Test results confusing

[BFlying]

My mum has had an underactive thyroid for years...alongside type 1 diabetes. She was told she wasn't having enough levothyroxine, so the doctor wanted her to put it up to 100, but she asked to go on 75, as she felt 100 would be too much. The doctor agreed. She had a blood test on the 7th December and had a message to make a routine appt with the gp. This is for about the 19th of January. Anyway, we don't understand the results.

Her TSH level is 5.16mu/l

It was 0.797 in October

Her serum free t4 level is 24.2pmo/l

So one suggests underactive thyroid, the other suggests overactive!

If anyone is more clued up on what the results mean, could they possibly explain?

It's confusing!

Thanks

[pennyannie]

Hello BFlying :

Please add ranges :

The TSH is high and likley over range - and shouting out for more T4 medication -

as once taking any form of thyroid hormone we generally feel best with a TSH down at under 2 - likely under 1 and towards the bottom of the range.

The T4 reading is likely over range :

Could there be an absorption issue ?

With any increase in T4 - Levothyroxine - one would not expect the TSH to jump up like this but go lower -

Was this a fasting blood test and the T4 for that day not taken until after the blood draw ?

Might make sense to ask for a rerun of the thyroid blood test ?

There is nothing here suggesting overactivity - what symptoms are being tolerated ?

Is the patient with Hashimoto's - a thyroid auto immune health issue ?

[PurpleNails Administrator]

Did she take 75mcg consistently & unchanged at least 6 weeks before testing?

Usually high FT4 & FT3 will cause the TSH to be low. Low FT4 & FT3 will cause high TSH. but the TSH doesn’t always accurately reflect what the FT4 & FT3 are “doing” & what if they are FT4:FT3 are unbalanced one very low & the other high? TSH doesn’t tell you where your FT4 & FT3 are. You need all 3 tested.

Add lab ranges to results, ranges vary between labs. 24.2 is above most range for FT4. but high FT4 can occur if tested within a few hours of taking dose & it doesn’t tell you if FT3 is right.

Recommended tests are taken early as possible to 09.00, fast overnight, delay dose until after draw. Remove supplements containing biotin 3 days before draw. Was this how the test was arranged?

Also important to test folate, ferritin, B12 & vitamin D. Have these been tested?

[SlowDragon Administrator]

Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine

For full Thyroid evaluation she needs TSH, FT4 and FT3 tested

Also both TPO and TG thyroid antibodies tested at least once

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

As type one diabetes is autoimmune it’s virtually certain her hypothyroidism will also be autoimmune

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.

Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease

When were vitamin levels last tested

What vitamin supplements is she taking

20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis

In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)

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)

Is this how she did the test

If she took levothyroxine before test this will give false high Ft4 result

Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins

Testing options and includes money off codes for private testing

thyroiduk.org/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

[TSH110]

She is still under medicated and needs a further increase in her dose of levothyroxine. Her TSH should be under 1

[Knackeredoldhag]

hi, I have hashimotos and half of my thyroid left. My blood test results can go up and down like a yoyo. I believe (for myself anyway, everyone is different) that my levels go up and down however much medication I’m taking.

I tend to go on how I’m feeling.. I’m currently alternating between 75mg one day and 100mg the next. I can sometimes feel ‘shakey’ and over anxious and at other times feel I need a bit more because I’m tired and sluggish. It definitely seems to be up and down with me, and occasionally stable. But that might just be me..!😂

[BFlying in reply to Knackeredoldhag]

That's interesting what you say, as my mum has been battling anxiety. She's having more good days than bad (touch wood!) But nevertheless it's not like her. When she was on 100, they said they're giving her slightly too much. Now on 75, it's not enough. I think 25mcg is such a big jump

[Sparklingsunshine in reply to BFlying]

She could try 87.5mcg, ie 12.5mcg increase/ decrease. As you say 25mcg either way is too much for some. I've even heard of some members who only change their dose by 6.25mcg at a time as they are very sensitive to dose changes. Suggest your mum invests in a good pill cutter. Or alternate day dosing of 100/75mcg.