Recent blood test results are:
Serum free T4 level 14.2 pmol/L [12.0 - 22.0]
Serum TSH level 2.18 mU/L [0.27 - 4.2]
I realise I am within range but thinking the Serum free T4 is getting a bit close to the low side. Does anyone know if this indicates anything? I guess I am wondering if it suggests I am heading for needing an adjustment to my Levothyroxine....
Thank you.
Most feel well with TSH around 1 & this is where a healthy TSH tends to lie.
The FT4 in upper 3rd of range & FT3 at least half way.
How do you feel? If well the level might be suitable for you but if you think you’d benefit from a better level there’s lots of room in range for TSH to drop & FT4 to rise.
Increase by 25mcg per day & repeat test in 6 weeks. You might want to consider private options to include FT3 results & key nutrients to see where FT3 is.
How much levothyroxine are you currently taking
Do you always get same brand levothyroxine at each prescription
Your results suggest you likely need dose increase
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
plus both TPO and TG thyroid antibodies tested at least once
Very important to test vitamin D, folate, ferritin and B12 at least once year minimum
what vitamin supplements are you currently taking
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)
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...
Monitor My Health also now offer thyroid and vitamin testing, plus cholesterol and HBA1C for £65
(Doesn’t include thyroid antibodies)
monitormyhealth.org.uk/full...
10% off code here
thyroiduk.org/getting-a-dia...
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...
I think I do get the same brand. At least they told me that when I asked some time ago but they wouldnt contact me if there were ever a brand change . Regarding blood tests, I have just had some , not all you mention, and as you seem aware of, I had to fight tooth and nail to get them done.
was test early morning and last dose levothyroxine 24 hours before test
Which brand of levothyroxine is 125mcg
Appox how much do you weight in kilo
Do you have hypothyroid symptoms?
Did you get vitamin levels tested
Tests were done around lunch time, I did not take Levo that morning so probably was 24 hours from last dose, Brands are TEVA Levo 25mcg and MERCURY Levo 100mcg- I dont know my weight in Kilos- I block it out my mind 
-It is hard to say which symptoms I have are related as I do not get enough sleep and thus am always tired but I do have quite a few other symptoms. To be honest I havent felt great since diagnosis so I find it difficult to tell what's causing what if you know what I mean. My weight is an issue and I can't really seem to shift it. I am not totally dedicated I suppose but I walk my dog every day, at least a mile, usually more. I eat healthy though I must obviously be eating more than I expend or I wouldnt be overweight. I had my serum b12 tested recently which was very good though I know with B12 that test does not ell the whole story. I had my Zinc level tested some months ago and it was within range. She has not checked the vit D nor the iron though she says the full blood count would show sings if I were having a iron issue?
Teva brand levothyroxine upsets many many people
Make sure you get Mercury Pharma 25mcg next time
Many people find Levothyroxine brands are not interchangeable.
Most easily available (and often most easily tolerated) are Mercury Pharma or Accord
Mercury Pharma make 25mcg, 50mcg and 100mcg tablets
Mercury Pharma also boxed as Eltroxin. Both often listed by company name on pharmacy database - Advanz
Accord only make 50mcg and 100mcg tablets
Accord is also boxed as Almus via Boots, and Northstar 50mcg and 100mcg via Lloyds ....but Accord doesn’t make 25mcg tablets
beware 25mcg Northstar is Teva
Northstar levothyroxine being phased out this month
Many patients do NOT get on well with Teva brand of Levothyroxine. Teva is lactose free.
Teva contains mannitol as a filler instead of lactose, which seems to be possible cause of problems. Mannitol seems to upset many people, it changes gut biome
But for some people (usually if lactose intolerant, Teva is by far the best option)
Aristo (currently 100mcg only) is lactose free and mannitol free.
Wockhardt is very well tolerated, but only available in 25mcg tablets. Some people remain on Wockhardt, taking their daily dose as a number of tablets
List of different brands available in U.K.
thyroiduk.org/if-you-are-hy...
Posts that mention Teva
healthunlocked.com/search/p...
Teva poll
healthunlocked.com/thyroidu...
Once you find a brand that suits you, best to make sure to only get that one at each prescription.
Watch out for brand change when dose is increased or at repeat prescription.
Government guidelines for GP in support of patients if you find it difficult/impossible to change brands
gov.uk/drug-safety-update/l...
If a patient reports persistent symptoms when switching between different levothyroxine tablet formulations, consider consistently prescribing a specific product known to be well tolerated by the patient.
academic.oup.com/jcem/artic...
Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).
Thank you very much for this information. I did ask the pharmacist (I use an online chemist) what the ingredients were in my Levo but never received a reply. I wrote them again yesterday so am hoping to hear soon. I was not aware the meds contain lactose. I am vegan, so would prefer a med without animal products if at all possible.
