NHS TSH test 1 week apart from Medichecks test

[Flaxjax]

Hello again lovely people! I had an advanced Thyroid test done with Medichecks (venous sample following all recommendations on timing and supplements) which showed a TSH of 6.09miu/L (0.27-4.2) and I asked for advice from the forum on my full results as it said to me I need a dose increase (which also the Doctors report from Medichecks suggested too). So I contacted my GP and they refused to accept the private test results and requested an NHS one (TSH only). I did this (following all protocols again) one week later. My TSH is now 2.43 miu/L (0.34-5.6)

Can anyone shed light on why the results might be so very different only a week apart? I mean I knew TSH was unreliable as a measure of 'thyroid function' as its the pituitary gland asking for thyroid hormone and my T3 ad T4 are in range but T3 is only approx 50% through range so its hard to know what to do for the best (still too fat and occasionally foggy and tired lol) xx

[SlowDragon Administrator]

Was NHS test early morning too?

You still need dose increase in levothyroxine with TSH over 2

TSH should be under 2 as an absolute maximum when on levothyroxine

gponline.com/endocrinology-...

Graph showing median TSH in healthy population is 1-1.5

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

Comprehensive list of references for needing LOW TSH on levothyroxine

healthunlocked.com/thyroidu....

onlinelibrary.wiley.com/doi...

If symptoms of hypothyroidism persist despite normalisation of TSH, the dose of levothyroxine can be titrated further to place the TSH in the lower part of the reference range or even slightly below (i.e., TSH: 0.1–2.0 mU/L), but avoiding TSH < 0.1 mU/L. Use of alternate day dosing of different levothyroxine strengths may be needed to achieve this (e.g., 100 mcg for 4 days; 125 mcg for 3 days weekly).

[Flaxjax in reply to SlowDragon]

Hi SlowDragon thanks for the reply much appreciated. Yes both tests were done at 8;45am. I have a particularly unsympathetic GP practice I'm considering buying some levo to do a trial of a slightly higher dose to see if it improves my symptoms...

[SlowDragon Administrator in reply to Flaxjax]

Suggest you see /speak to GP and use NHS links to support an increase in dose

The fact your TSH is over 2, plus symptoms (list them ….but don’t mention wanting to lose weight)

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.

[flower365 in reply to SlowDragon]

Hi SlowDragon, can you tell me the recommended dosage of levothyroxine for over 70 years and with cardiovascular disease ( stent) per kg please. Thanks

[SlowDragon Administrator in reply to flower365]

By assessing symptoms and full thyroid and vitamin testing at least annually

Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

List of private testing options and money off codes

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

Only do private testing early Monday or Tuesday morning.

Link about thyroid blood tests

thyroiduk.org/getting-a-dia...

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

Symptoms of hypothyroidism

thyroiduk.org/wp-content/up...

Tips on how to do DIY finger prick test

healthunlocked.com/thyroidu...

Medichecks and BH also offer private blood draw at clinic near you, or private nurse to your own home…..for an extra fee

See you are in Spain

Do you come back to U.K. ?

Get tested then

[flower365 in reply to SlowDragon]

Thank you for your rapid response.

Yes I have seen all this info before but couldnt find in it the answer to my query.

Am currently awaiting results from a local lab in Lugo but was specifically interested in why your criteria for dosage advice excluded over 65 and a CVD diagnosis as both apply to me.

Thanks

[SlowDragon Administrator in reply to flower365]

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.

standard STARTER dose is 50mcg unless over 65 years old or CVD, when standard starter dose is 25mcg.

Regardless of which dose started on levothyroxine should still be increased slowly upwards until on adequate dose to give good Ft3 and Ft4 levels

[Flaxjax]

Thank you for the information SlowDragon, much appreciated xx