I’d be really grateful if you could take a look at my test results below and let me know what you think please. Since having the left side of my thyroid removed in February 23 because of a suspiciously large nodule, my blood tests had showed lower than optimum levels and so I was started on Levothyroxine 50mg in September 23. My GP says that’s the correct dose based on my recent blood tests. However, since then, In order not to gain weight, I’ve had to eat very few calories each day, and whereas I would expect to be losing weight on my current diet, there’s little chance of that happening, and some days I feel tired. (The nodule that was removed turned out to be low grade cancerous, but no further action was required).
It would seem that myTS3 hasn’t been tested since before my operation. And not at all afterwards. The only time my antibodies were tested was on 30/8, which was just before I started taking Levothyroxine.
All the blood tests below were taken before 9.00am and before eating, however the test since taking Levothyroxine on 3/1/24 would have been taken only 6 hours after taking the dose. (I take my Levo at 2.00/3.00am).
I have a follow up appointment on 5/2 at the ent dept of the hospital where I had my hemithyroidectomy exactly one year ago, and so would really appreciate some pointers as to what I should be asking during that appointment. (I’m assuming I should be asking for more testing, antibodies and TS3, and leaving 24 hrs since taking Levo). Thank you so much for reading this.
Once on any form of thyroid hormone replacement the TSH should be kept below 2 and we generally feel best when the TSH is low in it's range probably under 1 and towards the bottom of its range.
With a TSH over 3 you are likely already experiencing symptoms of hypothyroidism and in some countries treatment is started when the TSH is 3 or over -
and the TSH lowers as the thyroid hormone replacement is increased to build up your store of thyroid hormones within the body so to support you with better health and well being.
This will happen as your dose of T4 - Levothyroxine is increased by 25 mcg daily with a follow up blood test in around 6-8 weeks time where again - the whole process is repeated until you have relief of symptoms of hypothyroidism.
Ideally we need to see a Free T3 alongside the Free T4 results and I would imagine the aim is to try and get both these vital hormones back to where-
I presume you felt well - prior to having the hemi-thyroidectomy ?
Prior to surgery your T3 was around 53% and you T4 around 41% :
Now we are looking at just a T4 of around 47% :
T4 is a pro-hormone and needs to be converted in the body into T3 the active hormone that runs all the body functions - through from your physical to your mental, emotional, psychological and spiritual well being, your inner central heating system and your metabolism.
No thyroid hormone works well until our core strength vitamins and minerals are up and maintained at optimal - I now aim for a ferritin at around 100 - folate around 20 - active B12 around 75 ++ ( serum B12 500 ++ ) and vitamin D at around 100.
Conversion of T4 into T3 can also be down regulated by inflammation, antibodies and physiological stress ( emotional or physical ) depression, dieting and ageing.
Reading the above it seems to me you are reducing your food intake because of a lack of metabolism - and therefore weight gain- which is perfectly normal and something we all tend to do -
but when hypothyroid dieting compounds your health issues as the body senses we are in starvation mode so conserves energy and body fats by down regulating T4 to T3 conversion - and we need regular food intake, good fats and cooked from scratch healthy meals to enhance T4 to T3 conversion.
You are in somewhat uncharted waters as only recently experiencing how hypothyroidism can impact your health - if you go into Thyroid UK - thyroiduk.org. the charity who supports this patient to patient forum there is a list of hypothyroid symptoms and this might just help you understand better where you are in all this.
A fully functioning working thyroid would be supporting you on a daily basis with trace elements of T1. T2 and calcitonin + a measure of T3 at around 10 mcg + a measure of T4 at around 100 mcg. - with T3 is said to be around 4 times more potent than T4 :
Having had a hemi does not mean you just need half the normal thyroid hormone dose - we are all different as to our requirements but would envisage you will likely need full spectrum thyroid hormone if T4 monotherapy alone does not relieve your symptoms of hypothyroidism.
