Help with results please: hello, im new to this... - Thyroid UK

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Help with results please

Apesxx profile image
6 Replies

hello, im new to this forum. Just wondering if anyone can help with my results and help advise on what i should do.

Over the last 4 years my TSH levels have been gradually increasing until i was started on Levothyroxine last october, however GP has only given me 25mcg. Just had repeat bloods and its still over range.

the past bloods results i have:

TSH and T4

sep 2019- 4.8 mu/l Range (0.30-6.0)

Feb 2020- 6.3 mu/l- Range (0.30-6.0)

March 2021- 6.2- Range (0.3-6.0) T4 12.0 range (10.4-24.5). TPO 150iu/ml range (0-35).

July 2021- 5.29- Range (0.35-5.0) This was an afternoon test

October 2022- 13.3- Range 0.30-6.0)- Started on 25 mcg Teva -T4 12.8 range (10.4-24.5)

Jan 2023- 8.2 - Range 0.30-6.0). T4- 13.7- Range (10.4-24.5)

I did the advanced thyroid test on medichecks this week and results are:

CRP- 0.7 (range 0-5).

Ferritin - 40.5ug/l- (Range 13-150ug/l)

Folate- serum- 5.28 ug/l- (Range >3.89

Active B12- 112 pmol/L- (Range 37.5-150)

Vit D- 72nmol/l- (Rnage 50-200)

TSH- 8.26mu/l- (Range 0.27-4.2)

Free T3- 4.37 pmol/l- (Range 3.1-6.8)

Free Thyroxine- 16 pmol/l- (Range 12-22)

TGA- 70iu/ml- (Range <115)

TPO antibodies- 85iu/ml- (Range <34).

i didnt take any vitamin supplements in the week before and i didnt take my Levothyroxine for over 24 hours before these tests. Ive also had issues with B12 in the past with my bloods coming back from the GP as 219 ng/l (range 160-1000) in sep 2019 however an active test at this time came back as deficient about 35 i think but the GP refused to accept those results. so i do supplement that now.

Should my GP now be increasing my Dose of Levothyroxine? im currently on 25mcg. i sent a message to the GP to ask but they have ignored me. Im going to ring tomorrow morning as ive still got numbness in my hands, and ive got really bad anxiety at the moment. Other things i noticed are: tremors in my muscles, palpitations at night, i have bald patches in my head, im always cold, regular constipation, dry skin.

I currently weigh 80kg. Also i have been doing a degree the last 2 years so am under a lot of stress.

They were really reluctant to start me on it in the first place as im 36.

Many thanks for any advice.

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Apesxx
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6 Replies
Jaydee1507 profile image
Jaydee1507Administrator

Firstly, your GP has failed you. Just too shocking they have left you with a TSH above range on 25mcgs Levo. You need an immediate increase and you are going to have to become your own best advocate. Make an appointment with your GP and insist on an immediate increase.

Your folate is low, buy some Thorne Basic B complex which will also boost your other B vitamins.

Your ferritin is too low, should be around 90-100. Start eating chicken livers or pate a few times a week.

Vit D should be higher. I'm sure someone will advise how much you need to take.

tattybogle profile image
tattybogle

Hi Apesxx

yes your dose needs increasing now . and the NHS guidelines for treating hypothyroidism very clearly tell GP's to do this ... so make sure they follow them . ( i'll link to the right bit below )

as you are 36 you should have been started on 50mcg levo, NOT 25mcg (25mcg is advised as a more gentle start for people who are over 65 or who have heart conditions)

Starting you on 25mcg has just made the process of getting you up to the right dose ( and feeling better ) take 3 months longer than it needed to . cks.nice.org.uk/topics/hypo...

"The NICE clinical guideline recommends:

Consider starting LT4 at a dosage of 1.6 micrograms per kilogram of bodyweight per day (rounded to the nearest 25 micrograms) for adults under 65 years of age with primary hypothyroidism and no history of cardiovascular disease.

Consider starting LT4 at a dosage of 25–50 micrograms per day with titration for adults aged 65 years and over, and adults with a history of cardiovascular disease.

The British National Formulary (BNF) recommends:

For adults aged 18–49 years — initially 50–100 micrograms once daily; adjusted in steps of 25–50 micrograms every 3–4 weeks, adjusted according to response; maintenance 100–200 micrograms once daily.

For adults aged 50 years and over, with cardiovascular disease, or severe hypothyroidism — initially 25 micrograms once daily; adjusted in steps of 25 micrograms every 4 weeks, adjusted according to response; maintenance 50–200 micrograms once daily.

