First blood test results after starting Levothyroxine

[Nineby]

Well, I got my first test results back today and a text from my doctor saying that my TSH levels were down from 12.6 to 5.45 (yay) and that I can either stay on the 50mg I'm currently on or she will increase the dosage slightly if I still feel fatigued.

My T4 has also increased from 9.6 but the dr didn't mention that.

I'm pretty sure from reading the very helpful advice on here that I really do need it to be increased to get into that 'normal' range so will be asking for an increase. I think if it was not for this group I would be feeling very unsure about what to do right now!

(I do still feel tired but I don't think it is as bad as before I started treatment)

[SlowDragon Administrator]

Yes you need next 25mcg dose increase in levothyroxine

Which brand of levothyroxine are you currently taking

Best to not change brand when changing dose

Only change one thing at a time

Bloods should be retested again in another 6-8 weeks

ALWAYS book early morning test, ideally around 9am and last dose levothyroxine 24 hours before test

Previous post vitamin results

B12 was 395 ng/L (normal range 180 - 900)

Ferritin was 29.2 microg/L (normal range 10 - 200)

Folate 7.2 microg/L (normal range 3.0 - 20.0). 

It looks like Vit D was not tested.

Have you had thyroid antibodies tested yet

Or vitamin D

NHS easy postal kit vitamin D test £29 via

vitamindtest.org.uk

B12 and folate are too low

what vitamin supplements are you currently taking

Ferritin is deficient

Request GP do full iron panel test if not been tested yet

[Nineby in reply to SlowDragon]

Thanks the the replies and the link to the Vit D test, I have ordered that now.

The brand is Almus (which I believe is also referred to as Accord)

I'm currently taking multivitamins designed for energy:

Vit D3 NRV 100%, Niacin 50%, B6 57%, B12 80%, Biotin 24%

I am thinking my Vit D test might show decent levels because of the above.

My weight is currently 56.4kg (I was cheeky and asked the nurse to weigh me after I had my bloods done 😆)

I've not had an antibody test, can that be done through NHS or privately?

[SlowDragon Administrator in reply to Nineby]

EXACTLY which multivitamin

Multivitamins are never recommended on here

Most contain iodine not recommended for anyone on levothyroxine

Most contain iron, shouldn’t supplement unless had full iron panel test for anaemia

NHS should test thyroid antibodies at diagnosis…..there are two different antibodies involved in autoimmune thyroid disease (Hashimoto’s)

High TPO and/or high TG antibodies

NHS only tests TG antibodies if TPO antibodies are high

Significant minority of Hashimoto’s patients only have high TG antibodies and therefore struggle to get diagnosed

Link about thyroid blood tests

thyroiduk.org/getting-a-dia...

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

Medichecks or Blue horizon will test both antibodies

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

 Suggest you get next dose increase in levothyroxine and organise full thyroid testing after 6-8 weeks

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested.

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high thyroid antibodies 

Autoimmune thyroid disease with goitre is Hashimoto’s

Autoimmune thyroid disease without goitre is Ord’s thyroiditis. 

Both are autoimmune and generally called Hashimoto’s.

Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)

20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis 

In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)

Recommended on here that all thyroid blood tests early morning, ideally just before 9am and last dose levothyroxine 24 hours before test 

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins

List of private testing options and money off codes

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code

thyroiduk.org/getting-a-dia...

monitormyhealth.org.uk/

Only do private testing early Monday or Tuesday morning. Watch out for postal strikes, probably want to pay for guaranteed 24 hours delivery 

Symptoms of hypothyroidism 

thyroiduk.org/wp-content/up...

[SlowDragon Administrator in reply to Nineby]

Yes Accord is also boxed as Almus via Boots or Northstar via Lloyds

Accord don’t make 25mcg tablets

Request extra 50mcg tablets per month and cut in half to get 25mcg

[SlowDragon Administrator in reply to Nineby]

Average replacement thyroid dose levothyroxine is 1.6mcg per kilo

Some people need less…..some need higher dose

All four vitamins need to be optimal

56.4kg x 1.6mcg = 90mcg per day approx

90mcg per week is 630mcg per week

75mcg x 3 per week and 100mcg x 4 per week = 625mcg per week

So …..eventually…..if after 3-4 months on 75mcg per day …..you might need further small increase in dose to 100mcg 4 days week

[SlowDragon Administrator]

Approx how much do you weigh in kilo

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.

[jimh111]

I'd take the offer of an increase (she probably means to 75 mcg). You can then see if it makes you feel better. It will take several months for you to recover. I would tend to wait a little longer for the next blood test to let things settle down - unless you start to feel bad.

[mrskiki]

If you find you don't need it you can always miss a months prescription to use them up. You dont wven need to start immediately. I got a 25 added to my 50 and collected them separately to avoid teva at the time. However I am now stuck on 100mg which is low for my weight and still have serious fatigue and getting worse. I can't get an increase as I can't even get a telephone appointment until I retest after another 3 months as the GP was happy with a TSH of 4.27 even if I was not. If you turn this down, you may be stuck like me if the GP changes.

[Nineby in reply to mrskiki]

Thanks for the reply. I have booked in a telephone appointment with my Dr on Monday to ask for my dose to be increased. I hope you manage to get your dose sorted out soon.

[mrskiki in reply to Nineby]

Thankyou, I'll be giving it another go next month x