Only Teva and Aristo are lactose free
Aristo only available as 100mcg tablets at moment and not widely available
You need to test vitamin D, folate, ferritin and B12 at least annually
Down to us to maintain OPTIMAL vitamin levels
Monitor My Health also now offer thyroid and vitamin testing, plus cholesterol and HBA1C for £65
(Doesn’t include thyroid antibodies)
monitormyhealth.org.uk/full...
10% off code here
thyroiduk.org/getting-a-dia...
Do you have autoimmune thyroid disease (hashimoto’s)
Are you on strictly gluten free diet/dairy free diet
I forgot say I did get the folate. It was within nornal but at the very low end. I have asked numerous times for Ferritin and keep being told I don't need it as the other tests would suggest if there were an issue with iron. 
I did ask for vitamin D also but it was not until I got the results that i saw they didn't do it. I have Hashimoto's. I am vegan so I am dairy free but I am not gluten free.
With Hashimoto’s it’s essential to test vitamin D, folate, ferritin and B12 at least annually
As vegan you will need to do full iron panel test at least annually
Do iron panel test early morning and fasting
Stop iron supplements 5-7 days before test
Medichecks iron panel test
medichecks.com/products/iro...
Down to you to ensure your vitamin levels are optimal
Exactly what vitamin supplements are you currently taking
I have been vegan for years- iron has never been a problem with regard to diet though of course we can all develop an absorption issue at any time I suppose. I do try hard to keep an eye on vits and minerals. I always try to get them from food sources so I add seeds/nuts etc to foods. I take Together Health Vegan Multi and Testa omega 3. I have been tested for coeliac's several times and always comes back neg but could be benficial to try eliminating it anyway.
What was your most recent ferritin result?
Unfortunately our ability to view the past blood tests results online is limited to 60 days. I can not remember the number. I am going to request the ferritin and vit D to be checked again though as it is probably about time.
Always a good idea to keep spreadsheet of all your results over time
Ferritin at least over 70 and nearer 100 better
A trial of strictly gluten free diet is always worth doing
Only 5% of Hashimoto’s patients test positive for coeliac but a further 81% of Hashimoto’s patients who try gluten free diet find noticeable or significant improvement or find it’s essential
Approx 50-60% Hashimoto’s patients find dairy free beneficial
Hashimoto’s and leaky gut often occur together
Both dairy and gluten are inflammatory foods
Hi. I agree with PurpleNails . Your levels wouldn't suit everybody as some would not feel well, but it's how you feel that really matters. If you've got symptoms and don't feel well then your levels would suggest there's room to try an increase in dose.
Thank you everyone. The test results say "normal, no further action required" and I am guessing it is just that GP's are not that interested if the numbers fall within range, even if close to the edge. I have been having some issues which are why I had an appt. in the first place. Despite that, the results are marked with "normal, no further action required" by the GP. I currently take 125mg per day and have done for a long time.
So you think an increase of 25 mg per day is a safe increase dose to try?
This post has a useful list of recommendations advising GP's to keep TSH between 0.4/ 0.5 and 2/ 2.5 in patient on levo .. some are taken directly from Uk GP's 'update' sources, and one is written specifically for GP's by NHS Specialist Registrars in Cardiology and Endocrinology... so there should be no argument about the validity of the recommendation.
*edit ~So it can be used to support a request for an increase as long as it doesn't take TSH below 0.5ish ..(and of course they don't know if TSH will go lower than that or not, unless they agree to "a trial increase to se if it improves your symptoms" )
healthunlocked.com/thyroidu.... my-list-of-references-recommending-gps-keep-tsh-lower-
personally , i now think it's smarter to increase/ decrease by just 12.5mcg and give that a try for 3 or 4 months rather than going up / down by 25mcg all at once.
for me 12.5mcg is enough to have a definite impact on how i feel and also an impact on TSH level. ,, and 25mcg has sometimes proved to be to much/ or too little and has then had to be adjusted back by 12.5mcg anyway .
although if requesting an increase from the GP, then by all means ask for the full 25mcg increase and just split the tablets in half to get 12.5mcg (or take alternate daily doses of 125/ 150mcg ~ which evens out over the week to 137.5mcg and is common prescribing practice )
.. that way you will build up a useful buffer of spare tablets in case you do later want to fine tune your dose further.
12.5mcg tablets are extremely expensive compared to all the other sizes,( £13 as opposed to £1) and they are only made by TEVA which some people don't get on with anyway. So not much point asking for 12.5mcg tablets from GP.
Thank you very much- I will do that. And thank you for the link which will be very helpful!
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