P.S. Since you didn't leave 24 hours from your last dose of T4 before the blood tests your T4 reading is actually a false ' high ' as showing what just ingested - so in reality your T4 is running lower than 47 % -
Once on T4 monotherapy we generally feel best when the Free T4 is in the top quadrant of the range with the Free T3 tracking just behind at around 60/70% through its range.
Thankyou so much Pennyannie for your detailed reply. I really appreciate you taking the time to enlighten me. It helps so much to know about the optimum numbers within the range and of course I’ve now learnt about the timings and criteria for getting an accurate blood reading. I will get more tests done privately and correctly asap. and then hopefully convince my gp to increase my Levo.
Thankyou to everyone involved for the existence of this wonderful forum!
the test since taking Levothyroxine on 3/1/24 would have been taken only 6 hours after taking the dose. (I take my Levo at 2.00/3.00am).
So Ft4 result is false high result
In future as you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test
If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal
Your results show you clearly need next 25mcg dose increase in levothyroxine up to 75mcg
Bloods should be retested again in another 6-8 weeks
Likely to need further increase in coming months unless extremely petite
Guidelines of dose Levo by weight
approx how much do you weigh in kilo
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
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.
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.
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).
Thankyou so much SlowDragon for taking the time to reply to me. And for your very helpful links for private blood testing, I will definitely get this done again now that you have informed me of the correct procedure too.
I take supplements for b12 and vit D so my blood tests show good levels for those, but I will need to check Ferritin and Folate figures
My weight is 58 kg.
Thankyou so much for your part in enabling the existence of this wonderful informative forum.
Ok, Thankyou, that’s good to know re likely eventual dose. Yes that’s my mission now, to get my gp to increase my dose.
When I had half of my thyroid removed, I was told that the remaining part of my thyroid would likely step up and produce all that I needed. That wasn’t the case for me but I’m thinking that the remaining part is still producing some hormones, just not enough?
Also, am I right in thinking that I can’t have hashimotos because the reason for my hypothyroidism is having a hemithyroidectomy?
I’m thinking that the remaining part is still producing some hormones, just not enough?
Once we start on replacement thyroid hormones, because the feedback loop is altered, vast majority of patients will eventually be on full replacement dose
Pituitary senses the levothyroxine, TSH reduces and and your remaining half of thyroid stops working so hard…..or stops virtually completely
Also, am I right in thinking that I can’t have hashimotos because the reason for my hypothyroidism is having a hemithyroidectomy?
You had hemi thyroidectomy because of large nodule
You probably also want to check you don’t have high TG antibodies and both TPO and TG antibodies are included in private testing bundle
Significant minority of Hashimoto’s patients only have high TG antibodies
Thankyou for your reply SlowDragon, I had a follow up appointment made for me by the hospital where I had my operation a year ago, shortly after my last post 4 weeks ago, where I saw an ent “specialist”. I asked her if she would prescribe me an extra 25mcg per day because I wanted my TSH to come down to around 1, and she was very open to this which took me by surprise. I left there with a prescription! So far I haven’t noticed any difference but it’s early days. Although I don’t think my levels will have come down to 1 on 75mcg and so will have to persuade my GP to prescribe another 25mcg because I’ve been discharged by the hospital now.
My GP had refused to increase my prescription to 75mg because she said I was now within the range at just below 4 (and this was when I had taken my Levo tablet just 6 hours before).
And so my next NHS blood tests are booked in for the end of March but I have also purchased an Advanced Thyroid test with Blue Horizon to be done during the same week.
Thanks to the information from this wonderful forum, both my appointments are scheduled for 8.30am, I will only drink water that morning and I will take my !evo tablets after the blood has been taken. I wouldn’t have known to do any of that without you.
I was going to post again with my results when I get them from Blue Horizon, but in the meantime was wondering about Goitorgens in some vegetables, and if it’s really necessary to give them up?
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