Advice and explanation pls

[Charlie27612]

I've had hashi's for 30 + years, last few years my thyroxine dose has been increased then reduced a few times. I had to wait 5 weeks for my bi-annual blood test got the results today, TSH mu/l 0.29 free t4 p/mol 19.0 and a text from gp of a telephone appt in 4 wks time 🙄 I am taking 125mcgs daily for last 7 months before that it was 100mcgs one day 125mcgs the next. My previous results were TSH 3.34 free t4 17.3 . Am I over medicated ? I should mention I have pernicious anaemia so on b12 injections also had very low vit d, so also treating that last 2 months (under a private dr for b12 and vit d ) in case there is any relevance as PA and hashi's are autoimmune diseases

[Jaydee1507 Administrator]

Welcome to the group. If you could complete your profile it helps members understand your thyroid journey so far and be able to advise you better. Click on your image icon to start. Fill out the free text box at the top.

Could you add reference ranges for each test? This is important as they vary from lab to lab.

What time of day was this blood test taken? Highest TSH is at 9am or earlier. Later in the day will result in a lower TSH.

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.

What was your latest folate result?

I highly doubt your overmedicated.

How do you feel?

[Charlie27612 in reply to Jaydee1507]

I had the test at 9am before any food drink or thyroxine, lab ranges for TSH 0.35 --5.50 t4 10.5---- 21.0

[Charlie27612 in reply to Charlie27612]

Sorry folate was 39.95 I take 5mgs every other day with my b12 injections

[Jaydee1507 Administrator in reply to Charlie27612]

Free T4 (fT4) 19 pmol/L (10.5 - 21) 81.0%

Obviously we don't have the full picture here because there is no FT3 result. FT3 is the active hormone and not everyone converts levo to T3 well.

How are you?

If you feel well and better on this dose I would strongly argue to stay on it. There are several posts pinned in the group that give evidence of keeping TSH lower and NICE guideline quotes to give to your GP.

Your folate is good.

[Charlie27612 in reply to Jaydee1507]

My gp never has tested my t3 , I feel okish, hard to tell as in early stages of b12 for pernicious anaemia and increased my vit d 2 months ago, d3 100ug + k2 1 daily I'm having private blood tests to check ferritin, folate and vit d every 4 /6 months a lot of my symptoms have improved especially the aches and tiredness

[Jaydee1507 Administrator in reply to Charlie27612]

In that case I'd recommend adding a full thyroid panel to your next private tests - TSH, FT4 & FT3. You may find it cheaper doing that yourself rather than via a private doctor.

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...

There is also a new company offering walk in (includes free blood draw) & mail order blood tests in London, Kent, Sussex & Surrey areas. Check to see if there is a blood test company near you. onedaytests.com/products/ul...

Only do private tests on a Monday or Tuesday to avoid postal delays.

[Charlie27612 in reply to Jaydee1507]

I do the tests through medichecks and private dr reviews the results as it is cheaper that way

[Charlie27612 in reply to Charlie27612]

I just wondered why the gp wanted a telephone appt with me, after these results ? I havent had much luck with this gp hence why I had to seek private treatment which enabled me to start treatment for my pernicious anaemia earlier than the nhs were going to, I felt like I was dying literaly and they put EVERYTHING down to my thyroid. I know symptoms of all 3 things cross over so its hard to know whats causing what

[SlowDragon Administrator]

essential to test TSH, Ft4 and Ft3 together

Test vitamin D twice year when supplementing

How much vitamin D are you taking

Important to test ferritin and folate at least annually too

As you have B12 injections it’s recommended also to supplement a good quality daily vitamin B complex, one with folate in (not folic acid)

This can help keep all B vitamins in balance and may help maintain B12 levels between injections too

Difference between folate and folic acid

healthline.com/nutrition/fo...

Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid.

thyroidpharmacist.com/artic...

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....

Igennus B complex popular option too. Nice small tablets. Most people only find they need one per day. But a few people find it’s not high enough dose

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...

As you have Hashimoto’s are you on gluten free or dairy free diet

[Charlie27612 in reply to SlowDragon]

I tried going gluten free for 6 months with no improvement last year, I dont drink milk but I love cheese 😏

[greygoose]

My previous results were TSH 3.34 free t4 17.3 . Am I over medicated ?

Most certainly not. With a TSH over 3 you are still hypo, and therefore under-medicated. A euthyroid TSH is around 1, but hypos often need it lower than that.

[Vasiliki99]

I don't know your results have changed but I would say it's ok unless you feel bad or hyper ...