Help with test results please: Hi, I had a... - Thyroid UK

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Help with test results please

Vivirose profile image
6 Replies

Hi, I had a parathyroidectomy in January.

Post op blood test in February had my TSH at 22.64 mU/L (range 0.35-5.5) & my T4 10.7 pmol/L (range 10.5-21.0)

I was put on 50mg levothyroxine & retested in May.

TSH had come down to 9.54 mU/L (range 0.35-5.5) & T4 was14.0 pmol/L (range 10.5-21.0)

GP has said he'd review in August which is when next blood test is due.

I've felt OK but in June I developed wandering thigh pains & leg cramps in both legs. Feels like sciatia. My tendency to constipation is worse. I had a private test. The results as in the picture above.

The test was done at 9am & 26 hours after my last levo pill as you suggest.

The May NHS blood test was 4 hours after levo pill.

My levo pill has always been Accord but my latest prescription (after private test) is mercurypharma.

Any advice on what the private test means would be very welcome. As a newbie I'm still learning. Thank you in advance.

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SlowDragon profile image
SlowDragonAdministrator

TSH had come down to 9.54 mU/L (range 0.35-5.5) & T4 was14.0 pmol/L (range 10.5-21.0)

GP has said he'd review in August which is when next blood test is due.

Make an appointment with different GP

Levothyroxine should have been increased by 25mcg in May after this test

Bloods retested 6-8 weeks after each increase

This continues until TSH is ALWAYS below 2

Most important results are always Ft3 followed by Ft4

Looking for Ft3 (active hormone) at least 50-60% through range

Ft4 (levothyroxine) usually a bit higher

Typically TSH will be around one or less

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)

Graph showing median TSH in healthy population is 1-1.5

web.archive.org/web/2004060...

Vivirose profile image
Vivirose in reply toSlowDragon

Thanks for your excellent advice. I’m shocked my GP is so little informed & will ask for my medication to be upped.

SlowDragon profile image
SlowDragonAdministrator in reply toVivirose

guidelines on dose levothyroxine by weight

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.

SlowDragon profile image
SlowDragonAdministrator

What’s the specialists advice on maintaining optimal vitamin D after parathyroidectomy

Normally with Low vitamin D

GP should prescribe 1600iu everyday for 6 months

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...

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...

SlowDragon profile image
SlowDragonAdministrator

B12 and folate too low as well

Low B12 symptoms

b12deficiency.info/signs-an...

methyl-life.com/blogs/defic...

With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a separate B12 supplement and a week later add a separate vitamin B Complex 

Then once your serum B12 is over 500 (or Active B12 level has reached 70), you may be able to reduce then stop the B12 and just carry on with the B Complex.

If Vegetarian or vegan likely to need ongoing separate B12 few times a week

B12 drops

natureprovides.com/products...

Or

B12 sublingual lozenges

uk.iherb.com/pr/jarrow-form...

cytoplan.co.uk/shop-by-prod...

B12 range in U.K. is too wide

Interesting that in this research B12 below 400 is considered inadequate

healthunlocked.com/thyroidu...

Low folate

supplementing a good quality daily vitamin B complex, one with folate in (not folic acid)

This can help keep all B vitamins in balance and will help improve B12 levels too

Difference between folate and folic acid

healthline.com/nutrition/fo...

B vitamins best taken after breakfast

Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule)

Thorne currently difficult to find at reasonable price, should be around £20-£25. iherb.com often have in stock. Or try ebay

Other options

healthunlocked.com/thyroidu....

IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate folate supplement (eg Jarrow methyl folate 400mcg) and continue separate B12

Post discussing how biotin can affect test results

healthunlocked.com/thyroidu...

SlowDragon profile image
SlowDragonAdministrator

Reading your short profile

An ultrasound picked up a thyroid nodule. Fine needle aspiration didn’t get enough cells for a biopsy so I had a hemitbyroidectomy to confirm diagnosi

I think you mean you had a hemi thyroidectomy…….not parathyroid tumour removed

There are 4 parathyroid glands in centre of thyroid. They control bone metabolism. Nothing to do with thyroid…..other than located in centre of thyroid

When thyroidectomy is performed, the surgeon will always try to leave parathyroid glands in place

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