Test Results - Appt with GP

[Browneyes100]

I am in Levothyroxine 75mg have been on this since approx Sep 2021.

Not feeling great. These are the results. GP says it’s not urgent. I suspect it will end up being a chat and no further action.

Any advice on how to handle the GP appt?

[SlowDragon Administrator]

Request/insist on 25mcg dose increase in levothyroxine

Also request /politely insist on testing thyroid antibodies for autoimmune thyroid disease, vitamin D, folate, B12 and iron and ferritin levels

Thyroid levels should be retested 6-8 weeks after increasing dose levothyroxine to 100mcg every day

Which brand of levothyroxine are you currently taking

What vitamin supplements are you currently taking

When were vitamin levels last tested

Come back with new post once you get results

[SlowDragon Administrator]

The aim of levothyroxine is to increase dose slowly upwards in 25mcg steps, retesting 6-8 weeks after each dose increase

When adequately treated on just levothyroxine, TSH will almost always be below 2. Frequently TSH will be below 1

Most important results are always Ft3 followed by Ft4. Ft3 at least 50-60% through range and Ft4 usually a little higher at 60-70% through range.

Essential all four vitamins are optimal for good conversion of Ft4 (levothyroxine) to Ft3 (active hormone )

Guidelines on dose levothyroxine by weight

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.

some people need higher dose….others less

But a useful link to push for next increase in dose

Comprehensive list of references for needing LOW TSH on levothyroxine 

healthunlocked.com/thyroidu....

TSH should be under 2 as an absolute maximum when on levothyroxine 

gponline.com/endocrinology-...

NHS England Liothyronine guidelines July 2019

 

sps.nhs.uk/wp-content/uploa...

Page 9 

Test for Deficiency of any of the following: Vitamin B12, Folate,  Vitamin D, Iron

See page 13 

1. Where symptoms of hypothyroidism persist despite optimal dosage with levothyroxine. (TSH 0.4-1.5mU/L)

Graph showing median TSH in healthy population is 1-1.5

web.archive.org/web/2004060...

[Browneyes100 in reply to SlowDragon]

Really useful. Thank you. My Vit D and B12 came back within range

Does anyone know why the GP blood test ranges differ to these articles?

[SlowDragon Administrator in reply to Browneyes100]

Despite there being almost 2 million people in U.K. on levothyroxine and it being 2nd or 3rd most prescribed medication, GP’s frequently have little training on how to manage thyroid patients

Guidelines are available…..but frequently they don’t seem to have read them

if symptoms remain, with TSH over 2 dose should be increased.

ALWAYS test thyroid levels early morning around 9am and last dose levothyroxine 24 hours before test to get highest TSH and lowest Ft4

Just testing TSH is totally inadequate, but increasingly all that’s tested

Thousands of U.K. patients test privately to make progress

Exactly what are vitamin D and B12 results

You need folate, iron and ferritin tested too

[greygoose in reply to Browneyes100]

Does anyone know why the GP blood test ranges differ to these articles?

Because ranges vary from lab to lab according to the settings on the machines they use for the analysis. And there are a lot of different machines in use.

[Hibs1]

What helped me with my gp was printing off the symptoms list from thyroid UK and ticking off all you have. The comments from above have links with information for him too. Information on paper better than word of mouth Lucky for me I always have had ft4 tested too.

[Canadacats]

I have been on Levothyroxine since about the early 1990s. I can honestly say I have never felt any different than before! My GP refused an increase in dosage because of a risk of kidney damage (that I have acquired anyway). I take 125mg and 150mg on alternate days. Not a lot of help to you sadly, but we are still not able to see a GP at the practice I use. I wish there was an alternative that had some effect but as I am GP "homeless" this is probably not going to happen. I would say, if you are not happy, be firm but make sure you read the leaflet in with the tablets because you don't want to be worse off than you are currently. Since Covid I avoid jabs and pills whenever I can and use natural remedies. Time will tell. Sorry I can't be of more help. Good luck!