latest thyroid test results

[Regenallotment]

hi there,

I took another blood test to preempt my next request for a dose increase with the GP. According to NICE 1.6mcg/kg I should be titrating up to 115mcg. Currently on 50mcg.

THYROID STIMULATING HORMONE03/08/2022

2.55 mu/LTSH levels normal (normal range 0.27 - 4.2 mU/L) 

THYROXINE03/08/2022

16.7 pmol/LFT4 levels normal (normal range 12 - 22 pmol/L)

TRIODOTHYRONINE03/08/2022

4.3 pmol/LFT3 levels normal (normal range 3.1 - 6.8 pmol/L)

Bloods taken at 9am fasting, last Levo 26 hours earlier.

Thorne B complex stopped 7 days earlier.

Taking 3000iu D3/K2 better you loading dose for 6 more weeks.

Eating liver at least once a week.

Taking L-Glutamine morning and night. (An hour after Levo).

Thorne B complex after breakfast (when not blood testing the following week)

Taking Selenium mid afternoon, Zinc with copper at bed time and topical magnesium .

Have been gluten, dairy, soy free for 6 weeks.

I do feel better than I did, more energy/capacity for normal life, baby hairs growing back in my hairline, done my first solid poos in years, sleeping a bit better (but that isn’t saying much it was dire before) need to wee about 4 times a night, but I’m still 10kg overweight, aches, nightsweats, forgetful, low libido, overthinking, irregular periods, super heavy bleeding (transexamic acid 2 hours after Levo), weaker bladder than usual, tingling fingers, internal vibration feeling. Need naps after busy/ stressful days to get me through the week. Have to plan in rest days, to be able to cope. Oh and permanently sore throat.

So, what is my strategy?

How will I convince my GP that ‘normal’ isn’t ’well’ ?

What info shouldn’t I share with the GP and what should I share?

Am I being naïve to hope for a 115mcg prescription and the option to titrate to 75 then 100 etc myself over 2-3 months?

All and any advice and reassurance would be gratefully received. 🦋💚🦋

Thanks 🙏

[SlowDragon Ambassador]

FT4: 16.7 pmol/l (Range 12 - 22)

Ft4 only 47.00% through range

FT3: 4.3 pmol/l (Range 3.1 - 6.8)

Ft3 only 32.43% through range

Helpful calculator for working out percentage through range

thyroid.dopiaza.org

Request 25mcg dose increase in levothyroxine

Which brand of levothyroxine are you currently taking

Stay on same brand when increasing dose

Retest again in 2-3 Months

If GP is reluctant be ready with guidelines and push for dose increase

TSH should be under 2 as an absolute maximum when on levothyroxine

gponline.com/endocrinology-...

NHS England Liothyronine guidelines July 2019

sps.nhs.uk/wp-content/uploa...

Page 9

Test for Deficiency of any of the following: Vitamin B12, Folate, Vitamin D, Iron

See page 13

1. Where symptoms of hypothyroidism persist despite optimal dosage with levothyroxine. (TSH 0.4-1.5mU/L)

Graph showing median TSH in healthy population is 1-1.5

web.archive.org/web/2004060...

Aim is to bring a TSH under 2.5

UK guidance suggests aiming for a TSH of 0.5–2.5

gp-update.co.uk/SM4/Mutable...

[Regenallotment Ambassador in reply to SlowDragon]

Thanks so much, this is reassuring, yes I just put the % through range in the amazing clever spreadsheet and that really helps show up the detail. OK will ask for 25mcg increase based on this evidence. Much appreciated.

[helvella Administrator]

Many of us never need as much as 1.6 micrograms per kilo! I'd be grossly over-dosed.

You just have to see how it goes. These formulas have the potential to be very misleading. Don't treat them as defining a target.

Yes - I agree your dose of levothyroxine should be increased. And, no, I don't think you stand any chance of getting any sort of open ended prescription. Sadly.

[Regenallotment Ambassador]

Thanks that’s really helpful. h ok so 75-100 might be enough, sounds good. SlowDragon asked about brand, it’s Teva UK Ltd. Thanks for your help.

