TSH Results

[Carri3]

I have been on thyroxine for many years and have been on 50 mcg`s alternating with 75mcg`s, for most of the time TSH was 2.32 (Doctor said this is OK) but I'm not feeling OK. My cholesterol is borderline high so I have improved my already good diet to add more Oats & grains etc etc. He said my general health was very good for my age (72). I am seeing another Doctor in the same practice soon and am going to ask him if he would increase the dose of thyroxine by 25mcgs I think this is a reasonable request, do you agree?

[SlowDragon Administrator]

Welcome to the forum

How long ago was this test?

Was it done early morning

Suggest you request new thyroid test including Ft4 and Ft3 first

Plus vitamin D, folate, ferritin and B12 levels tested

Are you currently taking any vitamin supplements

Do you know if cause of your hypothyroidism is autoimmune thyroid disease, also called Hashimoto’s, usually diagnosed by high thyroid antibodies

ALWAYS book early morning test, ideally just before 9am and last dose levothyroxine 24 hours before test

This gives highest TSH and lowest Ft4

Do you always get same brand levothyroxine for 50mcg and 75mcg

Initially suggest you request increase dose to 75mcg daily

Retest again 8-10 weeks after increasing

Come back with new post once you get results

If GP won’t test …..test privately

[Carri3 in reply to SlowDragon]

Thank You for your advice Slow Dragon, I was tested only 3 weeks ago at around midday, no fasting and took my thyroxine that morning at 7.30am. I will ask the Doctor to test all that you suggested and get a fasting test at 9am, skipping thyroxine that morning until after the test.

[SlowDragon Administrator in reply to Carri3]

TSH has a significant daily rhythm and is highest early morning

Testing at 9am likely TSH would have been over 3

Just testing TSH is inadequate

Request GP either increase levothyroxine to 75mcg daily and retest thyroid and vitamins in 6-8 weeks

Or if they won’t increase levothyroxine now …..request full thyroid including Ft4 and Ft3 plus vitamin testing now

ALWAYS Book early morning blood test. Don’t say why, just that it’s convenient/only time you can do it.

[Carri3 in reply to SlowDragon]

Thanks again, I will let you know the results

[SlowDragon Administrator]

Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine

If been left under medicated a long time, very likely low vitamin levels

Low vitamins tend to lower TSH

 

For full Thyroid evaluation you need TSH, FT4 and FT3 tested 

Also 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

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 

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...

[tattybogle]

Hi Carri3 . put this list of recommendations for GP's to keep TSH between 0.4/0.5 and 2/2.5 for patients on Levothyroxine, under the GP's nose healthunlocked.com/thyroidu...

particularly the one that says " *note , this one clearly states that raised cholesterol.... etc"

Some were taken directly from UK GP's 'update' sources .. and * that one was written specifically for GP's by NHS Specialist Registrars in Cardiology and Endocrinology .. so there should be no question of the safely of those recommendations .

So , since they all say "if TSH is not lower than 0.5 on levo , there is no concern" , then your GP has no reason not to try a dose increase to see if it a) improves your symptoms , and b) lowers your cholesterol.

A GP does not know that a dose increase will take TSH lower than 0.5 unless they try it.. and if TSH is over 2 there is clearly plenty of room to try it.

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

Make sure you do all future thyroid blood tests early morning ..as close to 9 am as you can get ~ this give the highest TSH level for the daytime .

Also make sure you take the last dose of Levo 24 hours before the test ,, and take that days dose straight after the test ...... This gives a true fT4 result ~ if the last dose is taken too close to the test ,the fT4 result would be artificially high because it is absorbed into the blood at once .

Also its best to wait until after the test to have breakfast , as eating breakfast can lower the TSH too .

Links to the studies which show why this is best practice for thyroid testing are in replies further sown that post .

NHS do not accept it makes any significant difference , so they wont usually offer 9am blood appointments for thyroid testing ... often the only way to get an early morning slot for thyroid blood tests is to say you can't come at a later time as you have to be at work ....

[tattybogle in reply to tattybogle]

perhaps be cautious ,,and ask to try an increase to 75mcg every day first ?

[Carri3 in reply to tattybogle]

Thank You, You have been most helpful.