I am under medicated? First 6 weeks test results. - Thyroid UK

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I am under medicated? First 6 weeks test results.

Noona123 profile image
26 Replies

I was eventually diagnosed as hypothyroidism August 3rd 2022.

My GP put me on 50mcg Levo and referred me within 2 weeks to see an Endo because he was bit confused by my symptoms (including persistent ear ache) and suppressed TSH/ lowish T4 and T3 in May then 2 sets of hypo results in June and July. My last post has specific details of results.

Before my appointment the Endo/ Hospital requested lab results:

TSH 4.20 ( 0.35 -4.94)

FT4 9.5 ( 9 -19.1)

FT3 3.2 (2.4 -6.0)

At the time I took these tests, I had been on 50 mcg Levo for just over 2 weeks.

The Endo said he could feel a slight goitre, I was still having symptoms even though my results had now 'come back into range' (as above) and because my TPO ab were over 600 he increased my dose to 75mcg and said he wanted to re-test in 6 weeks and get the TSH to about 2.

Yesterday I took the blood tests 6 weeks after above meeting (following protocol advised on this very useful forum) Results:

TSH 2.21 (0.35 -4.94)

FT4 10.7 ( 9 - 19.1)

FT3 3.3 (2.4 - 6)

The blood was drawn at my local surgery and I was surprised when the results were put up on my account. Not so surprised though by the "No action needed". I was hoping for an increase to 100mcg as I still have aches and pains and fatique but not as bad as is was. Any thoughts on these results welcome! The T3 and T4 haven't gone up much was my thinking.

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Noona123
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26 Replies
Sofie007 profile image
Sofie007

Hey Noona, did your thyroid antibodies go down? X

Noona123 profile image
Noona123 in reply toSofie007

Hi Sofie007, Not sure where my reply has gone!! Will try again! My antibodies went up from 534 on a Medichecks test to greater than 600 three weeks later with NHS test. NHS didn't retest these again.

Sofie007 profile image
Sofie007 in reply toNoona123

Hi Noona, I am seeing a more “natural” gp next week because I want to bring my tpo down. If i get any tips, I will share them with you if you like.

Noona123 profile image
Noona123 in reply toSofie007

Thanks Sofie, I believe cutting out gluten may help, which I've tried but think I'll have to do it thoroughly for it to be effective! Have just read slow dragon's post to me! Any additional tips would be gratefully received. I'm training to be a sound healer so might find something there - will let you know!

Sofie007 profile image
Sofie007 in reply toNoona123

Oh sound healer sounds good :) yes i am open to anything.

Partner20 profile image
Partner20 in reply toNoona123

The NHS will not re-run antibody tests as once you have returned a positive level this simply confirms the condition you have. In your case you have autoimmune hypothyroidism caused by Hashimoto's, which you will always have, and once this is confirmed the antibody level is irrelevant. Some people try an anti-inflammatory diet to bring down their antibody levels, but unless you are actually reacting to the foods you eliminate from your diet, this will make little difference, and you risk cutting out vital food groups. Concentrate on optimising vitamin and mineral levels, which will help to make effective use of your levo. Vit.D will need to be supplemented with a maintenance dose once you have reached optimal level, which often takes some time. An increase in levo should hopefully optimise your thyroid levels.

Noona123 profile image
Noona123 in reply toPartner20

Thanks Partner20. I am hoping for an increased dose and in the meantime will work on my vitamins and minerals, particularly iron which I now realise isn't that great.

Jaydee1507 profile image
Jaydee1507Administrator

What time was your latest blood test? It needs to be as close to 9am as possible, maybe a bit before if possible.

Your FT3 is low in range so no wonder you are feeling unwell with aches and pains.

Have you had any vitamins tested? Being hypo causes our vitamins to be low. Ask GP if they can test ferritin, folate, B12 and D3.

Noona123 profile image
Noona123 in reply toJaydee1507

I followed all the protocols, my test was at 8.50 am no breakfast, 24hr before last dose, no biotin etc. The Endo actually requested a test for Ferritin as I have been very low in the past. This came back as 49 . He also wanted me to have a 9am cortisol test after the appointment which came back as 281 which he said was "quite re-assuring". My B12 and folate are optimal and my D3 is a work in progress. Have been taking the equivalent of loading doses for about 6 weeks to get it up from 60 to 100!

Jaydee1507 profile image
Jaydee1507Administrator in reply toNoona123

A ferritin of 49 is not good enough. Should be above 75, closer to 90/100. Supplementing needed with iron.

Both your FT4 and FT3 are low so you really need an increase and no wonder you have symptoms. 50mcgs Levo is really just a starting dose, you need to stress the symptoms you have and not be fobbed off with other reasons for them.