Advise the person to take LT4 medication on an empty stomach in the morning before other food or medication."

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

nice.org.uk/guidance/ng145/... (*note 'subclinical hypothyroidism' means 'TSH over range ,while fT4 is still within range' )

"Treating subclinical hypothyroidism

1.5.2When discussing whether or not to start treatment for subclinical hypothyroidism, take into account features that might suggest underlying thyroid disease, such as symptoms of hypothyroidism, previous radioactive iodine treatment or thyroid surgery, or raised levels of thyroid autoantibodies.

Adults

1.5.3Consider levothyroxine for adults with subclinical hypothyroidism who have a TSH of 10 mlU/litre or higher on 2 separate occasions 3 months apart. Follow the recommendations in section 1.4 on follow-up and monitoring of hypothyroidism.

1.5.4Consider a 6-month trial of levothyroxine for adults under 65 with subclinical hypothyroidism who have:

~ a TSH above the reference range but lower than 10 mlU/litre on 2 separate occasions 3 months apart, and

~ symptoms of hypothyroidism.

If symptoms do not improve after starting levothyroxine, re-measure TSH and if the level remains raised, adjust the dose. If symptoms persist when serum TSH is within the reference range, consider stopping levothyroxine and follow the recommendations on monitoring untreated subclinical hypothyroidism and monitoring after stopping treatment."

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

So get it increased to 50mcg now (because TSH is still over range)

Then get retested after 6-8 weeks on 50mcg (don't let them make you wait 3 months ..they have already wasted enough time) .

If TSH is 'in range' on 50mcg but GP says "well it's in-range now so i don't need to increase dose ant further", use this list of references recommending GP's keep TSH between about 0.5 to 2/2.5 in patients on Levo . healthunlocked.com/thyroidu.... ( my-list-of-references-recommending-gps-keep-tsh-lower-)

SlowDragon profile image
SlowDragonAdministrator

Levothyroxine doesn’t “top up” failing thyroid….it replaces it

That’s why standard starter dose is at least 50mcg and dose levothyroxine is increased slowly upwards in 25mcg steps after each blood test

Typically dose is increased over 6-12 months until on approx 1.6mcg levothyroxine per kilo of your weight per day

80kg x 1.6mcg = 128mcg as approx daily dose eventually required

As dose gets up over 100mcg per day you may find you will see weight starting to reduce

Many GP’s are utterly clueless as to how to manage hypothyroidism

You’re going to need to be pro active

Get dose increase to 50mcg

Which brand of levothyroxine are you currently taking

Many people find different brands are not interchangeable

Book bloods retested at 9am in 6-8 weeks time

High thyroid antibodies confirms autoimmune thyroid disease

Request GP test for coeliac disease (as per NICE guidelines) if not been tested yet

SlowDragon profile image
SlowDragonAdministrator

low vitamin levels

On levothyroxine we need OPTIMAL vitamin levels

Vitamin D at least over 80nmol and between 100-125nmol maybe better

Ferritin at least half way through range

Folate nearer 20

As your Active B12 is now over 70 you can replace separate B12 with supplementing a good quality daily vitamin B complex, one with folate in (not folic acid) 

This can help keep all B vitamins in balance and will help maintain B12 levels too

Difference between folate and folic acid 

chriskresser.com/folate-vs-...

Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid.

thyroidpharmacist.com/artic...

B vitamins best taken after breakfast

Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule) 

Thorne currently difficult to find at reasonable price, should be around £20 

If you want to try a different brand in the meantime, one with virtually identical doses of the ingredients, and bioavailable too, then take a look at Vitablossom Liposomal B Complex. Amazon sometimes has it branded Vitablossom but it's also available there branded as Yipmai, it's the same supplement

amazon.co.uk/Yipmai-Liposom...

or available as Vitablossom brand here

hempoutlet.co.uk/vitablosso... &description=true

IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate methyl folate supplement

how much vitamin D are you currently taking

Apesxx profile image
Apesxx

thankyou for the replies. I will ring the GO in the morning and insist on a dose increase and I will order the vitamins tonight.

I don’t currently take any Vit D but I do have a Vitabiotics mine that’s 25ug in the cupboard so I’ll start taking that again.

Dancer57 profile image
Dancer57

Hi Apesxx

Feel for you. I have same problem with my GP surgery. I dared to question my high TSH levels and am now seen as "difficult". Hopefully you will have better luck.

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