would anyone consider that the above readings going back to 2017 might be the reason I’ve not felt well for a long long time. I’m waiting on results for a thyroid test I had done yesterday morning
thyroid: would anyone consider that the above... - Thyroid UK
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Disey
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What results are the 2 columns showing? I suspect the righthand column is FT4. But is the left column TSH or FT3?
Sorry forgot to title the columns 🤦♀️ left column tsh, right column Ft4, I’ve never had ft3 tested until yesterday but no results yet
Thanks. This will help people to help you.
Your TSH has wandered close to top of range and through it once, but that's not enough for a GP to recognise a problem. Doesn't mean there isn't one though. Your FT4 is very low.
When you have future tests, always insist on a blood draw first thing in the morning. Our TSH is highest then. We want our TSH high to a) get a diagnosis or b) get a dose increase when medicated. Testing in the afternoon is pointless as TSH will be low then. I wonder how many of your previous tests have been drawn too late in the day.
You might be able to improve things for yourself by optimising the co-factors your thyroid needs to work well. That means top of range vitamin D3 (+K2), magnesium, vitamin B12 and ferritin (part of the iron panel). If you could get these tested and come back with results members can help guide you to improving the status of such and therefore maximising the change of helping your own thyroid to improve.
How do you feel?
Yesterdays test which I haven’t had results from was early morning, no levo for 24 hours and only water from waking. I will note down and send b12 and ferritin results over the yesrs too
Ah, I didn't realise you were on medication for it. My mistake. You are looking rather under medicated to me.
SlowDragonAdministrator
Yes pretty likely
Just testing TSH and Ft4 is completely inadequate
For full Thyroid evaluation you need 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
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
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
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
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
support.medichecks.com/hc/e...
Medichecks and BH also offer private blood draw at clinic near you, or private nurse to your own home…..for an extra fee
I am awaiting results for ft3 and up to date vit d however these are all vit d results since 2017
Vit d
All too low
How much vitamin D are you taking
NHS Guidelines on dose vitamin D required
ouh.nhs.uk/osteoporosis/use...
GP will often only prescribe to bring vitamin D levels to 50nmol.
Some areas will prescribe to bring levels to 75nmol or even 80nmol
leedsformulary.nhs.uk/docs/...
GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)
mm.wirral.nhs.uk/document_u...
But with Hashimoto’s, improving to around 80nmol or 100nmol by self supplementing may be better
pubmed.ncbi.nlm.nih.gov/218...
vitamindsociety.org/pdf/Vit...
Once you Improve level, very likely you will need on going maintenance dose to keep it there.
Test twice yearly via NHS private testing service when supplementing
Vitamin D mouth spray by Better You is very effective as it avoids poor gut function.
There’s a version made that also contains vitamin K2 Mk7.
One spray = 1000iu
amazon.co.uk/BetterYou-Dlux...
It’s trial and error what dose we need, with thyroid issues we frequently need higher dose than average
Vitamin D and thyroid disease
grassrootshealth.net/blog/t...
Vitamin D may prevent Autoimmune disease
newscientist.com/article/23...
Web links about taking important cofactors - magnesium and Vit K2-MK7
Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine
betterbones.com/bone-nutrit...
medicalnewstoday.com/articl...
livescience.com/61866-magne...
sciencedaily.com/releases/2...
Interesting article by Dr Malcolm Kendrick on magnesium
drmalcolmkendrick.org/categ...
Vitamin K2 mk7
betterbones.com/bone-nutrit...
healthline.com/nutrition/vi...
Have you had folate, B12 and ferritin levels tested?
Or BOTH TPO and TG antibodies
These are results for ferritin
Ferritin
How old are you
Post menopause higher ferritin levels are normal
healthunlocked.com/thyroidu...
We have received further information the lab about ferritin reference ranges. They confirm that they are sex dependent up to the age of 60, then beyond the age of 60 the reference range is the same for both sexes:
Males 16-60: 30-400 ug/L
Female's: 16-60: 30-150
Both >60: 30-650
The lower limit of 30 ug/L is in accordance with the updated NICE guidance and the upper limits are in accordance with guidance from the Association of Clinical Biochemists. ‘
I’m 59
So highish ferritin is normal
these are results for b12
B12
Any folate result?
folate
Folate
so both folate and B12 could do with improving
With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a separate B12 supplement and a week later add a separate vitamin B Complex
Then once your serum B12 is over 500 (or Active B12 level has reached 70), you may be able to reduce then stop the B12 and just carry on with the B Complex.
If Vegetarian or vegan likely to need ongoing separate B12 few times a week
Highly effective B12 drops
natureprovides.com/products...
Or
B12 sublingual lozenges
uk.iherb.com/pr/jarrow-form...
cytoplan.co.uk/shop-by-prod...
B12 range in U.K. is too wide
Interesting that in this research B12 below 400 is considered inadequate
healthunlocked.com/thyroidu...
Low folate
supplementing a good quality daily vitamin B complex, one with folate in (not folic acid)
This can help keep all B vitamins in balance and will help improve B12 levels too
Difference between folate and folic acid
healthline.com/nutrition/fo...
