Latest blood test results

[DitzyGrandma]

Happy New Year!A bit of a long post so please accept my apologies.

Firstly thanks for the previous advice on taking vitamins to help with my Hashi diagnosis, which l got last September.

I received my blood results from Medichecks this afternoon. Bloods were done 24 hrs after my last levo at 9.30 am 2 days ago. I stopped taking my vitamins and B Complex week before the test.

My results are:

TSH 5.68 [0.27-4.2]

T4 13.8 [12-22]

T3 5.4 [3.1-6.8]

TPO 127 [O-34]

Vit D 86.8 [50-250]

B12 102 [37.5-188]

Foliate 40.8 >7

Ferritin 206 [30-650]

My results from GP surgery in December are:

TSH 5 [0.35-4.94]

T4 10.9 [9-19]

Don't think they test T3 at my surgery.

I had a phone appointment with GP to discuss my results, and he said he would book another blood test for 6-8 weeks and kept my medication the same. It wasn't the GP whom l saw in person when l was put on Levo last autumn and l felt fobbed off and am now feeling frustrated and wish it was the other GP as l believe he would have increased my medication. I now know that l will have to be assertive going forward.

I have 2 questions from both results:

1. Should l ask for a second opinion from GP or sit and wait until February and hopefully get a face to face appointment instead of with other GP

2. Advice on timing for taking Vits needed.

I currently take Igennus B Complex 1 tab daily,

Better You Vit D+K2 spray (3 sprays) and am just starting Igennus Triple Magnesium Complex 3rd day - (look like horse tablet - so l have cut them in half) they advise taking 1 tablet in a morning and 1 in an evening. I have only been taking 1. I have missed the morning one out as it is advised not to take them until 4 hrs after Levo, which l take at 7.30 a.m.

When would you lovely and knowledgeable people suggest l take them all so that there are no interferences with my Levo.

Sorry for long post, just feeling overwhelmed at moment adjusting to taking medication to try to improve my quality of life. I had a good day Monday and overdid things and am now suffering for it.

Thanks D 😊

[SlowDragon Administrator]

How much levothyroxine are you currently taking?

Are you still only on 25mcg daily

Your high TSH and low Ft4 shows you need immediate 25mcg increase in levothyroxine to 50mcg

You might initially want to only increase by 12.5mcg, by cutting a 25mcg tablet in half to take 37.5mcg daily for a few weeks, before increasing to 50mcg daily

Retest 8 weeks after

Levothyroxine doesn’t “top up” your thyroid levels, it replaces it

Important to be on high enough dose

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).

[DitzyGrandma in reply to SlowDragon]

Thanks SlowDragon, yes l am still on 25 mcg GP wouldn't increase it before my blood test and l was told l had to wait for my December blood results. However it was a different GP who couldn't get off the phone quick enough. I felt like an inconvenience tbh.

Initially hospital cocked things up when l went for my Diabetes blood test at end of October and did a full blood test instead as the nurse just saw tests GP had booked for December. Don't like how they book blood tests online months in advance. l much prefer the old way by going to surgery for it to be done but unfortunately that is the way our practice is going.

[SlowDragon Administrator in reply to DitzyGrandma]

You need to be a nuisance , make another appointment, ensure the GP knows you’re on levothyroxine and push for next increase in dose

Be ready to quote guidelines, many GP’s are clueless as to how to manage hypothyroid patients

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.

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...

[DitzyGrandma in reply to SlowDragon]

Thanks for your replies, l will read and take note of these and ask to speak to another GP who prescribed Levo in first place for an increase. I have never visited Dr's apart from previous pregnancies and other minor illnesses so it's a new ball game to me. Gone are the days when your GP knew you by name and family connections sadly.

[TiggerMe Ambassador]

It's got to be worth calling them and saying that you have had advice from Thyroid UK that you need to increase your dose now based on your current results and keeping you on a child's dose is very bad for your health...

We all often find that we need to be persistent or a nuisance! 🤗

[DitzyGrandma in reply to TiggerMe]

Thanks Eeyore100, l have put my trust in GP being knowledgeable, which sadly isn't the case. I will phone surgery for an increase, it doesn't help that ours is currently closed due to a car incident last year which caused considerable damage so l have to go to the other one. I appreciate the advice and supports on this forum.

Just a quick question if you don't mind. My magnesium l have just started suggests 2 tablets, 1 in morning and 1 in evening. I know it is advised to leave a 4 hr gap from Levo so l am confused about timings. I am leaning towards taking both at lunchtime at same time as B complex and vit D spray but if you think otherwise l can think again.

[TiggerMe Ambassador in reply to DitzyGrandma]

Generally B vits are best before midday as they can be 'stimulating' so you can take them with your Vit D spray and I'd suggest taking the magnesium at evening/bedtime as it is supposed to be calming and relaxing 🤗