Blood testing

[Littlebuddha]

Hey all, as my GP will not do a full blood or vitamin test, could you please advise the best company to go to. TIA

[Buddy195 Administrator]

thyroiduk.org/help-and-supp...

Medichecks Advanced thyroid and Blue Horiizon are popular on the forum.

[Littlebuddha in reply to Buddy195]

Thank you Buddy 195, much appreciated 🙏

[SlowDragon Administrator]

How much Levo are you taking

Is your hypothyroidism autoimmune

About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high TPO and/or high TG 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.

Significant minority of Hashimoto’s patients only have high TG antibodies (thyroglobulin)

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)

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

Important to also test vitamin D, folate, ferritin and B12 too

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

Also important to stop any vitamin supplements that contain biotin 5-7 days before test

[Littlebuddha in reply to SlowDragon]

Thank you so much for your in depth response. I'm only taking 25mcg levothyroxine per day! Hardly seems worth it tbh. My GP has never contacted me regarding a blood test, I contacted them to ask if I could have a full blood test and vitamin deficiency test but they refused this! I will look into Medichecks and BH. Thank you once again, much appreciated.

[SlowDragon Administrator in reply to Littlebuddha]

Roughly how old are you and approximately how much do you weigh

Standard STARTER dose levothyroxine is 50mcg

Bloods should be retested 6-8 weeks after each increase

Dose is SLOWLY increased upwards in 25mcg steps

Guidelines on EVENTUAL dose levo required is approximately 1.6mcg of levothyroxine per kilo of your weight per day

So unless extremely petite, most people will be on at least 100mcg levothyroxine per day

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...

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).