease also called Hashimoto’s

With two thyroid tests with TSH over 5, especially with high thyroid antibodies, you should be prescribed levothyroxine

Starting levothyroxine - flow chart

researchgate.net/figure/Flo...

pathlabs.rlbuht.nhs.uk/tft_...

Guiding Treatment with Thyroxine:

In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months.

The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).

The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range.

……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.

The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.