[SlowDragon Ambassador in reply to Regenallotment]

Why are you taking Teva…..are you lactose intolerant?

Teva upsets many people

Have you ever had different brand levothyroxine?

Many people find Levothyroxine brands are not interchangeable.

Many patients do NOT get on well with Teva brand of Levothyroxine.

Teva contains mannitol as a filler, which seems to be possible cause of problems. Teva is the only brand that makes 75mcg tablet. So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half

But for some people (usually if lactose intolerant, Teva is by far the best option)

Glenmark or Aristo (100mcg only) are lactose free and mannitol free. May be difficult to track down Glenmark, not been available very long

Most easily available (and often most easily tolerated) are Mercury Pharma or Accord

Mercury Pharma make 25mcg, 50mcg and 100mcg tablets

Accord only make 50mcg and 100mcg tablets

Accord is also boxed as Almus via Boots, and Northstar 50mcg and 100mcg via Lloyds ....but Accord doesn’t make 25mcg tablets

beware 25mcg Northstar is Teva

List of different brands available in U.K.

thyroiduk.org/if-you-are-hy...

Posts that mention Teva

healthunlocked.com/search/p...

Teva poll

healthunlocked.com/thyroidu...

Once you find a brand that suits you, best to make sure to only get that one at each prescription.

Watch out for brand change when dose is increased or at repeat prescription.

New guidelines for GP if you find it difficult/impossible to change brands

gov.uk/drug-safety-update/l...

If a patient reports persistent symptoms when switching between different levothyroxine tablet formulations, consider consistently prescribing a specific product known to be well tolerated by the patient. If symptoms or poor control of thyroid function persist (despite adhering to a specific product), consider prescribing levothyroxine in an oral solution formulation.

academic.oup.com/jcem/artic...

Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).

[Regenallotment Ambassador in reply to SlowDragon]

Thanks, I’m taking Teva because that was what I was first given by my chemist, at the time I didn’t know there were alternatives and I have no reason to believe it isn’t suiting me, I don’t source my meds privately just via usual NHS system. Thanks for the info I’ll have a read and bare this in mind. I don’t know if I’m lactose or mannitol intolerant.

[Cornwaller]

Have you had your b12 levels checked. Some of your symptoms are consistent with b12 deficiency. See B12d.org.

[Regenallotment Ambassador in reply to Cornwaller]

Yes thanks I have, they were over halfway through range in June. I’m taking Thorne Basic B as recommended (stopped for test week obvs).

[mistydog in reply to Regenallotment]

Is that a complex because you really need separate high dose B12

[Regenallotment Ambassador in reply to mistydog]

I chose the Thorne Basic B as I was recommended it on this forum after the previous June blood tests with vits. The biotin element is also recommended by Isabella Wentz Hashimoto’s protocol, I’ve found her books helpful too. Why do you ask? Am I missing something or taking something you don’t think I need? My plan was to try all the vits advice for 12 weeks (I’ve been introducing one every 2 weeks as recommended) then re-test and see what that shows. Ideally dropping any or switching to maintenance doses after that.

[SeasideSusie Remembering in reply to mistydog]

mistydog

Why does the OP need a high dose B12 supplement? Her most recent result posted 2 months ago is for Active B12 of 109.

[mistydog in reply to SeasideSusie]

It wasn't clear if it was a multivitamin that is all

[SeasideSusie Remembering in reply to mistydog]

mistydog

You said she needs a separate high dose B12 supplement which she doesn't as she has a decent level of Active B12, and I wondered where you got the idea that she did.

Thorne Basic B is a B Complex not a multi vitamin.

[rosie61]

When I was given Teva it made me feel like my B12 injection hadn't worked. I now have no Teva printed on my prescriptions, which worked well until the new young chemist gave North Star he said it was not Teva and I pointed out that in small print it had Teva written on it, and on the information insert it had Teva right at the end of the second page......... and the tablet packet had it boldly printed on it. He eventually managed to get me some Mercury Pharma 25mcg so hopefully he will remember next time.......................................

[Regenallotment Ambassador in reply to rosie61]

Ah thanks for the tip, if I’ll have to give that a go too. Much appreciated.