Can you advise re Test results TSH 21 T4 17.9 what does this mean? Do I need to up Levothyroxin or lower it

[Fortie]

Test Results TSH 21 T4 17.9

[tattybogle]

Hi , we need more information to answer that :

what dose of thyroid hormone were you taking for the 6 weeks before this test ?

Were you taking it every day consistently ?

How many hours before the test did you take the last dose of thyroid hormone ?

Do you know the lab range for that fT4 result ? it should be after the result in brackets.

Are you taking anything else ?

[Fortie in reply to tattybogle]

currently taking 175 levothyroxin daily - before oct 22 was on 150 levo but was upped as Dr said I needed to in Oct 22. Test last week was a fasting blood test and I did not take any levo on that morning. I also take Nizatadine for chronis Gastitis (has Gastritis for years)

[SlowDragon Administrator in reply to Fortie]

 I also take Nizatadine for chronis Gastitis (has Gastritis for years)

So do you always take levothyroxine on it’s own on empty stomach and then nothing apart from water for at least an hour after

No other medication or vitamin supplements within 2 hours minimum

You need folate and B12 levels tested

Serum Total 25-OH Vit D Level 21nmol/L

Vitamin D is deficient

GP should prescribe LOADING Dose vitamin D

That’s total of 300,000iu vitamin D over 6-8 weeks

NHS Guidelines on dose vitamin D required

ouh.nhs.uk/osteoporosis/use...

GP will often only prescribe to bring vitamin D levels to 50nmol.

Some areas will prescribe to bring levels to 75nmol or even 80nmol

leedsformulary.nhs.uk/docs/...

GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)

mm.wirral.nhs.uk/document_u...

But with Hashimoto’s, improving to around 80nmol or 100nmol by self supplementing may be better

pubmed.ncbi.nlm.nih.gov/218...

vitamindsociety.org/pdf/Vit...

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

Test twice yearly via NHS private testing service when supplementing 

vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function.

There’s a version made that also contains vitamin K2 Mk7. 

One spray = 1000iu

amazon.co.uk/BetterYou-Dlux...

Another member recommended this one recently

Vitamin D with k2

amazon.co.uk/Strength-Subli...

It’s trial and error what dose we need, with thyroid issues we frequently need higher dose than average

Vitamin D and thyroid disease 

grassrootshealth.net/blog/t...

Vitamin D may prevent Autoimmune disease 

newscientist.com/article/23...

Web links about taking important cofactors - magnesium and Vit K2-MK7

Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Interesting article by Dr Malcolm Kendrick on magnesium 

drmalcolmkendrick.org/categ...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

[Fortie in reply to SlowDragon]

Many Thanks for your reply. I have to wait until the 06.03.023 before I can get a Docs tel call appt to discuss. I will read the article links. I was a bit perplexe by the test result of TSH level on the 3.02.23 test. It is showing as 0.08 - what does this mean ?

[SlowDragon Administrator in reply to Fortie]

GP will quite likely just look at very low TSH and want you to reduce dose

BUT your terrible vitamin levels will be lowering TSH

Suggest you say you’re not reducing dose as currently improving very low vitamin levels

Extremely common on levothyroxine to need to supplement vitamin D, magnesium and vitamin B complex continuously to maintain optimal vitamin levels

Levothyroxine is Ft4 - storage hormone

Active hormone is Ft3

To convert Ft4 to Ft3 we need GOOD vitamin levels

[Fortie in reply to tattybogle]

sorry - may have misled you - just checked and the T4 was 15.9 not 17.9 as stated - my typo error

[tattybogle in reply to Fortie]

ok ,, so the TSH is very high which usually indicates your GP needs to increase the Levo dose again.

can you see the [lab range] for that fT4 result .. ?

[Fortie in reply to tattybogle]

i dont have the lab range - booked a GP tel call appt to discuss. Many thanks for your help

[Fortie in reply to tattybogle]

Hi

I now have sight of my Test results for 03.02.2023 :

Serum free T4 15.9 (7.9-14.4) Abnormal

Serum Total 25-OH Vit D Level 21nmol/L

Serum TSH Level 0.08 mLU/L (0.38-5.33 ) Abnormal

Serum Lipids

Serum Cholesterol 5.1 mmol/L

Serum Triclg 1.5 mmol/L

Serum HDL Cholesterol 1.4 mmol/L

Serum Cholestrerol HDL Ratio 3.6

Serum LDL Cholesterol 3.0

Se non HDL Chol Level 3.7

The previous test in Aug 22 was as follows:

Serum TSH Level 4.5 (0.27-4.2) Abnormal

Serum Ferritin 130 ug/L (30-470)

Serum Sodium 142mmol/L (133-146)

Serum Potassium 4.1 mmol/L (3.5 - 5.3)

Serum Creatinine 72 umol/L ( 45-84)

EGFR (CKD-EPI) 1.72m*2 75ml/min

Haemoglobin estimation 152g/l (120-150 ) Abnormal

There are a few others but thought this would be enough for you to advise.

