Blood test results

[Dadof5]

I have received my first test results from Monitor my Health

and would appreciate your thoughts.

TSH 1.8mu/L (0.27-4.2mu/L)

FT4 14.5 pmol/L (12-22pmol/L)

FT3 4.4 pmol/L (3.1-6.8pmol/L)

I currently take 150mg of Levothyroxine daily.

Thanks

[SeasideSusie Remembering]

Dadof5

Presumably test done as we advise, ie no later than 9am, water only before the test, last dose of Levo 24 hours before the test, no Biotin, B Complex or any supplement containing Biotin for 3-7 days before the test ?

If so then your results show that you are undermedicated.

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

TSH is too high, FT4 is only 25% through range and FT3 is 36.14% through range. This suggests that you need an increase in your dose of Levo of 25mcg now and retest in 6-8 weeks .

[SlowDragon Administrator]

Presumably you took test early morning and last dose levothyroxine 24 hours before test

Which brand of levothyroxine are you currently taking

Do you always get same brand levothyroxine at each prescription

How long have you been on 150mcg

Do you normally take levothyroxine waking or bedtime

FT4: 14.5 pmol/l (Range 12 - 22)

Ft4 is only 25.00% through range

FT3: 4.4 pmol/l (Range 3.1 - 6.8)

Ft3 better at 35.14% through range

Most people when adequately treated will have both Ft3 and Ft4 at least 60-70% through range

Your results show you are not on high enough dose levothyroxine

Print out copy of results and give to GP

Request 25mcg dose increase in levothyroxine

Bloods should be retested in 6-10 weeks

[SlowDragon Administrator]

ESSENTIAL that GP test vitamin D, folate, ferritin and B12 at least once a year as per guidelines on managing thyroid patients

When were these last tested

What vitamin supplements are you currently taking

Also have you ever had thyroid antibodies tested for autoimmune thyroid disease

or have you previously had thyroidectomy or RAI?

[Dadof5]

Where to start

I followed all the advice here no levothyroxine for 24hrs before hand, drank plenty of water and took the test around 08:30.

The only other medication I took in the previous 24hrs was metformin and avortstatin about 10pm the previous night.

I have been on 150mg since last August down from a dosage of 175mg. I was on that dose for about a year and a half but didn’t get tested because of Covid/lockdown. I was on 150mg prior to that for years. The doctor asked me to drop back to 150mg because when I finally got tested I had a TSH of 0.20.

As I stated in another post I have always taken my medication on the day of my blood tests because until finding this website I didn’t realise I shouldn’t. And the doctors have never told me differently!

I have never had any of the other tests done that are recommended here but will be trying to get my doctor to do them.

As for the brand of levo I’m not sure it’s usually a accord or northstar currently I have 100mg northstar and 50mg accord but only started them this week. I think it was all northstar last time. To be honest I never really notice a difference with the different brands and the other morning I took 6 x 25mg because I hadn’t picked up my latest script for the pharmacy .I have never had a thyroidectomy or RAI. Although I did test positive for Covid Wednesday evening.

[SlowDragon Administrator in reply to Dadof5]

I have always taken my medication on the day of my blood tests because until finding this website I didn’t realise I shouldn’t. And the doctors have never told me differently!

Well many GP’s wouldn’t know how you should do test

If taking levothyroxine before test it causes falsely high Ft4, but doesn’t affect TSH

TSH is higher the earlier in day you do test, because TSH has circadian rhythm

Dose levothyroxine should never be reduced based just on TSH

Also Metaformin can lower TSH

cureus.com/articles/50564-e...

Most important results are always Ft3 followed by Ft4

You need to get vitamin D, folate, ferritin and B12 levels tested

Ideally you would also test both thyroid antibodies too

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

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)

Suggest you consider getting full testing at next test 6-8 weeks after increasing levothyroxine back to 175mcg

Teva is only brand that makes 75mcg. Teva brand upsets many people so you might want to avoid getting 75mcg tablets

[SlowDragon Administrator in reply to Dadof5]

Did cholesterol rise after reduction in levothyroxine to 150mcg

nhs.uk/conditions/statins/c...

If you have an underactive thyroid (hypothyroidism), treatment may be delayed until this problem is treated. This is because having an underactive thyroid can lead to an increased cholesterol level, and treating hypothyroidism may cause your cholesterol level to decrease, without the need for statins. Statins are also more likely to cause muscle damage in people with an underactive thyroid.

[Dadof5 in reply to SlowDragon]

To be honest I am not sure because when viewing my test results I don't think it shows the cholesterol figure, might be wrong so will go and check and report back.

To be honest since lockdown my dostors surgery has gone downhill and it is virtually impossible to see a doctor. Hell this week I ended up seeing a nurse a a totally different surgery and that was arranged by my surgery.

[Dadof5 in reply to Dadof5]

Right if the cholesterol figure I should be concerned about is Plasma ldl cholesterol. Then it is never shown in my results. Just get “see comment”.

[Charlie-Farley]

GP's can start Yo-Yo dosing - chasing TSH, but because the TSH does not (frequently actually) agree with your wellness, they should test your thyroid hormones as a guide and put your symptoms first.

The NICE guidelines on dosing with levo suggest a Guideline dose of 1.6ug Kg. I'm 15 stones (can't remember the Kgs) and on 150ug. The guideline dose HAPPENED to work very well for me, but my TSH is far lower than 'they' would like. I have read sufficient literature to satisfy myself it is better to feel well than have a half life being dosed by TSH which would leave me immobile and ill.

TSH is unreliable on many levels and as an indirect measure a rather perplexing choice to use when the ACTUAL thyroid hormones (FT3, FT4) would be a more realistic guide along with the 'KING of diagnostics' our symptoms.

As a minimum, I would urge you to read up on the NICE guidelines for Hypothyroidism and NICE guidelines for Dosing Levothyroxine. You can find the relevant sections by a quick Google. Read carefully there's lattitude written into the guidelines but doctors are reluctant to use it as they know so little in reality. However these are their guidelines - always great to use them to pull them up!😂

There is also mention of fixing the brand - once again on first principles, I believe everyone should. It reduces the variables. If you are trying to get to a good balance, changing from one brand to another can send you out of whack. Lots of lived experience on here to attest to that (another wealth of information).

The fewer balls you are juggling to get to your sweetspot the better. Its easier to work out 'what is doing what'. It follows the same principle as when SlowDragon and SeasideSusie say introduce one vitamin at a time, so you can make sure it does not disagree with you. 🙂👍