thyroid results …. Just increased thyroxine from 100 to 125

[Delilahmy]

based on my daughters recent results

TSH 13.45 ( (0.1 to 0.5

Serum T4

11 ( 12.0 to 23.0)

Dr advised to retake bloods in 3 months

Any advice appreciated thanks

[SeasideSusie Remembering]

Delilahmy

TSH 13.45 ( (0.1 to 0.5

That is a very strange TSH range, it's usually something like 0.27-4.20 or 0.35-4.5 so it would have 4 points between bottom and top of range, not 0.4 as your range shows.

So GP increased dose from 100mcg to 125mcg after seeing those results? If so that's the correct thing to do as they show very undermedicated.

Blood test should be repeated 6-8 weeks after increase not 3 months. GP should check guidelines on titration.

How long since your daughter was diagnosed and how long had she been on 100mcg Levo?

Did she take the test as we advise:

* 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, split dose and 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.

Does she take her Levo on an empty stomach, one hour before or two hours after food, with a glass of water only, no tea, coffee, milk, etc, and water only for an hour either side, as absorption will be affected. Does she take any other medication and supplements 2 hours away from Levo, some need 4 hours.

Has she had key nutrients tested:

Vit D

B12

Folate

Ferritin

these all need to be at optimal levels for thyroid hormone to work properly.

Does she take any supplements or other medication?

[Delilahmy in reply to SeasideSusie]

Thankyou Susie Becky was diagnosed whilst pregnant about a year ago and had pregnancy diabetes which was medicated with insulin this has now resolved since having her baby. Initially started on 50 thyroxine then 75 then 100 now 125

Current meds are Bisoprolol 1.25

Thankyou for your comprehensive reply …. Oh my name changed from Myish forgot to mention

[SeasideSusie Remembering in reply to Delilahmy]

Does she take her Bisoprolol well away from her thyroid meds? I take Bisoprolol and it doesn't seem to interfere with my absorption of thyroid meds or levels (unlike Propranolol which apparently does) but it's still best to keep it a few hours away.

So her GP was right to increase her dose of Levo but she shouldn't leave it 3 months to retest, 8 weeks will be more than enough and she may need another increase as she seems to have a long way to go to get her levels down. 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 the patient feels well.

[Delilahmy in reply to SeasideSusie]

Thankyou so much Susie I’ve passed all this info to Becky and she’s going to ask doctor for repeat tests and for vit tests xx again many thanks

[Delilahmy in reply to SeasideSusie]

no vit d b12 folate or ferritin done to Beckys knowledge

Black and white

[SlowDragon Administrator in reply to Delilahmy]

Request they test vitamin D, folate, B12, ferritin and thyroid antibodies for autoimmune thyroid disease (also called Hashimoto’s)

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested.

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high thyroid antibodies 

Autoimmune thyroid disease with goitre is Hashimoto’s

Autoimmune thyroid disease without goitre is Ord’s thyroiditis. 

Both are autoimmune and generally called Hashimoto’s.

Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)

20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis 

In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)

Her blood levels should be retested 6-8 weeks after each dose change or brand change in levothyroxine

Recommended on here that all thyroid blood tests early morning, ideally just before 9am and last dose levothyroxine 24 hours before test 

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins

List of private testing options and money off codes

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins then cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code

thyroiduk.org/getting-a-dia...

monitormyhealth.org.uk/

NHS easy postal kit vitamin D test £29 via

vitamindtest.org.uk

Only do private testing early Monday or Tuesday morning. 

Watch out for postal strikes, probably want to pay for guaranteed 24 hours delivery 

Link about thyroid blood tests

thyroiduk.org/getting-a-dia...

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

Symptoms of hypothyroidism 

thyroiduk.org/wp-content/up...

[Delilahmy in reply to SlowDragon]

Thankyou for all the great wonderdul advice. Becky is going to ask for all tests and hopefully they will do them. If not she will do private testing

[SlowDragon Administrator]

As you have Hashimoto’s, it’s virtually guaranteed your daughter’s hypothyroidism is also autoimmune

Request coeliac blood test if not already on strictly gluten free diet

[Delilahmy in reply to SlowDragon]

ah Thankyou Slowdragon - sorry Becky us daughter in law xx sorry should have been clear x Thankyou so much for your reply