Many Thanks

[tattybogle in reply to Fortie]

ah OK , so the title of this post was incorrect , your TSH was not 21 it is 0.08 , so you need to ignore any previous replies you received about needing a Levo dose increase

free T4 15.9 (7.9-14.4) Abnormal

TSH 0.08 (0.38-5.33 ) Abnormal

Because your TSH is actually low not high , and because your fT4 is a bit over range , your GP will probably suggest a slight reduction in your levo dose now based on these TSH /fT4 results .

You were previously taking 150mcg which looked like it was not enough ..and 175mcg appears to be a bit too much going but the fT4/TSH results ..so a small reduction to half way between would be the intelligent thing for GP to try next ... 137.5mcg ( 150mcg one day /175 the next/ alternate ........... but results are not everything.... it is equally important to consider how you feel on this current dose .

Also this is important to know ~ how long a gap did you leave between taking the last dose of Levo and taking this blood test ?

[Fortie in reply to tattybogle]

Many Thanks - yes the receptionist gave me incorrect dtls - I have now arranged to view my results on mu patient access a/c. TSH 0.08.

I have been feeling better on the new dose - no brain fog more alert = I had also change my diet in that I am not eating thing with fat - replaced with good fats nuts /olive spread etc as there had prev been an up on the Trigl choesterol. but just this week I am feeling a chest discomfort which is usually an indication I might be over medicated - I have been wrong in the past but the test result looks to indicate this might be the case. Doc did mention might be between doses but asked me to take the +25 taking to 175 daily as I was feeling breathless /no energy /bone pain etc and I have seen the diff and had felt much better until this week.

[tattybogle in reply to Fortie]

probably a good idea to try 150 / 175 alternate days then ( or 162.5 each day if you prefer ~by cutting a 25 in half each day )

[Fortie in reply to tattybogle]

Many thanks - I will try that👍

[Fortie]

sorry - may have misled you - just checked and the T4 was 15.9 not 17.9 as stated - my typo error

[Regenallotment]

Just checking is TSH 21 or 2.1?

[Fortie in reply to Regenallotment]

Hi - the receptionist stated figs as 21 and 15.9 so not sure . Will need to check with GP now. Thanks

[Regenallotment in reply to Fortie]

ask them for the ranges in brackets too, that will help x

[SlowDragon Administrator]

ALWAYS get printed copies of results (avoids mistakes)

Just testing TSH and Ft4 is completely inadequate

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

What vitamin supplements are you currently taking

Request GP test vitamin levels

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

NHS no longer tests Ft3 routinely

Very likely You will need to test privately

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

plus test both TPO and TG thyroid antibodies tested at least once

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...

monitormyhealth.org.uk/

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 

[Fortie in reply to SlowDragon]

Thank you - that was very informative - will check for a printed result and research - not currently taking any vitamins

[Fortie in reply to SlowDragon]

Hi

I now have sight of my Test results for 03.02.2023 :

Serum free T4 15.9 (7.9-14.4) Abnormal

Serum Total 25-OH Vit D Level 21nmol/L

Serum TSH Level 0.08 mLU/L (0.38-5.33 ) Abnormal

Serum Lipids

Serum Cholesterol 5.1 mmol/L

Serum Triclg 1.5 mmol/L

Serum HDL Cholesterol 1.4 mmol/L

Serum Cholesterol HDL Ratio 3.6

Serum LDL Cholesterol 3.0

Se non HDL Chol Level 3.7

The previous test in Aug 22 was as follows:

Serum TSH Level 4.5 (0.27-4.2) Abnormal

Serum Ferritin 130 ug/L (30-470)

Serum Sodium 142mmol/L (133-146)

Serum Potassium 4.1 mmol/L (3.5 - 5.3)

Serum Creatinine 72 umol/L ( 45-84)

EGFR (CKD-EPI) 1.72m*2 75ml/min

Haemoglobin estimation 152g/l (120-150 ) Abnormal

There are a few others but thought this would be enough for you to advise.

Many Thanks

[playtime2]

Your Endo should give you YOUR target TSH level. Increasing or decreasing your dose then follows from that. Everyone is different and MY TSH target would most likely not be yours.

[playtime2]

We can not tell you what you might want to try without knowing from your doctor what your target TSH number is. Everyone is different. Your doctor knows what your target numbers should be and how to get you there. This forum is GREAT for many things but not for giving you your traget numbers.

[Fortie in reply to playtime2]

Many Thanks for the info

[SarahJane1471 in reply to playtime2]

I have never heard about a “target” TSH. We are all different. Please can you explain where you have been told/read that a GP/endocrinologist states there should be a “target” TSH?