new blood test, any ideas.

[Haze1975]

new blood test taken on thrusday.

TSH level: 2.27 miu/L [0.35 - 4.94]

Serum albumin level 39 g/L [35 - 50] 

Serum calcium level 2.25 mmol/L [2.1 - 2.55] Serum total protein level 80 g/L [64 - 83]

Any idea or help please

[SeasideSusie Remembering]

Haze1975

As pointed out before, just testing TSH is inadequate, it can't tell you your thyroid status, you need FT4 and FT3 tested as well. If GP can't get them tested then you might want to use one of our recommended private labs.

However, your TSH is high for a treated hypo patient, generally we feel best when it's 1 or below with FT4 and FT3 in the upper part of their reference ranges.

Other results are in range but whether they are optimal for you isn't possible to say, maybe there is a particular reason they are being tested?

[Haze1975 in reply to SeasideSusie]

No idea. Because I normally get more information on a blood test, as I’d request to see all my notes so don’t know why the doctor who analysis it didn’t put the full blood test on there. The blood test was taken for an annual review for my thyroid hospital in December. But this is the first blood test for the year as the doctor hasn’t requested one.

[SlowDragon Administrator in reply to Haze1975]

Increasingly common that NHS only tests TSH

You may need to get full testing yourself privately

[tcpace in reply to SeasideSusie]

Sorry to hijack this thread but I was interested in your comment " .... your TSH is high for a treated hypo patient, generally we feel best when it's 1 or below with FT4 and FT3 in the upper part of their reference ranges". My GP is telling me my current TSH of 2.9 is fine (no T3 or T4 results) and was dismissive of my response that my TSH ought to be close to or less than 1. I'm on 100mcg T4. Do you know of any authoritative source for your comment that I could show my GP? The TSH of 2.9 may explain the fatigue I've had for the past 12 months or so.

[SeasideSusie Remembering in reply to tcpace]

tcpace

A normal healthy person with no thyroid condition would have a TSH of no more than 2, often around one, as shown in the graph below, so why would it be acceptable for someone who is hypothyroid to have a TSH higher than a normal healthy person.

Also, it's important to remind GPs (tactfully) that TSH is not a thyroid hormone, it's a pituitary hormone, the thyroid hormones are T4 and T3 and it's only by looking at the FT4 and FT3 results that we can get a true picture of our thyroid status.

For hypothyroid patients, sources that your GP may accept that mention TSH:

From GP Notebook

gpnotebook.com/simplepage.c...

Target level for TSH during thyroxine therapy

Fine tuning of the dose could be necessary in some patients

* aim of levothyroxine treatment is to make the patient feel better, and the dose should be adjusted to maintain the level of thyroid stimulating hormone within the lower half of the reference range, around 0.4 to 2.5 mU/l. If the patient feels perfectly well with a level in the upper half of the reference range, then adjustment is unnecessary

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.

So the above are stating the absolute maximum TSH but clearly show it could be very much less.

Also, point out:

nice.org.uk/guidance/ng145

where it says

Guideline development process

How we develop NICE guidelines

Your responsibility

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.

The above is saying guidelines are a guide they are not rules to stick rigidly to and that the response and needs of the individual patient should be taken into account, in other words if the patient is still not well when the TSH is "in range" then work towards a level where the patient is relieved of symptoms.

Also, the following may or may not be acceptable to your GP, it is from Also, Dr Anthony Toft, past president of the British Thyroid Association and leading endocrinologist, who 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.

TSH level of health people

[tcpace in reply to SeasideSusie]

Excellent, just what I'm looking for. Thank you SusieS.

[SlowDragon Administrator]

How do you feel

What brand levothyroxine are you currently taking and how much

What vitamin supplements

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

 

For full Thyroid evaluation you need TSH, FT4 and FT3 tested.

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

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...

[Haze1975 in reply to SlowDragon]

I’ve been on just Teva makes of a 125mg, but this month the pharmacy has given me 100mg from accord, and 25mg from Teva brand. But they normally try and give me both the same brand of tablets. And has been on the Teva for most of the year now.

Witch I’d could get an early blood test, but due to work commitments and the blood nurses been off sick, the blood test now run walking mon, wed and fri 9/12 walking in. and pre book appointments Tuesday and Thursday 9/12 mine was taken at 10.30am on Thursday. With no medication on that day, until the bloods was taken.

Very tied, and sleeping a lot when finished work. When I’d do sleep and wake back up at 1. 2. 3. In the morning. Or sometime I’d be up to 1/2 in morning and can’t get to sleep. But if I manage to sleep through the night, I’m always still tied through. But I’ve not seen an endo for 2 years now, due to id had cancelled on him in January this year, and I was meant to go to hospital the year before but the letter was on line stated phone, but they did ring and said why wasn’t I there. But endo appointment is on the 5 of December. As I’ve still got 3 more years, as was told I’d would have to see a specialist for 10 years after having cancer.

[SlowDragon Administrator in reply to Haze1975]

Strongly recommend getting full thyroid and vitamin testing done yourself then

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