I got my results from my GP surgery today they only tested TSH which came back at 4.14, I was told by the receptionist that its normal, no futher action required.Last GP blood test TSH was 8.5
Should I ask to speak to the doctor and ask for a increase in my levo?
I will.go and sign a form tomorrow to get a copy of blood test results
Thanks
You most certainly should. A euthyroid ('normal') TSH is around 1, and hypos usually need it lower than that, when on thyroid hormone replacement, to feel well. A TSH of 4.14, whilst is the totally unrealistic range, is very far from 'normal'.
yes, ask GP for increase based on these recommendations (some taken from GP's 'update' sources , one was written specifically for GP's by Specialist Registrars in Endocrinology and Cardiology , so there should be no argument about their validity:
healthunlocked.com/thyroidu....
~~~~~~~~~~~~~~~~~~~~
Explanation of why getting TSH 'in range' is not good enough .. the shoe size analogy :
Are you still on a starter dose of 50mcgs?
The British National Formulary (BNF) recommends:
For adults aged 18–49 years — initially 50–100 micrograms once daily; adjusted in steps of 25–50 micrograms every 3–4 weeks, adjusted according to response; maintenance 100–200 micrograms once daily.
Your TSH is far too high. Often GP's and prescribing pharmacists rely on lab comments as to whether they take action or not.
Should I ask to speak to the doctor and ask for a increase in my levo?
Yes thats exactly what you need to do. Ignore the standard message that your results are OK as they are absolutely not. Your TSH needs to be around or just under 1.
You will likely need to be insistent and best to gather some information now about keeping TSH lower - see tattybogles links. Stand firm and don't bac down. Pick the GP that you see/speak to carefully. If one won't do it, try another one.
Are you supplementing any low vitamin levels?
Have you tried a strictly gluten free diet?
so you definitely need next dose increase up 75mcg daily
As you currently are taking Accord brand levothyroxine, Accord don’t make 25mcg tablets
Request extra 50mcg tablets instead so you can stay on Accurate. Use pill cutter or sharp craft scalpel and cut tablets in half to get 25mcg
Thank you, I will contact GP this morning and update what he says.
I’ve had the exact same issue in the last few months, both my gp and push dr refuse to increase my Levothyroxine and the push dr has now sent me for lots more tests including addisons because she said my symptoms’cannot’ be my thyroid as it is in range! Yet they’re the exact same symptoms i experience every time my thyroid is out. Good luck hope you have a better experience than me but yes I do agree with all of the above, you should definitely be on a higher level of medication.
Even if we frequently start on only 50mcg, 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.
Comprehensive list of references for needing LOW TSH on levothyroxine
healthunlocked.com/thyroidu....
TSH should be under 2 as an absolute maximum when on levothyroxine
gponline.com/endocrinology-...
NHS England Liothyronine guidelines July 2019
sps.nhs.uk/wp-content/uploa...
Page 9
Test for Deficiency of any of the following: Vitamin B12, Folate, Vitamin D, Iron
See page 13
1. Where symptoms of hypothyroidism persist despite optimal dosage with levothyroxine. (TSH 0.4-1.5mU/L)
many members will have TSH below 1 when adequately treated
Graph showing median TSH in healthy population is 1-1.5
Please try to see a different GP who will listen to you or take NICE Guideline’s to them. I was left with TSH at 4’s 5’s & more at times. Always told it was normal. I was in hospital for something else & managed to bring it up & the Consultant I saw asked GP to refer me to Endocrine. When I got there I was told I had been under medicated for years! I’ve had 2 increases in Thyroxine since then. So please push the GP to listen x
GP has just rang, he said because T4 and T3 wasn't tested he can't increase levo as it might cause more problems, he said he will sent me for those blood tests, if they will do them,All a bit confusing.
I think he was saying if T3 and T4 are in range im ok, is this correct or should i still push for increase in levo to get TSH down to 1?
ok so let him do fT4 / fT3 tests .. lab probably won't agree to do fT3, but will hopefully agree to do fT4.
However , when fT4 comes back as 'somewhere within range' (which it probably will) ... you can still ask him to trial an increased dose using that list of references i gave you in my earlier reply. They apply to all patients on Levo and they DO still apply when fT4 is 'in range' .
However , if fT4 comes back right at the top of the range / or over range.. then he would have grounds to say no to an increase (but cross that bridge if/when you come to it ... fT4 is very unlikely to be top end / over range when your TSH is still so high )
Thank youBooking blood test now.
I think you definitely need an increase of Levo to bring down your TSH level.
Recently had my annual TSH blood test and it had risen from 1.1miu/L to 2.1miu/L (range 0.2-4.0) on 75mcg levo. NHS Lab notes say "Results suggest under replacement" and my GP has upped me to 87.5mcg per day (take 75 and 100 on alternate days) and re-test in 6-8 weeks. (female 73yrs)
Post TT blood results
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