blood results

[travboo]

Hi I have Hashimotos and was started on 100mg of Levothyroxine in June GP has now increased it by 25mg every other day. However I still feel rubbish. I recently had my bloods done privately and they came back as below, can anyone tell me if they look ok as the GP has said everything is normal

[SeasideSusie Remembering]

travboo

If you are still symptomatic then no, they're not OK.

The aim of a treated hypo patient on Levo only, generally, is for TSH to be 1 or below with FT4 and FT3 in the upper part of their reference ranges, if that is where you feel well.

Your results show that your TSH is too high, your FT4 is only 20% through range with FT3 at 29.7% through range. This suggests that you need an increase in Levo, 25mcg now and retest in 6-8 weeks.

Always advised here, when having thyroid tests:

* Book the first appointment of the morning, or with private tests at home no later than 9am. This is because TSH is highest early morning and lowers throughout the day.

In fact, 9am is the perfect time, see first graph here, it shows TSH is highest around midnight - 4am (when we can't get a blood draw), then lowers, next high is at 9am then lowers before it starts it's climb again about 9pm:

healthunlocked.com/thyroidu...

If we are looking for a diagnosis of hypothyroidism, or looking for an increase in dose or to avoid a reduction then we need TSH to be as high as possible.

* Nothing to eat or drink except water before the test - have your evening meal/supper as normal the night before but delay breakfast on the day of the test and drink water only until after the blood draw. Certain foods may lower TSH, caffeine containing drinks affect TSH.

* If taking thyroid hormone replacement, last dose of Levo should be 24 hours before blood draw, if taking NDT or T3 then last dose should be 8-12 hours before blood draw. Adjust timing the day before if necessary. This avoids measuring hormone levels at their peak after ingestion of hormone replacement. Take your thyroid meds after the blood draw. Taking your dose too close to the blood draw will give false high results, leaving any longer gap will give false low results.

* If you take Biotin or a B Complex containing Biotin (B7), leave this off for 7 days before any blood test. This is because if Biotin is used in the testing procedure it can give false results (most labs use biotin).

These are patient to patient tips which we don't discuss with phlebotomists or doctors.

[SeasideSusie Remembering in reply to SeasideSusie]

If GP is reluctant to increase dose then use the following information to support your request:

From GP online

gponline.com/endocrinology-...

Under the section

Cardiovascular changes in hypothyroidism

Replacement therapy with levothyroxine should be initiated in all patients to achieve a TSH level of 0.5-2.0pmol/L.

Also, Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine (the professional publication for doctors):

"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l. In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance. But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l. This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l).*"

*He confirmed, during a talk he gave to The Thyroid Trust in November 2018 that this applies to Free T3 as well as Total T3 and this is when on Levo only. You can hear this at 1 hour 19 mins to 1 hour 21 minutes in this video of that talk youtu.be/HYhYAVyKzhw(Not working as expected?)

You can obtain a copy of the article which contains this quote from ThyroidUK

Email : [e-mail]

and ask for the Dr Toft article from Pulse magazine. Print it and highlight Question 6 to show your GP.

[travboo in reply to SeasideSusie]

thank you for your advise. I do follow the advise regarding the blood tests and always have mine between 8.30 -9.00. I will contact my GP again it is so frustrating he has told me to exercise more and watch my diet but I struggle to carry out any strenuous activities without my muscles feeling like they have stopped working it’s the strangest sensation

[SlowDragon Administrator]

As you have Hashimoto’s

Essential to test vitamin D, folate, ferritin and B12

Have you had these tested by GP or privately

What vitamin supplements are you currently taking

Have you had coeliac blood test done yet

Or are you already on strictly gluten free diet

Or dairy free diet

Which brand of levothyroxine are you currently taking

Do you always get same brand

Was this test done early morning and last dose levothyroxine 24 hours before test

Was test done at least 6-8 weeks after increasing levothyroxine to 125mcg and 100mcg on alternate days

[travboo in reply to SlowDragon]

Hi

No I haven’t had any other tests done. I am trying to avoid Gluten by eating clean and I don’t really have diary anyway. My brand of Levo is Teva and I have been on that one for the past 2 months. I take a daily supplement of D3 with K2(spray) and a B12 (spray) last test was done at 08.45 am and I took my Levo after the test but this was done before the 25mcg increase, due to get my next one on 28th November

[SlowDragon Administrator in reply to travboo]

request all four vitamins are tested

No point testing for coeliac if on low gluten diet

But it does need to be no gluten to be effective

Teva brand upsets many people

Which brand of levothyroxine were you taking previously

[travboo]

Ok thank you. I was given different brands of Levo each time the last one before Teva was Accord