Do I need an increase? TSH 3.15

[Griffo_]

Hi all,

I’ve been on 50mcg levo for around 7 weeks now for subclinical hypo / hashimoto’s. Prior to this, my TSH was 6.30. I’ve just had results from a test I had this morning that has come back as TSH 3.15.

They haven’t tested T3 or T4 - just my TSH and kidneys (which were also fine).

I’m still very symptomatic and struggling even more with my mental health.

Thanks

[greygoose]

Yes, you absolutely do. With a TSH over 3, you're still hypo. 50 mcg is only a starter dose, not meant to be a definitive dose. TSH should come down to 1 or under.

[Griffo_ in reply to greygoose]

Thank you. My NHS GP surgery has just put “normal - no action needed”? 😂

I’ll take it to the private GP that prescribed in the first place.

[greygoose in reply to Griffo_]

Yes, for an NHS GP anything within range is considered to be 'normal', even though it isn't always. But, they're not trained to recognise the niceties of thyroid treatment!

[SlowDragon Administrator]

Absolutely yes

Retest again 6-8 weeks after being on 75mcg

Likely to need further increase after this one

[SlowDragon Administrator]

Levothyroxine doesn’t “top up” your own thyroid output….it replaces it

So almost everyone ends up on full replacement dose eventually

That’s likely to be approximately 1.6mcg Levo per kilo of your weight per day

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.

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

healthunlocked.com/thyroidu...

jamanetwork.com/journals/ja...

See also at approx 16 mins into this YouTube clear info of dose levothyroxine

youtu.be/8Xy5i2pMtNA(Not working as expected?)

Guidelines are just that ....guidelines. Some people need more some less

healthunlocked.com/thyroidu...

[Griffo_]

  greygoose   SlowDragon

Went to see my private GP who has given me an increase and also ran some more comprehensive bloods.

Free Thyroxine (Free T4)

Reference Range: 10.4 - 19.4 pmol/l

Result: 16.4 pmol/l

Thyroid Stimulating Hormone (TSH)

Reference Range: 0.55 - 4.78 mIU/l

Result: 3.917 mIU/l

Free T3

Reference Range: 2.6 - 7.1 pmol/L

Result: 5.56 pmol/L

Thyroid Peroxidase antibodies

Reference Range: <60 U/ml

Result: > 1300 U/ml

Triiodothyronine (T3)

Reference Range: 0.6 - 1.81 ng/ml

Result: 1.74 ng/ml

T4

Reference Range: 59 - 154 nmol/L

Result: 153.4 nmol/L

[greygoose in reply to Griffo_]

OK, so you have Hashi's - did you already know that? Which means that your levels are probably going to fluctuate a bit. But those levels don't look too bad, but with plenty of room for an increase.

[Griffo_ in reply to greygoose]

Yeah I found that out from a blood test a while ago. Hoping that fact is why I’ve been having a lot of rib and abdominal discomfort this year! (Along with other random symptoms - joint pains, swollen lymph nodes, etc etc!)

I think I’ll get my vitamin levels checked again.

[greygoose in reply to Griffo_]

Your symptoms are from being hypo. Hashi's doesn't have any particular symptoms, just the symptoms of low thyroid.