blood test results translation please

[App1]

Can I have assistance please in interpretation and also advice on next steps. I suspect an increased dose?

Diagnosed in April and initially on 50 Levothyroxine Accord a day. Increased in August to 4 days @ 50 and 3 days @ 75 as I was feeling awful mostly.

Had my 3 monthly test this week. Early morning, no Levo etc. Results as follows:

T.S.H. 7.1 (0.3-5.5) miU/L ABNORMAL Up from 2.2

T4 13.2 (10-22) pmol//L NORMAL Down from 19

VIT D is 85 nmo1/L SUFFICIENT Down from 100

I feel well some days and overall my body temp is comfortable. I do suffer sudden drastic drops in energy/fatigue/ with no particular pattern, and a foggy fuzzy head some days so it’s hit and miss for planning anything or going somewhere. I take Magnesium and Vitamin D3.

I look forward to your views.

[Jaydee1507 Administrator]

Your TSH is still out of range and so you're still hypo. Also your T4 level is pretty low. Is there a reason you only went up 12.5mcgs last time? A 25mcg increase would be in order.

Do you have any other vitamin levels? Ferritin, folate, B12? We need these at optimal levels to use our thyroid hormone properly.

[App1 in reply to Jaydee1507]

thanks. Only vit D was done. The slow increase was put in place following conversation between GP and Endo. I will bear the 75 in mind in my call with GP next week. Accord is my Levo".........I’m adept at splitting!

[SlowDragon Administrator]

You need at 25mcg increase per day - so 3 days at 100mcg and 4 days at 75mcg

Which brand of levothyroxine are you currently taking?

Many people find different brands of levothyroxine are not interchangeable

Teva brand levothyroxine upsets many people

Teva is only brand that makes 75mcg tablets

You need B12, folate and ferritin levels tested too

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

Always test thyroid levels early morning ideally around 9am and last dose levothyroxine 24 hours before test

[App1 in reply to SlowDragon]

Thanks. It’s great to have voices of experience, much appreciated both you and Jaydee. I’ll go for the consensus of 25 increase.. 75 base instead of 50. I’m on Accord. Much appreciated. I’ve taken on board the other vitamin requirements. Im already on D3 and Magnesium as I said and also Selenium and K2.

[SlowDragon Administrator in reply to App1]

Best not to change brand levothyroxine while increasing dose

Only change one thing at a time or you don’t know which might be responsible for any issues

Request GP prescribe increased number of 50mcg tablets instead of an extra 25mcg tablet

Then cut in half to get 25mcg dose to add to 50mcg

Accord only make 50mcg and 100mcg tablets 

Accord is also boxed as Almus via Boots, and Northstar 50mcg and 100mcg via Lloyds ....but Accord  doesn’t make 25mcg tablets

Most easily available (and often most easily tolerated) are Mercury Pharma or Accord

beware 25mcg Northstar is Teva

Mercury Pharma make 25mcg, 50mcg and 100mcg tablets 

List of different brands available in U.K.

thyroiduk.org/if-you-are-hy...

Once you find a brand that suits you, best to make sure to only get that one at each prescription.

Watch out for brand change when dose is increased or at repeat prescription.

Government 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. 

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).

Levothyroxine is an extremely fussy hormone and should always be taken on an empty stomach and then nothing apart from water for at least an hour after

Many people take Levothyroxine soon after waking, but it may be more convenient and perhaps more effective taken at bedtime

verywellhealth.com/best-tim...

No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.

Some like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away

(Time gap doesn't apply to Vitamin D mouth spray)

If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test

Similarly if normally splitting your levothyroxine, take whole daily dose 24 hours before test 

If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal

REMEMBER.....very important....stop taking any supplements that contain biotin a week before ALL BLOOD TESTS as biotin can falsely affect test results - eg vitamin B complex