BIG CHANGE IN TSH

[Shirlchristine]

Have been on 75 levothyroxin over 10 years. Felt so cold I asked for blood test which showed TSH 0.32, T3 3.55 and T4 19.3. Previous TSH six months ago was 4.44. Why such a big change?

[SlowDragon Administrator]

Was test done early morning and last dose levothyroxine 24 hours before test

Which brand of levothyroxine are you currently taking

ESSENTIAL to test folate, ferritin and B12 at least annually

Vitamin D test ideally twice year

And both TPO and TG thyroid antibodies tested at least once

TSH over 2 was too high and suggests you were not on high enough dose levothyroxine

Being on too low a dose levothyroxine frequently results in low vitamin levels due to lower stomach acid when hypothyroid, which results in poor nutrient absorption and lower vitamins as direct result

We need OPTIMAL vitamin levels for good conversion of Ft4 (levothyroxine) to Ft3 (active hormone)

Please add ranges on Ft4 and Ft3 results (figures in brackets after each result)

Ft3 looks low

[Shirlchristine in reply to SlowDragon]

Free T3 at 3.55 (2.6-5.7]

Free T4 at 19.3 (9-19)

TSH at 0.32 [0.35-4.94)

B12 was 471 and Serum Folate 18.5 (3-20)

Levothyroxin brand was the usual Teva UK

All others in range except cholesterol and EPIeGFR. I take sodium Chloride tablets for low blood pressure.

The test was taken in the morning after I had taken the levothyroxin early and had eaten breakfast .

[SlowDragon Administrator in reply to Shirlchristine]

The test was taken in the morning after I had taken the levothyroxin early and had eaten breakfast .

So Ft4 is falsely high as you took levothyroxine BEFORE test and TSH often drops after food

ALWAYS Test early morning, only drink water between waking and test and last dose levothyroxine 24 hours before test

FT3: 3.55 pmol/l (Range 2.6 - 5.7)

Ft3 only 30.65% through range

thyroid.dopiaza.org/

Most people when adequately treated will have Ft3 (active hormone) at least 50-60% through range

Low vitamin levels tend to lower TSH

High cholesterol suggests under medicated for thyroid

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.

Low GFR also indicates the same….inadequate treatment for hypothyroidism

ncbi.nlm.nih.gov/pmc/articl...

The GFR is reversibly reduced (by about 40%) in more than 55% of adults with hypothyroidism[40] due to several reasons. 

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 supplements within 2hours

Iron, magnesium, PPI, vitamin D tablets at least 4 hours away from levothyroxine

What vitamin supplements are you currently taking?

Low blood pressure suggests adrenal exhaustion, common when under medicated for thyroid

Next steps

Get FULL thyroid and vitamin testing doing correct timing. Test early morning, just before 9am and last dose levothyroxine 24 hours before test

You need vitamin D and ferritin levels tested

List of private testing options and money off codes

thyroiduk.org/getting-a-dia...

Only do private testing early Monday or Tuesday morning. 

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 vitamin D and ferritin then cheapest option for just TSH, FT4 and FT3 and includes BOTH TPO and TG antibodies -£29 

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

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...

NHS easy postal kit vitamin D test £31 via

vitamindtest.org.uk

[SlowDragon Administrator in reply to Shirlchristine]

75mcg dose levothyroxine is very low dose unless you’re extremely petite

Approximately how much do you weigh in kilo

Guidelines suggest likely eventual daily dose levothyroxine is likely to be approx 1.6mcg levothyroxine per kilo of your weight per day

Teva brand levothyroxine upsets many people

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, 

 Many patients do NOT get on well with Teva brand of Levothyroxine. Teva is lactose free.

But 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 

Teva is the only brand that makes 75mcg tablet. 

So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half

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. 

March 2023 - Aristo now called Vencamil

healthunlocked.com/thyroidu...

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.

Ideally only ever change one thing at a time otherwise you can’t tell what’s happening

Change dose or brand

[Jaydee1507 Administrator]

Can you add the ranges for each test? They vary from lab to lab so are important.

Looking at your FT3 it looks on the low side but I need to see the lab range to be sure.

I certainly found that with a low FT3 my TSH varied.

Do you always get the same brand of Levo at every prescription?

What were your latest results for ferrritin, folate, B12 & D3?

What supplements are you taking?

When hypo we get low stomach acid which means we cannot absorb vitamins well from our food, regardless of a great diet. For thyroid hormone to work well we need OPTIMAL levels of vitamins. Have you recently or could you ask your GP to test levels of ferritin, folate, B12 & D3? Private tests are available, see link for companies offering private blood tests & discount codes, some offer a blood draw service at an extra cost. thyroiduk.org/help-and-supp...

Did you do the test as per the protocol recommended here? Recommended blood test protocol: Test at 9am (or as close as possible), fasting, last levo dose 24hrs before the blood draw, last T3 dose 8-12 hours before blood draw & no biotin containing supplements for 3-7 days (Biotin can interfere with thyroid blood results as it is used in the testing process)? Testing like this gives consistency in your results and will show stable blood levels of hormone and highest TSH which varies throughout the day. Taking Levo/T3 just prior to blood draw can show a falsely elevated result and your GP/Endo might change your dose incorrectly as a result.

[SlowDragon Administrator]

Low blood pressure

Suggest you consider getting adrenal levels tested eventually

But first get levothyroxine and vitamins optimal

looking at previous post 6 years ago your dose was increased to 100mcg

When was it reduced back to 75mcg

Adrenal testing

regeneruslabs.com/products/...

portal-app.inspira-regeneru...

[Shirlchristine in reply to SlowDragon]

I weigh 67 kilos. I went up to 100mcg for a short time after I had been on ketogenic diet which did not seem to suit me. Now been on 75mcg for several years. Have been very stressed recently as my husband has Parkinson’s disease.

[SlowDragon Administrator in reply to Shirlchristine]

come back with new post once you get further test results

Keto diet can badly affect conversion of Ft4 to Ft3

[Shirlchristine in reply to SlowDragon]

Last week’s blood test showed TSH 0.06 and T4 19.4. I am still getting low basal temperatures around 35.4. They have booked me another blood test for mid-June. No change to thyroxin as yet.

[SlowDragon Administrator in reply to Shirlchristine]

B12 was 471

Serum Folate 18.5 (3-20)

how long ago were these tests done

What vitamin supplements are you currently taking

Please add vitamin D and ferritin results

Levothyroxine brand was the usual Teva UK

Teva brand upsets many people

Are you lactose intolerant and/or on lactose free diet

Next step get full thyroid testing done yourself

Test early Monday or Tuesday morning, last dose levothyroxine 24 hours before test