New thyroid results

[Jump1]

So I did another test private I reduced my dose back down to 50mg. My new results 5 weeks later are as follows

TSH is now 2.47

T3 4.08 range 3.1-6.8

T4 16.4 range 12-22

Considering the Dr was only giving me a trial and said If results only improve and symptoms don't she isn't going to continue the trial.

Do you think Dr would increase my dose if I said I'm starting to feel constipated and cold at times and a bit tired in evening.

Or will she say what everyone says which is your results are normal.

[humanbean]

You might find this link of interest :

healthunlocked.com/thyroidu...

Note that the peak of the TSH graph is at 1.25, which is substantially lower than yours, suggesting that you are under-dosed.

The values in the table below the graph come from Table 3 in this paper :

eje.bioscientifica.com/down...

.

For comparing results from different tests with different reference ranges it is useful to check the "percentage through the range" for your Free T4 and Free T3 results.

Your Free T3 is 26.5% of the way through the range.

Your Free T4 is 44% of the way through the range.

Most people who feel well on Levo only have their Free T4 and Free T3 roughly the same percentage through the range (or within no more than 10% of each other). Your Free T3 percentage is much lower than your Free T4 percentage, so your conversion from T4 to T3 is not great.

Not only that, but people who feel well on Levo usually have a percentage through the range of about 60% - 80%, although those levels are flexible depending on how you feel. Yours is only 44%.

Free T3 would usually be 50% - 70% of the way through the range in people who feel well, but again these are flexible. Yours is only 26.5%.

Be aware that the info on percentages is something patients have come up with themselves, and doctors pay no attention to it. But it is interesting and useful to us.

[Jump1 in reply to humanbean]

Thanks for the percentage information it's useful I never really understand that. I know the Dr will say results are fine. Sure you don't even get past the receptionist with those test results. Anyway I did them private so have to do the official Dr ones. But how do I get the Dr to agree to increase my dose. I supplemented myself because I cudnt be bothered with the fight to get it increased and everyone said don't do that. So I need to know how I'm gonna get them to increase my dosage when statistically I'm within their range and she's said I'm only on a trial. My tsh was just over 5 when she agreed because I threatened to self medicate and was only because my thyroid antibodies were high too.

My white blood cells neutrophils have gone low again and overall total cholesterol is high but my good cholesterol counters it by all accounts so they say it's misleading but it has crept up a bit

[humanbean in reply to Jump1]

See this link from the NICE Clinical Knowledge Summaries :

cks.nice.org.uk/topics/hypo...

Initiation and titration

The dose of levothyroxine (LT4) should be individualized on the basis of clinical response and thyroid function test (TFT) results. Treatment must be monitored regularly to determine an adequate dose and to avoid both under- and over-treatment.

The NICE clinical guideline recommends:

Consider starting LT4 at a dosage of 1.6 micrograms per kilogram of bodyweight per day (rounded to the nearest 25 micrograms) for adults under 65 years of age with primary hypothyroidism and no history of cardiovascular disease.

Consider starting LT4 at a dosage of 25–50 micrograms per day with titration for adults aged 65 years and over, and adults with a history of cardiovascular disease.

The British National Formulary (BNF) recommends:

For adults aged 18–49 years — initially 50–100 micrograms once daily; adjusted in steps of 25–50 micrograms every 3–4 weeks, adjusted according to response; maintenance 100–200 micrograms once daily.

For adults aged 50 years and over, with cardiovascular disease, or severe hypothyroidism — initially 25 micrograms once daily; adjusted in steps of 25 micrograms every 4 weeks, adjusted according to response; maintenance 50–200 micrograms once daily.

Advise the person to take LT4 medication on an empty stomach in the morning before other food or medication.

I know there are other links that suggest TSH should be under 2?

SeasideSusie will probably have the links somewhere.

[SeasideSusie Remembering in reply to Jump1]

From GP online

gponline.com/endocrinology-...

Under the section

Cardiovascular changes in hypothyroidism

Replacement therapy with levothyroxine should be initiated in all patients to achieve a TSH level of 0.5-2.0pmol/L.

Also, Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine (the professional publication for doctors):

"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l. In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance. But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l. This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l).*"

*He confirmed, during a talk he gave to The Thyroid Trust in November 2018 that this applies to Free T3 as well as Total T3 and this is when on Levo only. You can hear this at 1 hour 19 mins to 1 hour 21 minutes in this video of that talk youtu.be/HYhYAVyKzhw(Not working as expected?)

You can obtain a copy of the article which contains this quote from ThyroidUK:

[e-mail]

The relevant information is in answer to Question 6.