Hi everyone, I am currently on 75mcg Levothyroxine. Was reduced over two years ago. However, over past 7 months feel bloated, very tired so my doctor ran blood tests. All came back satisfactory.
Cholesterol 5.9 mmol/L They never test for T3 I feel that something needs to be tweaked for sure. I would like to have complete bloods done privately and would really appreciate any advice as to best tests. I noted that you can either do pin prick tests or have it done at a private clinic. I live near Jesmond in UK and note there is a clinic there. Just want a thorough check and then can go back to my own GP. Many thanks Carlene UK.
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Presumably your surgery said that. They're not actually. I assume they're all within range and that's why they said they were satisfactory, but we always need reference ranges with results as these vary from lab to lab.
Even without ranges it's possible to say:
Serum TSH Level 2.7 mIU/L
Too high for someone on thyroid hormone replacement. The aim of a treated hypo patient on Levo only, generally, is for TSH to be 1 or below with FT4 and FT3 in the upper part of their reference ranges, if that is where you feel well.
Testing just TSH is inadequate, it's not a thyroid hormone, it's a pituitary hormone. FT4 and FT3 are the thyroid hormones and it's only these than can tell us our thyroid status. TSH is useful for diagnosis but once on thyroid hormone replacement it's not much use other than to tell us it's too high.
This result shows that you need an increase in your dose and you should ask your GP for 25mcg extra (compromise on 12.5mcg if he's reluctant) and use the following information to support you:
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.
B12 220 ng/L - ng/L is the same as pg/ml below
According to an extract from the book, "Could it be B12?" by Sally M. Pacholok:
"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".
"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."
There have been many people with a level in the 300s who have been found to need B12 injections.
Do you have any signs of B12 deficiency – check here:
If you do then list them to discuss with your GP and ask for testing for B12 deficiency and Pernicious Anaemia. Do not take any B12 supplements or folic acid/folate/B Complex supplements before further testing of B12 as this will mask signs of B12 deficiency and skew results and if you have B12 deficiency is not detected and treated then this could affect your nervous system. B12 deficiency should be treated before starting folic acid because folic acid can sometimes improve your symptoms so much that is masks B12 deficiency.
If you don't have any symptoms you could self supplement, so come back and let us know either way.
Serum Folate 14.7 ug/L
Probably OK but need the range.
Haemoglobin A1c Level 40 mmol/mol
Looks like not far off pre diabetes which I think might be 42?
Mean Cell Haemoglobin level 32.3 pg
Can't comment without range.
EGFR (CKD-EPI) 85 ml/min/1.73m*2
No idea, sorry.
Serum Cholesterol 5.9 mmol/L
Need range, but if this is high then high cholesterol is a symptom of hypothyroidism so with undermedication it could well be high.
I would like to have complete bloods done privately and would really appreciate any advice as to best tests. I noted that you can either do pin prick tests or have it done at a private clinic.
The two most popular are the full thyroid/vitamin panels below, either will be fine. Whether you choose fingerprick of venous blood draw is up to you, many of us find fingerprick tests easy enough, some can't manage them:
Both tests include the full thyroid and vitamin panel. They are basically the same test with just a few small differences:
Blue Horizon includes Total T4 (can be useful but not essential). Medichecks doesn't include this test.
B12 - Blue Horizon does Total B12 which measures bound and unbound (active) B12 but doesn't give a separate result for each. Medichecks does Active B12.
Total B12 shows the total B12 in the blood. Active B12 shows what's available to be taken up by the cells and is said to be the better test. You can have a reasonable level of Total B12 but a poor level of Active B12
Blue Horizon include magnesium but this is an unreliable test so don't let this sway your decision, it also tests cortisol but that's a random cortisol test and to make any sense of it you'd need to do it fasting before 9am I believe.
If you decide on the fingerprick test bear in mind there are 2 or 3 postal strikes coming up within the next couple of weeks. Also a fingerprick test should only be done on a Monday or Tuesday and posted the same day to arrive next day - the only way to guarantee this is with Royal Mail's Special Delivery Guaranteed Next Day by 1pm (you have to pay extra for this at the post office counter and get a receipt with tracking number). The Tracked 24 return envelope provided with the test kit doesn't guarantee next day delivery. Posting later than Tuesday without Special Delivery may mean blood sample hanging around and spoiling if there are any delays in delivery.
If you decide on a fingerprick test I have some tips on how best to do it if you'd like me to post them, just ask.
Hi thank you soo much for responding I will go for private and have bloods done at a clinic. I know for sure something isn't right. Really appreciate your advice. Carlenex
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