Blood test results

[greenfingers]

Can anyone see any problems please with the following results other than the Ferritin which I am aware of but not sure why I have this problem?

I feel as though I my heart is racing, I feel lightheaded and my stomach is bloated about an hour after taking 75 mcg thyroxine. I thought I was going to pass out this morning. My stomach is painful and bloated.

Any advice is welcome.

CRP HS 0.97mg/L ( 0-5)

Ferritin 183 ug/L (13-150)

Folate Serum 10.74 (>3.89)

Vit B12 Active 115.0 (37.5-150)

Vit D 93

TSH 2.06 (0.27-4.2)

Free T3 3.54 (3.1-6.8)

Free Thyroxine 16.8 (12-22)

Thyroglobulin Antibodies 33 (<115)

Thyroid Peroxidase Antibodies 9 (<34)

[SlowDragon Administrator]

How long have you been on just 75mcg levothyroxine

Which brand of levothyroxine is this

Approx how much do you weigh in kilo

Was this test done early morning, ideally just before 9am and last dose levothyroxine 24 hours before test

FT4: 16.8 pmol/l (Range 12 - 22)

Ft4 only 48.00% through range

FT3: 3.54 pmol/l (Range 3.1 - 6.8)

Ft3 really poor at 11.89% through range

Helpful calculator for working out percentage through range

thyroid.dopiaza.org

Shows you are currently under medicated and poor conversion

First step is to get 25mcg dose increase in levothyroxine

Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine

Most people when adequately treated will have Ft3 at least 50% through range

Approx how old are you?

What vitamin supplements are you currently taking

Have you ever had high thyroid antibodies in previous tests

Are you on strictly gluten free diet or dairy free diet

[greenfingers in reply to SlowDragon]

Thanks for replying.In April this year my TSH was 0.13 (0.2-4) done at GP’s this was after I was taking 75mcg alternate with 100. I was told to reduce dose to 75 every day.

June this year it was 0.94 (0.2-4) was told all ok.

Now as you see the TSH has increased by rather a lot. I only take Vit D 400 per day as I can’t tolerate anything higher unfortunately.

I have been taking Wockhardt for a couple of years but was unable to get them this time so am on Mercury Pharma, I believe this is having an impact.

I weigh 57kg, recently had put weight on. The test was done before 9am.

I am 67, not sure about high antibodies previously. Not on any diet.

[SlowDragon Administrator in reply to greenfingers]

Never agree to dose reduction in levothyroxine based just on TSH

Many people when adequately treated will have very low or suppressed TSH

You’re not over treated if Ft3 is not over range

In future, instead get full thyroid testing done yourself privately

Test early Monday or Tuesday morning, ideally just before 9am and last dose levothyroxine 24 hours before test

All four vitamins need testing annually

Vitamin D is good

Do you take any magnesium supplements?

High ferritin can be deceiving

Ferritin increases with inflammation

But iron can be low

Very common for ferritin to increase post menopause

Range for ferritin if male is 15-400.

This is likely more appropriate range for us post menopause

Request GP specify Wockhardt brand on all future prescriptions

Either try 6-8 weeks back on just Wockhardt as first step

Then retest

Or

Try 75mcg and 100mcg alternate days (Wockhardt only)

[greenfingers in reply to SlowDragon]

Do you think the Pharmacy would exchange Mercury Pharma for Wockhardt if they can get any? I really don’t think I can take an increase in current manufacturer.

[greenfingers in reply to greenfingers]

No I don’t take Magnesium.

[SlowDragon Administrator]

Always check the bag before leaving the counter in the pharmacy

Refuse to accept any other brand

If they can’t supply Wockhardt….take prescription to alternative pharmacy

You may need to ring around

Ask GP for new prescription now

3 x 25mcg per day 3 days a week

4 x 25mcg per day 4 days a week

Or cut 4th one in half and take 87.5mcg every day

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).

You might find it beneficial to split your dose levothyroxine as well….taking half daily dose waking and half at bedtime

See this post yesterday

healthunlocked.com/thyroidu...

[greenfingers in reply to SlowDragon]

I wouldn’t have switched only they couldn’t get them he is very good and does ring round to find them. Thanks for your advice. I was concerned about increasing due to racing heart.

[FAB-jellybean]

Hi Greenfingers, you might find that you are sensitive to taking your thyroxine (T4) all in one go. Some people are. You could try splitting the dose, taking in 2 or 3 times a day. Eg, when you get up, just before bed and another dose somewhere around half way in between. You'll probably need to cut your tablets up to do that but it's not an issue as long as you have a wee pill box to keep them in. I personally find splitting my doses beneficial. If you're worried about increasing because of your heart rate you could try taking the same dose every day by cutting a 25mcg tablet in half to give you 87.5mcg a day which is a smaller increase than the full 25mcg on alternative days as SlowDragon suggested.

Your conversion rate doesn't look good either as SlowDragon also said. If increasing your T4 along with ensuring you have optimal vitamins and magnesium doesn't help this, you could ask for a referral to an endo to get a trial of T3. It does need to be split in 2 or 3 doses per day as it's short acting in comparison to T4. I was very much couch bound and also needed anti-depressants until I had T3 added because my conversion rate is also poor. Good luck

[greenfingers in reply to FAB-jellybean]

Thank you for your help. I think I will split the dose, I can at least try. All I want is to feel well.