1st results since starting Levo - dose advice and restarting IVF

[StormsPass]

Morning everyone 🙂

Yesterday I had my 1st endo follow up after starting Levo 6 weeks ago. Some of you may remember my IVF was abruptly cancelled when we discovered I was hashi hypo.

I am shocked at the results in 6 weeks. Endo has advised to maintain 75 dose but I have swung a bit out of range so would really appreciate some advice. He did suggest I could reduce the dose by 25 on some days but his view was stick on 75 and reset in 12 weeks or as soon as I get a positive pregnancy test. I said I wanted to retest sooner so we agreed 6 weeks.

I should restart IVF in 5 weeks for a frozen embryo transfer.

Reminder of Throid Results 6 weeks ago

TSH 28.5 range (0.47 - 4.2)

Free Thyroxine 11.2 (12-22)

Thyroglobin Antibody 399 (0-115)

Thyroid Peridoxase Antibodies >600 (0-34)

New results*

TSH 0.397 (0.47 - 4.2)

T4 23.4 (12-22)

T3 5.5 (3.1-6.8)

*note I had taken my Levo 6am that morning for a 9am test. I know this is contrary to advice here but my endo advised me to do so so I thought I should behave for this first test.

Symptom wise I still have muscle tendon joint pains at evening night & morning for last 4 weeks. Vits in bio all good have upped Vit D

As always any comments hugely appreciated thank you 😊

[SlowDragon Administrator]

so ignore Ft4 result as it’s false high as took levothyroxine before test

Suggest you stay on current dose

Retest again in another 8 weeks

Have you had coeliac blood test

If not get that done BEFORE trialing strictly gluten free diet

[StormsPass in reply to SlowDragon]

Thank you so much SlowDragon

I haven’t done a Coeliac test so I will do that. I had trialed GF for a few weeks but fell of the wagon when M&S ran out of GF mince pies! So a good time to test!

Have a good day 🙂

[Fusk1]

If you have taken your pill before your tests, then your tsh and ft4 are OK, they don't show you are in a hyperthyroid state, just your medication works. If you are still feeling muscle, tendon, joint pains then your tissues haven't still reach an euthyroid state so you must continue your medication without change

[StormsPass in reply to Fusk1]

Thank you Fusk1 I love your response, it makes total sense for my non-medical brain 😊

[greygoose in reply to StormsPass]

Actually, it's not your FT4 that is ok - it isn't, as slowdragon said - it's your FT3 that is ok.

[StormsPass in reply to greygoose]

Is my FT4 an issue at that level?

[greygoose in reply to StormsPass]

It isn't the real level. It's a false high because you took your levo before the blood draw. You now how no idea what your FT4 is. Never listen to an endo when he tells you to take your hormone before the blood draw, it's often a trick to lower your dose! Always leave a gap of 24 hours between your last dose and the blood draw.

[StormsPass in reply to greygoose]

Thank you greygoose understood 🙂

[greygoose in reply to StormsPass]

You're welcome.

[helvella]

How does your endo propose making adjustments to FT4 results depending on time between taking tablet and blood draw?

There is no scientific/mathematical formula for doing so. Indeed, if you did not make a fuss, the endo would not have known it was three hours after.

Three hours is approximately the time to the peak of FT4 in blood after taking a levothyroxine dose. (Varies a bit depending on all sorts of factors including our individuality.)

See if he gets out a calculator (or uses something on his computer). You'll know because he will have to ask you exactly when you took it and when the blood was drawn.

The best he can do is take a guess.

[StormsPass in reply to helvella]

I expect he has taken a guess.

[helvella in reply to StormsPass]

That is all he can have done!

And if that guess is wrong?

A peak reading says little about the base level above which it is a peak!

Your personal rate of absorption could be significantly faster or slower than that of others. Faster results in a higher peak. Slower results in a lower peak.

The level typically found between around twelve and twenty-four hours after a dose is a trough value which avoids this sharp peak issue. It is far more consistent. And less perturbed if you end up doing something like alternate day dosing (e.g. 75 one day, 100 the next, to approximate 82.5 daily).

[StormsPass in reply to helvella]

Thank you helvella. I think I may order a home test to compare.