Hey Everyone, I've been back for another blood test this morning and the phlebotomist said she has only been told [by the doctor] to take bloods for T4 testing.Is this standard?
Im sure that last time i was tested for TSH and antibodies, of which TSH was just within range and antibodies were well out of range (1274ui/ml).
The last blood test was at 1pm with food, drink and Levo in my system, whereas todays test was before 9am after fasting (only water) and no Levo for 48hrs.
How much levothyroxine are you taking
How long on this dose
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)
48 hours is far too long and will give false low Ft4
High thyroid antibodies confirms your hypothyroidism is autoimmune
NHS won’t retest thyroid antibodies
For full Thyroid evaluation you need TSH, FT4 and FT3 tested
Very important to test vitamin D, folate, ferritin and B12 at least once year minimum
Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease
About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high thyroid antibodies
Autoimmune thyroid disease with goitre is Hashimoto’s
Autoimmune thyroid disease without goitre is Ord’s thyroiditis.
Both are autoimmune and generally called Hashimoto’s.
In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)
Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins
Testing options and includes money off codes for private testing
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/testing/thyro...
Link about Hashimoto’s
thyroiduk.org/hypothyroid-b...
Symptoms of hypothyroidism
thyroiduk.org/signs-and-sym...
Tips on how to do DIY finger prick test
See detailed reply by SeasideSusie
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
Looking at previous post
You have only been on 50mcg 4 weeks?
Too soon to test really
Always wait 6-8 weeks
TSH (all ignorant medics look at) is slow to respond
Initially TSH drops on dose increase in levothyroxine, then starts to slowly climb back up as your body gets ready for next increase
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.
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).
Thanks for the quick reply. Ive been on the 50mcg for 6 weeks now after previously only being on 25mcg.
The raise to 50mcg and today's blood test was instructed to my GP by the On-Call Consultant Endocrinologist at Leicester Royal Infirmary after i had an assertive and frank conversation with my GP and stating that they need to treat the symptoms, not the reference range.
She realised i wasn't going away quietly and probably thought she could get back up from a specialist, but it played in my favour.
I only ask about why they've only tested for T4 this time as id previously only been tested for TSH, TPO and prior to that TSH and vitamin levels.
Because unfortunately NHS is useless on thyroid testing
Levothyroxine doesn’t “top up” failing thyroid…… it replaces it so essential to be on high enough dose
But we have to increase slowly otherwise can not tolerate increase in metabolism
Approx how much do you weigh in kilo
Guidelines on the EVENTUAL dose Levo likely is approximately 1.6mcg per kilo of your weight per day
So as a bloke I would imagine that’s likely to be at least over 100mcg
Dose likely to be increased to 75mcg after this test
If not tested vitamin D, folate, ferritin and B12 request (politely insist) these are tested
which brand of Levothyroxine are you currently taking
Many people find different brands are not interchangeable
I currently weigh 124kg. Usually hover between this and 128kg. My levo brand since i started (25 & 50mcg) has been Accord.I have a follow up appointment with a GP on 21st December, so will "politely" ask that the other tests are carried out.
There is a very rough calculation to work out an approximate final dose of Levo.
weight in kilos x 1.6 which would give you an estimated final dose of around 198mcgs. So you see you have a way to go with increases in 25mcg steps at 6-8 week intervals before you reach anywhere approaching that level.
If you are happy with the Accord brand then you can ask for it to be written in the first line of the prescription and then the pharmacy should always give you that brand. Its not a great idea switching brands.
Accord don’t make 25mcg tablets so when increasing to 75mcg get extra 50mcg tablets and cut in half to get 25mcg using pill cutter or sharp scalpel
Accord only make 50mcg and 100mcg tablets.
Accord is also boxed as Almus via Boots,
Mercury Pharma make 25mcg, 50mcg and 100mcg tablets
Mercury Pharma also boxed as Eltroxin. Both often listed by company name on pharmacy database - Advanz
Wockhardt is very well tolerated, but only available in 25mcg tablets. Some people remain on Wockhardt, taking their daily dose as a number of tablets
Lactose free brands - currently Teva or Vencamil only
Teva makes 25mcg, 50mcg, 75mcg and 100mcg
Many patients do NOT get on well with Teva brand of Levothyroxine.
Teva is lactose free.But Teva contains mannitol as a filler instead of lactose, which seems to be possible cause of problems. Mannitol seems to upset many people, it changes gut biome
Teva is the only brand that makes 75mcg tablet.
So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half
But for some people (usually if lactose intolerant, Teva is by far the best option)
Aristo (currently 100mcg only) is lactose free and mannitol free.
March 2023 - Aristo now called Vencamil
healthunlocked.com/thyroidu...
healthunlocked.com/thyroidu...
List of different brands available in U.K.
thyroiduk.org/if-you-are-hy...
Posts that mention Teva
healthunlocked.com/search/p...
Teva poll
healthunlocked.com/thyroidu...
Once you find a brand that suits you, best to make sure to only get that one at each prescription.
Watch out for brand change when dose is increased or at repeat prescription.
Government guidelines for GP in support of patients if you find it difficult/impossible to change brands
gov.uk/drug-safety-update/l...
If a patient reports persistent symptoms when switching between different levothyroxine tablet formulations, consider consistently prescribing a specific product known to be well tolerated by the patient.
academic.oup.com/jcem/artic...
Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).
And here
pharmacymagazine.co.uk/clin...
Discussed here too
124kg x 1.6mcg = 198mcg as an approximation of possible EVENTUAL daily dose Levo you might need
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