Latest Test Results - your advice please -

[Lemondrizz1]

Test results taken as you advise on 22 December 2022 results enclosed -

Despite TSH T4 and T3 being requested and taken - the results in are only for TSH and T3 as the last time -

Serum TSH level - (XaELV) Below range 0.06 mlU/L (0.3 - 5.5) Below low reference limit

Serum free Triiodothyronine level (Xa ERq) 5.7 pmol/L (3.1.- 6.8)

Are you able to give me any advice please before I speak with the GP next week.

I have been on 100mcg Levothyroxine since 1 November 2022.

Many thanks for your help

Lemondrizz.

[SlowDragon Administrator]

obviously you need TSH, Ft4 and Ft3 tested together

Have you had thyroid antibodies tested

When were vitamin D, folate, ferritin and B12 last tested

Looking at previous posts

B12 was low ….now improving with supplements

Ferritin high ….but is within range for your age …over 60 years old ….up to 600

Ferritin range on Medichecks 

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

We have received further information the lab about ferritin reference ranges. They confirm that they are sex dependent up to the age of 60, then beyond the age of 60 the reference range is the same for both sexes: 

Males 16-60: 30-400 ug/L

Female's: 16-60: 30-150

Both >60: 30-650 

The lower limit of 30 ug/L is in accordance with the updated NICE guidance and the upper limits are in accordance with guidance from the Association of Clinical Biochemists. ‘

[Lemondrizz1 in reply to SlowDragon]

Many thanks Slow Dragon -

My Vit D was last taken 14/9/22 and was 91

Vit B12 - 18/10/22 had increased from 249 on 1/10/22 to 560 ish with B12 drops I am still taking B12 drops and B Complex.

Folate was done on 3/10/22 and was 8.9 ug/L

I had asked for them all to be done this time with my Thyroid check but was refused them as they had been done within the last 3 months.

TP Antibodies test was done 27/5/22 - 4.25 - but TG test never done.

My fear is that they will want to reduce my Thyroxine - and although not feeling well - I am feeling better than I have done in the last 17months - since increase to 100 Levo was feeling a good improvement and lifting of symptoms - and then went down with Covid - so unsure now if my symptoms are post Covid rather than connected to Hypothyroidism -

Still the matter of them wanting to read the BT results rather than treat the patient.

My GP had definately asked for the three tests - it seems to be the Lab that makes the decision.

I am thinking of getting private tests - but fear that the GP will not accept them.

Very interesting to read about the raised ferritin levels -

So just trying to make my plan of action in order to move forward.

So any help that you can offer will be much appreciated.

Lemondrizz

[SlowDragon Administrator in reply to Lemondrizz1]

Refuse to reduce dose levothyroxine

Ft3 is not over range

So you need to test TSH, Ft4 and Ft3 and both thyroid antibodies privately

If GP says " I have to reduce your dose because the guidelines say i can't let you have a below range TSH" .....

The first paragraph in the NICE (NHS) Thyroid Disease, Assessment and Management guidelines says :

nice.org.uk/guidance/ng145

"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. "

Comprehensive list of references for needing LOW TSH on levothyroxine 

healthunlocked.com/thyroidu....

[diogenes Remembering]

Your GP should realise that in T4 therapy a below-reference TSH doesn't often matter. Indeed this downloadable paper shows that in therapy TSH as low as yours can still express the body as euthyroid. You could download it and show its basic conclusions,

Thyroid. 2017 Apr;27(4):484-490. doi: 10.1089/thy.2016.0426. Epub 2017 Feb 6.

Biochemical Markers Reflecting Thyroid Function in Athyreotic Patients on Levothyroxine

Ito 1, Akira Miyauchi 1, Mako Hisakado 1, Waka Yoshioka 1, Akane Ide 1, Takumi Kudo 1, Eijun Nishihara 1, Minoru Kihara 1, Yasuhiro Ito 1, Kaoru Kobayashi 1, Akihiro Miya 1, Shuji Fukata 1, Mitsushige Nishikawa 1, Hirotoshi Nakamura 1, Nobuyuki Amino 1: 

DOI: 10.1089/thy.2016.0426

[Lemondrizz1 in reply to diogenes]

Many thanks for your reply and information that you have sent -

All really helpful to inform me when speaking with GP -

Lemondrizz