test results: I have just had my yearly thyroid... - Thyroid UK

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test results

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I have just had my yearly thyroid test results:

Serum TSH Level 3.12mu/L (0.35- 494)

Serum free T4 Level 13.6pmol/L (9.0- 19ul)

FT3 3.7 pmol/L (2.4-6.0)

I also had a cholesterol test and it’s 8 gone up in 2 months from 7.8.

Despite a healthy diet and drinking a cholesterol lowering drink every day.

I am on 75mcg levothyroxine daily and have been on this dose for a few years.

Every time I get my results back they are always ok, according to the nurse, and as she says, are within the guidelines, which I think are the numbers in the brackets.

My high cholesterol I know can be because of underactive thyroid but the nurse doesn’t seem to want to do anything about this other than suggest statins which I explained to her I didn’t want to take them because they are not good if you have thyroid problems I understand?

I never had high cholesterol before I was diagnosed with underactive thyroid 18years ago.

I am going through depression & anxiety at the moment, which I have a history of, and my body aches so much , especially when I go on my daily walk and I can’t walk very fast. Even doing housework makes me ache.

My question really is:

Do my results look ok and would it hurt to ask about trying an increase in my Levothyroxine to see if my cholesterol comes down and make me feel less achy.

Any advice would be much appreciated.

Thank you so much 😊

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14 Replies
SlowDragon profile image
SlowDragonAdministrator

So you clearly need dose increase in levothyroxine

Make an appointment and request increase to 100mcg daily

Symptoms of hypothyroidism

thyroiduk.org/signs-and-sym...

Retest bloods 8-10 weeks later

Which brand of levothyroxine are you currently taking?

ALWAYS test 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)

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

What vitamin supplements are you currently taking

When were vitamin levels last tested

in reply to SlowDragon

Thank you for your reply slow dragon.

My blood test was at 8.30 in the morning, a fasting one but I was told to take my levo that morning.

I take 1000mg vitamin D daily, 1000ml vitamin C, the brand well women multivitamins for age 50+, omega 3 for my Mental health ( along with antidepressants) and 375mg magnesium for my restless legs syndrome.

I haven’t had a vitamin test done in a while.

I feel I’m getting nowhere with the nurse and I’m waiting on a phone call from her about these results.

She is always focused on my high cholesterol .

If I don’t get anywhere with her this time then I’m going to go private because for a long time I feel that I’m under medicated.

It’s a nightmare getting through to these people and you can’t get a GP appointment.

in reply to SlowDragon

I meant to say the brand of Levo I’m on at the moment is Teva.

But this can sometimes change with each prescription.

SlowDragon profile image
SlowDragonAdministrator in reply to

How much do you weigh in kilo?

in reply to SlowDragon

Hi SlowDragon,

I was scanning through my posts when I saw your reply asking about my weight- so sorry I missed this.

I weigh 72.5 kg

SlowDragon profile image
SlowDragonAdministrator in reply to

So guidelines suggest 116mcg Levo per day

1.6mcg per kilo of your body weight per day

Only ever increase by 25mcg maximum per day in one go

in reply to SlowDragon

Thank you very much 😊

Does this mean that if your weight goes down, your dosage has to or does it all depend on test results?

SlowDragon profile image
SlowDragonAdministrator in reply to

In ideal world it should slowly reduce yes

SlowDragon profile image
SlowDragonAdministrator

Was this test done as recommended, early morning and last dose levothyroxine 24 hours before test

FT4: 13.6 pmol/l (Range 9 - 19)

Ft4 only 46.00% through range

FT3: 3.7 pmol/l (Range 2.4 - 6)

Ft3 worse at only 36.11% through range

Most people on just levothyroxine, when adequately treated will have Ft4 (levothyroxine) at least 70% through range or higher

Likely low vitamin levels with such low Ft3 (active hormone)

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.

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).

pennyannie profile image
pennyannie

Hello Love-purple :

We generally feel best when taking T4 monotheraphy when our T4 is up in towards the top quadrant of its range with the T3 tracking slightly behind at around 60/70 % through it's range- or put another way at around a 1/4 ratio T3/T4.

20 odd years ago with a TSH over 3 - you would have been diagnosed as hypothyroid and T4 Levothyroxine would have been prescribed.

In 2024 we now need a TSH over 10 on 2 different blood test results months apart before you are diagnosed.

With a TSH over 2 you are likely with some symptoms of hypothyroidism.

Once on any thyroid hormone replacement the TSH should be kept under 2 and we generally feel best with a TSH towards the lower end -likely under 1 and towards the bottom of the TSH range.

No thyroid hormone replacement works well until your core strength vitamins and minerals are up and maintained at optimal levels -

I now aim for a ferritin at around 100 - folate around 20 - active B12 75 ++ ( serum B12 500++ ) and vitamin D at around 100.

in reply to pennyannie

Thankyou for your reply pennyannie.

It’s a never ending battle each year and you can never get a GP appointment.

Thanks for the information.

I’m now waiting for a phone call from the nurse but all she is concerned with is my high cholesterol.

I’m considering going private if I don’t get this sorted through the NHS.

pennyannie profile image
pennyannie in reply to

But high cholesterol - if on thyroid hormone replacement and already diagnosed as hypothyroid - is a symptom of under medication of thyroid hormone replacement.

There have been posts on here detailing the connection - let me try and link you in -

McPammy profile image
McPammy

with your TSH above 2.5 you’ll be having hypothyroidism symptoms. It needs to be below 2.5 and preferably at around 1.00. Those symptoms could be your depression and definitely high cholesterol. They both are strongly linked to being under medicated. You need an increase in levothyroxine and you could certainly do with addition of T3 liothyronine. However, the nhs is hugely reluctant to give you T3 but you can try and request it. Or another alternative is to try the private only route for a t3 plus t4 trial combination. That was the only thing that brought down my high cholesterol amongst many other other things that was failing are that are now optimal. Thank god for T3 and some Endocrinologists that actually know what they’re doing.

in reply to McPammy

Thank you 😊for your reply and advice Mcpammy.

I’m seriously thinking of taking the private route.

Need to get this sorted. It’s not being helpful to my mental health, especially at the moment.

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