Noona123 profile image
Noona123 in reply toJaydee1507

I've been trying to increase my iron but it's a slow process. I'll aim for over 75 as you say. I've got a Medichecks test who 'owe' me a ferritin and folate test that I've got to use by Novemebr so will re-test then. I've actually been taking some liquid iron my mum was prescribed (but didnt get on with) but I stopped that and have pumpkins seeds and even started having lambs liver which for an ex-vegetarian is a bit scary!! I've actually been on 75mcg Levo last 6 weeks (50 for a fortnight beforehand ) so I was hoping for higher T4 and T4. But I'm beginning to understand that that Hashimotos takes a while to settle down.

Jaydee1507 profile image
Jaydee1507Administrator in reply toNoona123

Oh no, must be awful for an ex vegetarian, poor you. Chicken liver pate is recommended here as well if that appeals at all. Keep chipping away at it though and you will get there.

Just wondering how and when you take your levo?

Regenallotment profile image
RegenallotmentAmbassador

hi

What has worked for me with the GP is explaining my symptoms are continuing and asking for a trial increase. Then wait 6-8 weeks and re-test.

How are your vitamin levels, diet and digestion?

Wellness and absorption of Levo are greatly improved with optimal D, B12, Ferritin and Folate.

🦋💚🦋

Noona123 profile image
Noona123 in reply toRegenallotment

I have a GP appoint booked for 2 weeks time to discuss ongoing symptoms, but technically I'm still under the Endo so have also emailed him saying I still have symptoms. Vitamin levels okay, don't have problems with digestion and have also been eating 2-3 Brazil nuts which I read on here help the conversion of T4 to T4. I eat really well as we have an allotment so grow lots of veggies and I've mostly cut out gluten. Maybe I need to give the Levo a bit longer?

SlowDragon profile image
SlowDragonAdministrator in reply toNoona123

I eat really well as we have an allotment so grow lots of veggies and I've mostly cut out gluten. Maybe I need to give the Levo a bit longer?

How good (or bad ) our diet is has nothing to do with low vitamin levels with Hashimoto’s

Being hypothyroid results in low stomach acid and as direct result poor nutrient absorption and low vitamin levels

Brazil nuts….the packet needs to say “grown in selenium rich soil “

Almost gluten free doesn’t work…..to be effective it needs to be absolutely strictly gluten free

Dairy free is less absolute……

Levothyroxine doesn’t top up failing thyroid, it replaces it. So almost everyone ends up on approx full replacement dose based on weight .

A few people need less, some need higher dose if gut is badly affected and poor absorption issues

SlowDragon profile image
SlowDragonAdministrator

Make an appointment with GP and request 25mcg dose increase in levothyroxine up to 100mcg daily

FT4: 10.7 pmol/l (Range 9 - 19.1)

Ft4 is only 16.83% through range

FT3: 3.3 pmol/l (Range 2.4 - 6)

Ft3 only 25.00% through range

Most people when adequately treated will have Ft3 and Ft4 at least 50-60% through range minimum

Which brand of levothyroxine are you currently taking

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

High thyroid antibodies confirms autoimmune thyroid disease

Have you had coeliac blood test done yet or vitamin D, folate, ferritin and B12

If not these all need testing now

What vitamin supplements are you currently taking, if any

SlowDragon profile image
SlowDragonAdministrator

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.

Noona123 profile image
Noona123 in reply toSlowDragon

Thanks SlowDragon. I weigh about 70kg so 100 mcg would be good . I've learnt alot from these forums about optimising nutrients etc which I've been doing so the ft4 and FT3 results were a bit surprising. My 75 mcg comes in 2 lots: 50 is accord and 25 is Teva which I've read can upset people but I seem to be okay on it - I'm not lactose intolerant though. If I had 100 I could just have accord which would be better perhaps rather than mixing them.

SlowDragon profile image
SlowDragonAdministrator in reply toNoona123

Yes I agree …up to 100mcg

You might need small dose increase after that ….see how you get on

jimh111 profile image
jimh111

You do need an increase. Your TSH has been lower than expected and even near zero in the past. Sometimes with autoimmune hypothyroidism there can be a period of high hormone levels which can suppress TSH. TSH can then remain low for a long time even though hormone levels are not high. So, they need to go by your symptoms and fT3, fT4 rather than TSH.

Noona123 profile image
Noona123 in reply tojimh111

Thanks Jim111, I'm beginning to realise that it's all quite a process!

Digger0 profile image
Digger0

Hi. Are you not seeing your endo again? I saw mine every 6 weeks (NHS) until my levels were correct.

Noona123 profile image
Noona123 in reply toDigger0

The Endo wrote to me and said if my levels came back 'normal' in 6 weeks he'll 'discharge me back to the care of the GP' - no option for talking further about results or symptoms. I havent got a direct email address for the Endo but have sent an email for his attention via a general dept email address. Might send it snail mail too. Are you able do you contact your Endo between appointments if needed?

Digger0 profile image
Digger0 in reply toNoona123

Yes, I could contact mine if needed.

tattybogle profile image
tattybogle

These references may come in handy to persuade GP /Endo to allow TSH lower than 2 :

healthunlocked.com/thyroidu...

Noona123 profile image
Noona123 in reply totattybogle

Thanks very much for all this info in this link tattybogle.

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