Hi Im not at all good with searching on this forum for my previous post so writing it here as I got my latest blood results for my Endocrine appointment on Friday. My previous results in February were TSH 3.13 (0.47-4.2)Free T3 2.9 (3.1-6.8)
T4 130 (59-154)
I saw the Endocrinologist for my first appointment in May who increased my dose of Thyroxine from 75mcgs to 100mcgs. for 2 months.
These are my results from last week
TSH 3.9 (0.27-4.2)
T3 3.2 (3.1-6.8)
T4 18 (11.0-22)
I have no idea why my TSH has increased
Any advice prior to my appointment very welcome. Thank you in advance.
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Otto11
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I've added a screenshot of this below.
February results:
TSH 3.13 (0.47-4.2)
Free T3 2.9 (3.1-6.8)
T4 130 (59-154) - this looks like Total T4 which is of little use, it's Free T4 that is important
New results after increase in dose:
TSH 3.9 (0.27-4.2)
T3 3.2 (3.1-6.8)
T4 18 (11.0-22)
I have no idea why my TSH has increased
There are a few things which can affect results.
TSH level varies throughout the day, it's highest early morning and lowers throughout the day. To compare results accurately we should always test under the same conditions.
Your new TSH result could have been affected by blood test being done earlier than the previous one, certain foods and drinks can affect TSH, supplementing with biotin in B Complex or any other supplement can affect any blood test results.
Your FT4 of 18 (11-22) is 63.64% through range, unfortunately you don't have an FT4 result from your previous test so we don't know if this has improved or not.
Your FT3 has improved very slightly from minus 5.4% to 2.7% through range which is extremely poor. Low T3 causes symptoms.
The aim of a treated hypo patient on Levo only, generally, is for TSH to be l1 or below with FT4 and FT3 in the upper part of their reference ranges. Your results show that you need an increase in your dose of Levo, 25mcg now and retest in 6-8 weeks to check your levels.
If your doctor is reluctant to increase your dose because your TSH is "in range" then use the following information to support your need for an increase:
Fine tuning of the dose could be necessary in some patients
* aim of levothyroxine treatment is to make the patient feel better, and the dose should be adjusted to maintain the level of thyroid stimulating hormone within the lower half of the reference range, around 0.4 to 2.5 mU/l. If the patient feels perfectly well with a level in the upper half of the reference range, then adjustment is unnecessary
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
You can obtain a copy of the article which contains this quote from ThyroidUK
Email : tukadmin@thyroiduk.org
and ask for the Dr Toft article from Pulse magazine. Print it and highlight Question 6 to show your GP.
Also, it's important for nutrient levels to be optimal for thyroid hormone to work properly so if not already done ask for the following to be tested:
Vit D
B12
Folate
Ferritin
Always advised here, when having thyroid tests:
* Book the first appointment of the morning, or with private tests at home no later than 9am. This is because TSH is highest early morning and lowers throughout the day.
In fact, 9am is the perfect time, see first graph here, it shows TSH is highest around midnight - 4am (when we can't get a blood draw), then lowers, next high is at 9am then lowers before it starts it's climb again about 9pm:
If we are looking for a diagnosis of hypothyroidism, or looking for an increase in dose or to avoid a reduction then we need TSH to be as high as possible.
* Nothing to eat or drink except water before the test - have your evening meal/supper as normal the night before but delay breakfast on the day of the test and drink water only until after the blood draw. Certain foods may lower TSH, caffeine containing drinks affect TSH.
* If taking thyroid hormone replacement, last dose of Levo should be 24 hours before blood draw, if taking NDT or T3 then last dose should be 8-12 hours before blood draw. Adjust timing the day before if necessary. This avoids measuring hormone levels at their peak after ingestion of hormone replacement. Take your thyroid meds after the blood draw. Taking your dose too close to the blood draw will give false high results, leaving any longer gap will give false low results.
* If you take Biotin or a B Complex containing Biotin (B7), leave this off for 7 days before any blood test. This is because if Biotin is used in the testing procedure it can give false results (most labs use biotin). See
biotin use can result in falsely high levels of T4 and T3 and falsely low levels of TSH
These are patient to patient tips which we don't discuss with phlebotomists or doctors.
Also, take your Levo on an empty stomach, one hour before or two hours after food, with a glass of water only, no tea, coffee, milk, etc, and water only for an hour either side, as absorption will be affected. Take any other medication and supplements 2 hours away from Levo, some need 4 hours.
Hi Thanks for your reply. Both my recent tests were done at 9am both on an empty stomach omitting Thyroxine the previous night. the Endocrinologist said to take it at night instead of my usual mornings.. I havn't taken any supplements at all as I was waiting the 8 weeks for blood test so didn't want to affect that. I've been taking 75mcg for many years & the recent increase 8 weeks ago was to 100mcgs. In 25 years my dose has never been higher than this. I'm just wondering what the Endocrinologist may say tomorrow & why my TSH has increased. My recent bloods show Vit D93 , folate 11, Ferritin 87 & B12 804 (this is higher due to a B12 injection after 2 years of lockdown. My Ferritin has dropped from 115 to 87 but otherwise much the same as previous test.
My Free Thyroxine was 19.7 in February (12-22) Im presuming this is the same as Free T4 but not sure.
My Free Thyroxine was 19.7 in February (12-22) Im presuming this is the same as Free T4 but not sure.
Yes, that's right, they are the same.
I'm just wondering what the Endocrinologist may say tomorrow & why my TSH has increased.
None of these results are ever static. You could test now and test 5 minutes later and they wouldn't be the same. Also, there will always be a difference between results from different labs on different equipment.
Ideally your endo will look at your results and say the TSH is too high and increase your dose of Levo. If you don't feel optimally medicated or are symptomatic you should tell him and suggest an increase anyway. If he says your TSH is in range so no need then you emphasise your symptoms and the information about where TSH should be that I have given you above.
Thank you very much. My Endocrinologist increased my dose of Thyroxine to 125mcs for 8 weeks then retest. I said in 25 years of being on replacement therapy I’ve never had this higher dose. His response was well you’ve never been 67 & a half before! He makes me laugh. So you were correct. So second increase & 🤞I feel some improvement. That would be wonderful. X
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