early morning blood test

[Daff0dil]

I have a check up blood test for 8.30 am Uk time and have spent ages trying to find the information I think(!) I read some time ago that I should not take my Levothyroxine 50mg before I am tested. This is something I have not done before so am seeking some reassurance that this is the correct thing to do my last dose was early yesterday morning about 24 hours ago. Is there anybody who can confirm or direct me to the response on here please, and yes I realise I have left this a bit late but I didn’t think it would be so difficult to find! Thanks

[Lalatoot]

Daff you can do what you want as long as you interpret your results correctly.If you dose once a day, leaving a gap of 24 hours means that you will get a measure of around the lowest level your ft4 gets. This can be helpful for getting a levo increase

If you leave 12 hours between dose and test you get average ft 4 level.

Test 2 to 4 hours after dose you get highest ft4 level which doesn't really reflect the levels you have the rest of the day .

Once you decide what to do it it's useful to always test with the same gap so results can be compared over time.

[Daff0dil in reply to Lalatoot]

Ah ok thanks. Got that so it would be difficult to make a direct comparison to any previous tests now., but it will be interesting to see if there is a massive difference. Thanks for fast response.

[SlowDragon Administrator]

50mcg is only the standard STARTER dose levothyroxine

How long have you been left on just 50mcg

See what results from GP show.

Frequently they only test TSH which is completely inadequate

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 

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...

Just Thyroid includes BOTH TPO and TG antibodies -£49

randoxhealth.com/at-home/Th...

If you can get GP to test vitamins and thyroid antibodies 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. 

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...

[Daff0dil in reply to SlowDragon]

Thanks for all the information Slowdragon. I was diagnosed back in October 2017 and following my insistence on further checks last March 2022 when I felt particularly tired and drained they discovered (not unusually I have since learnt, that I was short of Vitamin D).

At this point I attempted to collate all the test results that I could find (see attached) to try to help myself. I had already decided that the ectopic heartbeats that I had long before my thyroid diagnosis were probably linked, although cardiology did not make much of this having thankfully established that it was nothing sinister. They tried me on a beta blocker (Bisoprolol Fumarate 1.25mg daily) in September2017 which was before my thyroid diagnosis and I stopped it after 4 days as I felt like I was walking through treacle and actually for the first time in my life burst into tears in my now retired GP’s room. Ihave since been given Sotalol 40 mg twice a day. I only take one of these in the morning now, not under medical advice because despite informing my new current GP I don’t think my ectopic beats is a cardiac priority. Ihave since learnt what to avoid such as caffeine and manage it.

I can see from your list that I have not had all the tests you recommend and this may be where I go following the blood test I had yesterday which was early morning with Levothyroxine about 24 hours prior. Hopefully the patchy list of results I have will be clearer following the move to a new GP and subsequent crash of the online records that I could not access last year. The May 2022 information had to be requested as a hard copy and was a real faff to get. The nurse yesterday assured me it was now all sorted so-onwards! Thank you again for the advice and reading my loooong post.😊

Results

[SlowDragon Administrator in reply to Daff0dil]

Results in May last year showed you needed dose increase in levothyroxine

On levothyroxine TSH should always be below 2

Most people, when adequately treated will have TSH around or under 1 and Ft4 at least 60-70% through range

FT4: 14.2 pmol/l (Range 11 - 23)

Ft4 only 26.67% through range

[Daff0dil in reply to SlowDragon]

Thankyou. I will post my results which will hopefully be online in a few days if you wouldn’t mind looking over them? Also thought I may need to address the Serum ferritin which is on the low side.Probably because I returned to a Pescatarian diet summer 2019, although I am almost vegetarian tbh. Thanks again

[Daff0dil in reply to SlowDragon]

My results have come through online quickly and I am surprised they have not retested for vitamin D which I thought was supposed to be checked.

This is the second time there are some issues with my liver now. I am going around in circles. Is this all to do with not having my Levothyroxine increased from 50g when I was first diagnosed back in October 2017. Any thoughts please?

Data

[SlowDragon Administrator in reply to Daff0dil]

FT4: 14.5 pmol/l (Range 11 - 23)

Ft4 only 29.17% through range

you need dose increase in levothyroxine to 75mcg daily

Which brand of levothyroxine are you currently taking

Don’t change brand when increasing dose

Initially suggest 50mcg and 75mcg alternate days for 6 weeks before increasing to 75mcg daily

Retest 8 weeks later

Meanwhile test vitamin D, folate, ferritin and B12

[Daff0dil in reply to SlowDragon]

Thank you I will get an appointment with GP to address these points. I am currently taking Accord Levothyroxine, and have had some changes over the year but had this for a long time now.

[SlowDragon Administrator in reply to Daff0dil]

So Accord don’t make 25mcg tablets

Request extra 50mcg tablets per month and cut in half to get 25mcg

Initially you could cut in 1/4 to add 12.5mcg daily for 6 weeks, before increasing to 25mcg daily

[SlowDragon Administrator]

 guidelines on dose levothyroxine by weight

Even if we frequently don’t start on full replacement dose, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near full replacement dose

NICE guidelines on full replacement dose

nice.org.uk/guidance/ng145/...

1.3.6

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

Also here 

cks.nice.org.uk/topics/hypo...

pathlabs.rlbuht.nhs.uk/tft_...

Guiding Treatment with Thyroxine: 

In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months. 

The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).

The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range. 

……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.

The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.

[Daff0dil]

Thanks for the information. GP is carrying out further blood tests, including liver.