Advice on blood test protocol

[woofa27]

Coming up to 6 weeks of consistent dose taking, so want to do blood test.

Current Dosing routine:

45 Erfa - 7.15am

15 Erfa - 4.00pm

1. Should I do anything different before blood test?

2. What time should I take blood test? (privately sourced blood test, so can take any time)

Thank you in advance

[PixieElv]

Hiya

It is recommended to take your last dose 8-12h before your test to get the best reading.

No Biotin for about a week before your test either.

You get your lowest TSH earlier in the morning, with people testing around 8am on an empty stomach.

I hope that helps

[woofa27 in reply to PixieElv]

Thank you PixieElv, I was just a bit worried that 2nd dose wld give misleading results, as it contains t4 as well as t3.

[PixieElv in reply to woofa27]

I’m on NDT and i generally take my last dose at 4pm and then have my test around 6 or 7 am the next morning. I know that is more than 12 hours 😂 but it works for me

[woofa27 in reply to PixieElv]

🙏 Thank you

[SeasideSusie Remembering in reply to woofa27]

woofa27

You get your lowest TSH earlier in the morning, with people testing around 8am on an empty stomach.

Just to clarify this quote from PixieElv . TSH is highest early morning and lowers throughout the day so having an early morning test will give the highest TSH not the lowest TSH.

We suggest an early morning test (no later than 9am) to get the highest possible TSH because most doctors adjust dose by TSH and the patient may end up with an unwanted reduction in dose if the TSH is low.

Image attached shows the circadian rhythm of TSH and shows 9am being the best time.

As you're on NDT your TSH is going to be low anyway (NDT lowers and can even suppress TSH) so if your doctor prescribes your NDT he should know this and dismiss your TSH result and be guided by your FT3 result.

[woofa27 in reply to SeasideSusie]

Thanks SeasideSusie! I was willing to get up in the middle of the night (as self-testing) if that would've helped! My particular endo also works for the nhs, so I'm bit concerned the tsh will influence him more than I'd like. But then, I was also worrying that my t4 and t3 levels would appear higher due to my afternoon dose - I'm basically just sitting around feeling fat, achy, knackered and paranoid, whilst worrying myself stupid about where I'm going to be told to go from here... but am appreciating all the input from all you knowledgeable, generous people here on healthunlocked 😉

[pennyannie]

Hello Woofa:

Are these blood tests for you or have you been instructed to take a test by whoever is monitoring your health issues ?

Personally I think it's too soon and think you ae not on enough of PM dose the skew any results :

The T4 takes around 6-8 weeks to fully leave the body and in tht time you slowly build up the NDT by 1/4 grain increments weekly or fortnightly until you reach, if you do, 2 grains and then stay on that dos, letting it bed in and settle, for 6-8 weeks and then run a blood test.

I only reached 1 + 3/4 grains and felt a bit uncomfortable in my skin and worse than the week before, where I felt good, so dropped down to 1 + 1/2 grains and took a blood test 8 weeks later to compare with my bench readings from on 125 mcg T4.

Obviously having Hashimoto's throws a spanner in the works for you as you are liable to erratic, own thyroid hormone production.

I am with Graves Disease and post RAI thyroid ablation so presume I now do not have any thyroid function.

For all things Hashimoto's i read people impressed with the research and findings of Dr Izabella Wentz who writes as - thyroidpharmacist.com

[woofa27 in reply to pennyannie]

Hi pennyannie!

Firstly thank you for reply and sorry for all the detail:

Originally I was told by an endo to go away for 3 months and then do a blood test, but as per usual, I messed up and was not consitent with the dose he'd put me on (30E + 25L in am; followed by 15 E at 4 in pm) and because I felt terrible, I messed around.

I've been finding it quite difficult to breathe a lot of the time and have been feeling dizzy and achy absolutely everywhere with frequent headaches/migraines from hell with really bad cramps in calves and feet (if I take my temp during one of these headaches it's about 35.6/35.7), I tend to feel esp. bad in the evenings.

Hmm, been looking back at doses:

50l+30E - 6 wks {april - mid may}.

25l + 45E - 2 wks {end of May}

25l +45E - 8 days (in total - June + July) {last 25levo - 8th July}

60E - The other days have totalled 60E in one or more doses.

Not quite as lacking in structure as it might have been, but I think you're right, it is too soon to get a meaningful blood test. For crying out loud, why is it so darn difficult to be consistent?

What does PM mean? (post mortem!!! - 'cos that's how I'm currently feeling, seriously though, I'm not sure what that stands for 🙃)

Also, sorry, I'm not quite clear what you're suggesting - Do you think that I should just continue as I am for a bit longer to get an 8 week baseline and then maybe go back to the endo (I will have to go to the endo for a further prescription for the erfa at some point in the not too distant future anyway..)? OR are you saying I should build my dose up a bit first?

I just don't want to mess things up - the 6-8 week wait kills me every time.

Thank you pennyannie

[pennyannie in reply to woofa27]

I was referring to your PM - afternoon dose - not being high enough to skew results.

I think you need to continue to build up a balanced dose both AM and PM - and try and build up to around 2 grains.

Then run a blood test to compare to your bench reading from before you started this experiment and hopefully see an increased T3 reading and relief of some, if not all of these symptoms being tolerated.

[woofa27]

😂 oh!!!! I see! yeah, I kind of feel doing the same am and pm makes more sense. Thank you for all your time and advice. 😉