B vitamins best taken after breakfast
Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule)
Thorne currently difficult to find at reasonable price, should be around £20-£25. iherb.com often have in stock. Or try ebay
Igennus B complex popular option too. Nice small tablets. Most people only find they need one per day. But a few people find it’s not high enough dose
Post discussing different B complex
healthunlocked.com/thyroidu...
IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results
endo.confex.com/endo/2016en...
endocrinenews.endocrine.org...
In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate folate supplement (eg Jarrow methyl folate 400mcg) and continue separate B12 until over 500
Post discussing how biotin can affect test results
healthunlocked.com/thyroidu...
helvella.blogspot.com/p/hel...
Do you think a b12 injection would benefit me?
Very unlikely
hi, I’ve received latest test results today..
Serum free thiodothyronine (3.1-6.8) 4.5
TSH (0.27-4.2) 2.12
FT4 (12-22) 13.1
Vitamin d 44.9
How much levothyroxine are you currently taking
Which brand
Was test as recommended, early morning, last dose levothyroxine 24 hours before test
Can you confirm your vitamin D is 44.9nmol?
How much vitamin D are you taking
FT4: 13.1 pmol/l (Range 12 - 22)
Ft4 only 11.00% through range
FT3: 4.5 pmol/l (Range 3.1 - 6.8)
Ft3 slightly better at 37.84% through range
Most people when adequately treated will have Ft4 (levothyroxine) on just levothyroxine at least over 70% through range
So clearly you need 25mcg dose increase in Levo
Retest again in 8-10 weeks
Meanwhile working on maintaining OPTIMAL vitamin levels
SlowDragonAdministrator
There’s no thyroid info on your profile page
I think we all assumed you were trying to get diagnosed with these results
Not already on Levo
On Levo 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).
What date did you start on Levo?
I didn’t realise there was such a thing as putting thyroxine on profile, I joined the site ages ago. I’ve been levo for years, been given it, had it taken away, given back and also t3 but got it taken away, it’s been a rollercoaster with docs and endos, one says this, one says that and that’s why I reached out to you as I’ve been feeling so so bad. I think personally my whole body has gone into low mode, I’ve been under incredible stress from agoraphobia some years back, which led to me not being able to even be on my own indoors, that’s improved but still don’t leave the house alone, had extra stress these last couple of years and I think finally my body is completely worn out, I feel nauseous, headache constantly, aches and pains etc and they say I’ve got fibromyalgia 🤷♀️ I’ve not a jot of energy at mo, no desire to do anything at all.
I have asked gp to increase to 75 after my tests results suggest I need it. I’ve got vit d, vitamin b12 and b complex ready to start.
That test was how you said, early with no levo for 24 hrs and only water from waking to having the test, I’m going to just be kind to myself, take the supplements, eat well and hope for the best 🤞 thank you for all your help, I really do appreciate it, it’s good to know that someone knows what they’re talking about cos the docs sure don’t, I’ve relied on them for too long and it’s got me nowhere, however, talking with you and your team has enlightened me on how this all works
Fibromyalgia is just a fancy word for inadequately treated hypothyroidism
Few links about fibromyalgia
stopthethyroidmadness.com/f...
chriskresser.com/low-t3-syn...
holtorfmed.com/download/chr...
healthrising.org/blog/2019/...
Work out which brand of levothyroxine suits you best, then always get that brand
Retest thyroid levels 8-10 weeks after being on 100mcg levothyroxine
I’ve always felt like it was to fob me off to say I’d got fibro. I’ve just noticed that although I’d increased to 50 from 25 my tsh has gone down but so has my ft4, shouldn’t that have risen with an increase?
You’re only on 50mcg Levo?
TSH is totally unreliable once on replacement thyroid hormones. The most important results are ALWAYS Ft3 followed by Ft4
When adequately treated likely to have Ft3 at least 70% through range
If on just Levothyroxine, Ft4 likely a bit higher at 80%
SlowDragonAdministrator
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
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.
You mentioned….at one point you were on T3 as well
Typically Levo dose is reduced by 25mcg a week before adding SMALL dose T3
Initially 5mcg …..slowly increasing to 3 x 5mcg per day
Retest in 8-10 weeks
Invariably TSH will then be extremely low or suppressed
I got t3 off my doctor many years ago, prob bout 15 years, he referred me to endo who took it away before I even had chance to see if it worked. My docs now won’t prescribe t3 so I’ll just ask for increase in t4
yes I’m currently on 50 so going to ask for 75
50mcg is only standard STARTER dose
No wonder your Ft4 results are too low
Which brand is 50mcg
Ideally don’t change brand as you increase dose
The brand I’m on is called teva
Have you always been on Teva
Teva is lactose free
Are you on dairy free or lactose free diet?
Many people find Levothyroxine brands are not interchangeable.
Most easily available (and often most easily tolerated) are Mercury Pharma or Accord
Mercury Pharma make 25mcg, 50mcg and 100mcg tablets
Mercury Pharma also boxed as Eltroxin. Both often listed by company name on pharmacy database - Advanz
Accord only make 50mcg and 100mcg tablets. Accord is also boxed as Almus via Boots,
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
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