blood tests

[Marinello69]

Hi All,

I have doctors on Friday morning as I think my level of thyroxine to low due to joint pain, anxiety hair loss very dry skin.

Just double checking if she agrees to do blood tests is it Vitamin D, B12 Folate and Ferritn to be checked .

Also TSh, T4,T3, Tpo,TG and thyroid antibodies.

I’m currently on 75 if you are overweight should your level be increased.

[Jaydee1507 Administrator]

They are the correct tests that you need, although it's highly unlikely even if the GP agrees to doing FT3 that it will be done.

What do you weigh? If you need more Levo depends on blood results, sadly not symptoms not weight gain.

[Marinello69 in reply to Jaydee1507]

Than you I realise it blood results though thought I read somewhere about weigh and level of thyroxine maybe I’m mistaken.

I’m embarrassed to say 252 lbs

[Jaydee1507 Administrator in reply to Marinello69]

Hypothyroidism has a tendency to make us overweight so no need to be shy tbh. 252lb in kilos is 114 x 1.6 = 182 which is what your final dose is approximated at. If you're only on 75mcgs then you have a very long way to go levo wise. You've got a few dose increases before you've given levo a good chance but you will need to be self advocating and pro active to get there.

[Everdean in reply to Jaydee1507]

Is it possible to work out dosage from weight when on only t3? Thank you

[Jaydee1507 Administrator in reply to Everdean]

I'm not aware of a calculation for that. I did find this Thyroid Canada article which is interesting. thyroidpatients.ca/2019/09/...

[Everdean in reply to Jaydee1507]

Thank you

[SlowDragon Administrator]

is your test booked for as early as possible in morning …ideally 9am

Last dose levothyroxine should be 24 hours before test

If testing Friday morning, delay Wednesday evening dose levothyroxine until Thursday morning. Delay Thursday evening dose levothyroxine until after blood test on Friday morning. Take Friday evening dose levothyroxine as per normal

Looking at previous posts you use to be on 125mcg levothyroxine…..and now (highly likely inappropriately) reduced to 75mcg

likely to have very low vitamin levels, especially if you are taking PPI (omeprazole)

Request the test includes full iron panel test for anaemia including ferritin

What vitamin supplements are you currently taking

Joint pain = under medicated thyroid wise and likely low vitamin D ….and gluten intolerance

Hairloss often linked to low iron and ferritin

Are you now on absolutely strictly gluten free diet?

252lbs = approx 114 kilo

Guidelines on dose levothyroxine by weight is approx 1.6mcg per kilo of your weight per day

114 kilo x 1.6mcg = 182mcg levothyroxine per day as likely dose levothyroxine required

You would need to increase dose slowly back upwards in 25mcg steps

Retest 6-8 weeks after each dose increase or brand change in levothyroxine

Keeping all four vitamins at optimal levels

Some people can’t tolerate full dose….others need higher dose than guidelines

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.

[Marinello69 in reply to SlowDragon]

Thank you for all information it’s at 8.45am

Not 100% sure if doctor will repeat bloods going to ask . I have stop omeprazole didn’t pick up last prescription will hand back when back up repeat prescription.

I’m taking vitamins D spray , pukka vitamin C . Hrt T gel and tablet .

Also Echinacea enough for three days and not going to replace .

Fostar inhaler Asthma and blue inhaler if needed . Also have lynch pluns on leg going to ask if this is related to thyroid

[SlowDragon Administrator in reply to Marinello69]

Asthma inhalers can lower TSH as contains steroids

It’s ESSENTIAL to test TSH, Ft4 and Ft3 together

Lichen planus is autoimmune. Frequently improves dramatically on absolutely strictly gluten free diet

[Marinello69 in reply to SlowDragon]

Thank you , wanted to double check is it best to have breakfast before thyroid test , coffee or wait until after blood tests

[SlowDragon Administrator in reply to Marinello69]

ideally drink only water before test

A) coffee/tea/food can lower TSH

B) you want empty stomach to take levothyroxine immediately after blood test