Advice on latest readings...

[Mrs_Tumnus]

Serum free T4 level

10.0 pmol/L 7.0 - 17.0

Serum TSH level

4.81 mu/L 0.20 - 4.50

The above readings are my latest blood results. I have had hypothyroid symptoms for quite some time, but this is the first time my TSH levels have been flagged as abnormal. TSH readings have gradually been increasing over the last few years. I was started on 25mcg thyroxin two months ago but I don't feel any different. My mum has hypothyroidism.

Any advice?

Best wishes

[PurpleNails Administrator]

TSH & FT4 isn’t adequate test.

You also need FT3. Thyroid antibodies TPO & TGab plus folate, ferritin, B12 & vitamin D.

Levo wont work well is nutrients are low it doesn’t convert in body to FT3.

As your TSH still high is levo being increased? 25mcg per day increase retest after 6 weeks of unchanged dose. Including staying with sane brand.

Why were you started in less than standard starter dose?

Levo only initially top up failing thyroid, very soon it simply replaces levels any you require a increase. You won’t feel a continuous benefit until you are nearer the right replacement dose.

Most feel well when TSH around 1 but more importantly when FT4 is in top 3rd of range & FT3 at least half way.

[Mrs_Tumnus in reply to PurpleNails]

Thank you for your response.

I do have pernicious anaemia and for that I have B12 injections every 3 months. I haven't had the other things tested.

The GP stated that my TSH has to be over 4.5 on two tests 3 months apart for them to increase the dose. I am due another BT in the coming weeks to see what the levels are now.

[mistydog in reply to Mrs_Tumnus]

Sounds like you are unlucky enough to have an in ill informed GP. If you search this site you will find the NHS protocol for increasing levo.

[PurpleNails Administrator in reply to Mrs_Tumnus]

To commence Levo you would expect two TSH results above range. Or below range FT4 (or FT3 if they tested it). or an abnormal reading with antibodies, as antibodies confirms its virtually inevitable levels will decline.

Once on levo the aim should be to have TSH in lower part of range as then FT4 should be in higher part of range or until you feel better within range.

This doctor will keep you unwell, can you see another doctor?

[SlowDragon Administrator]

See/contact GP for next 25mcg dose increase in levothyroxine to 50mcg

Approx how old are you?

Standard STARTER dose of levothyroxine is 50mcg

Bloods should be retested 6-8 weeks after each dose increase

Likely to need further increase in levothyroxine after next test

ESSENTIAL to test vitamin D, folate, ferritin and B12

Have you had these tested

What vitamin supplements are you currently taking

Presumably you have autoimmune thyroid disease, also called Hashimoto’s. Usually diagnosed by high thyroid antibodies

Have you had thyroid antibodies tested?

Autoimmune thyroid disease often runs in families

pathlabs.rlbuht.nhs.uk/tft_...

Guiding Treatment with Thyroxine:

In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months.

The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).

The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range.

……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.

The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.

When adequately treated Ft4 will be at least 60-70% through range

Currently

FT4: 10 pmol/l (Range 7 - 17)

Ft4 is only 30.00% through range

ALWAYS test thyroid levels early morning, ideally just before 9am and last dose levothyroxine 24 hours before test

Which brand of levothyroxine are you currently taking

[klr31]

You possibly need an increase.

[Bearo]

Your doctor is confused. The three months apart thing is only for diagnosis. Once you start Levothyroxine the regime changes to testing every eight weeks or so until your TSH is 1 or below, and FT4 is in a good place. (We’d like FT3 tested but they don’t often request that)

Could you ask the GP to check the dosing guidelines below? If you don’t want to appear to be a know-all you could say you have two friends who are hypothyroid and they both followed that testing regime after diagnosis.

[Mrs_Tumnus]

Hi,

Thank you for the responses.

I have taken levothyroxine 25 for three months and had more blood taken today -

Serum TSH level

4.90 mu/L

0.20 - 4.50

Serum free T4 level

13.6 pmol/L

7.0 - 17.0

The GP has increased my dose to 50 and will retest in 8 weeks. Although the TSH has increased slightly, the T4 has also increased. I am guessing this is a good sign?