new test results and dose review advice.

[Phoenix_24]

Hello,

I was started on levothyroxine by my GP on the 8th of January following test results that showed hypothyroidism. I had had symptoms for a while snd thought they were perimenopause, but my TSH levels were tested previously and came back ok (as shown by my July 2023 test results) T4 wasn’t tested though.

it was only in January 2024 that my TSH and T4 were out and the GP put me on levo.

So after 6 weeks my levels were retested and they are better than expected but not perfect. The GP noted in the app that they were satisfactory and no further action was needed so I need to advocate for myself when I go to see them next week.

they have also put in a referral for the endocrinologist asking if I would benefit from an uptake scan which is waiting for endo review and I’m fully expecting the endo to reject.

Below are my results and I would be very grateful for your advice. TIA!

July 2023

TSH 0.43 miu/L (0.27-4.2)

T4 not tested

January 2024

Serum TSH level 65.7 miu/L [0.27 - 4.2];

-Serum free T4 level 6.9 pmol/L [10.5 -22];

Thyroid peroxidase Ab <28iu/mL (0-60)

Tissue transglutaminase IgA, 0.6 u/mL

(0-6.9)

February 2024

Serum TSH 4.01 muy/L [0.27-4.2];

Serum T4 level [17.2 pmol/L [10.5-22]

*Edit* I forgot to add that I am

On 50mg levothyroxine ( I am 5ft tall and 54kg) and last dose before final tests was 24h before- I followed the protocol. Test was done at 8:15 am fasted.

Vitamin D and iron were deficient and I’m supplementing, folate was low though within the randge snd I’m not supplementing yet but plan to.

Levels in my previous post.

[TiggerMe Ambassador]

What is your current dose?

You are looking to get your TSH to 1 or below, your fT4 is currently at 58% so you could do with a little more, they tend to work in 25mcg but I'd suggest 12.5mcg and see how you feel... of course what they don't test is your fT3 to see if you are converting to the active hormone

How are you feeling? Worth asking them to test, B12, Vit D, folate and ferritin if they haven't already as these are all key to getting the best conversion

[Phoenix_24 in reply to TiggerMe]

Sorry I should have said I’m on 50 mg Levo, based in weight I should be on about 75 mg but gp was reluctant to put me in that as a starting dose. I do feel better but still exhausted and have muscle pains and terrible constipation.

[TiggerMe Ambassador in reply to Phoenix_24]

So you really need the next increase, perhaps add magnesium to your supplement list too 🤗

[GlowCoach Administrator]

Well your TSH is only 'just' within the range.

It looks like you may have taken your Levo just before the test also making it look like a false high.

What time of day was the test? Highest TSH is at 9am or earlier.

Recommended blood test protocol: Test at 9am (or as close as possible), fasting, last levo dose 24hrs before the blood draw & no biotin containing supplements for 3-7 days (Biotin can interfere with thyroid blood results as it is used in the testing process)?

Testing like this gives consistency in your results and will show stable blood levels of hormone and highest TSH which varies throughout the day. Taking Levo/T3 just prior to blood draw can show a falsely elevated result and your GP/Endo might change your dose incorrectly as a result.

Many GPs are happy when our results fall within 'normal' range. We need to optimise them to feel better, along with OPTIMAL vitamin levels for thyroid hormone to work well.

If GP is hesitant to raise your dose ask for it as a trial which seems less intimidating for them.

What are your recent results for ferritin, folate, B12 & D3?

[Phoenix_24]

thank you! Sorry I forgot to mention I did follow the protocol for testing so took my last dose 24h before and the test was done at 8:15 am before breakfast and any medication. I’m not taking biotin (yet) but I am supplementing iron and vitamin D as both were very low in my previous tests ( results in previous post).

[SlowDragon Administrator in reply to Phoenix_24]

Push for 12.5mcg dose increase in levothyroxine

Which brand of levothyroxine are you currently taking

What were B12 and folate results

You need to test TG antibodies too

NHS won’t test unless TPO are positive

So you will need to test privately

[Phoenix_24]

folate level 5.8 ng/ml [3 - 26.8] and B12 level 646 ng/L [197 - 771].

Last month I was on Almus and for the last 2 weeks I’ve been on Accord.

Thanks for the tip , I will push for an increase and see how it goes. Is there any chance the Endo will accept the referral?

[SlowDragon Administrator in reply to Phoenix_24]

So folate is low

supplementing a good quality daily vitamin B complex, one with folate in (not folic acid)

This can help keep all B vitamins in balance

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

Post discussing how biotin can affect test results

healthunlocked.com/thyroidu...

helvella.blogspot.com/p/hel...

[SlowDragon Administrator in reply to Phoenix_24]

Almus is actually Accord …..boxed as Almus by Boots

[crimple]

Phoenix-24 Almus/Accord are the same but be aware that they do not make 25mcgm tablets and if you ask for an increase then ask for another box of 50mcgm tablets which you can cut in half with a pill cutter. You would probably need to cut into quarters to try 62.5mcgm at first, you might then need the 75 mcgm after a further 6-8 weeks. Many people do not do well when their dosage is increased and they get different brands of levothyroxine . They have different fillers which can cause issues. Accord seems most tolerated and Teva is very much love it or hate it brand. I cannot tolerate it because it contains acacia powder.

Private testing would be good to get an idea of what your T3 levels are like. NHS rarely tests T 3 even if GP requests it. Medichecks regularly offer discounts on blood tests. Most of us on here resort to testing ourselves. GP should check after each dose increase or if there is a change in brand. Beware of chemists who chop and change the brand of levo and if necessary get your GP to write your favoured brand on the scrip. good luck.

[Phoenix_24]

thank you, that really helps!