Thyroid testing

[Bridkid67]

Dont think iam being daft but when a Dr sends your bloods off for testing for TSH levels etc does the Lab know the bloods they are testing are patients taking thyroid replacement medicines etc ? and thats why they are not to worried about levels as long as they are ha within their ranges and expect the Drs to interpret the results as seen fit but are Drs taking the lab results literally and not bothered if they are within their ranges?

[greygoose]

The lab won't know if you're taking levo or not unless they're told. I don't know if it is normal practice to tell them. But, they might have a good guess if you're taking T3 because the FT3 will be higher than the FT4, which is not usual. But I doubt that they know very much about interpreting the results. And doctors certainly don't know how. The take each result as a separate entity and don't understand that the three have to be interpretted in conjunction with each other to get the full story. They only tend to look at the TSH. And if you're on thyroid hormone replacement, and the TSH is anywhere within the range, they think everything must be ok. If the TSH is below range, they automatically think you're over-replaced. And if you're not on THR they think you're hyper. Either way, they're not much concerned about over-range results unless they're over 10. Interpreting blood test results is an art and doctors are not artists!

[Bridkid67 in reply to greygoose]

Thanks for that my latest TSH reading is 2.8 on 50mcg levo so i really need to push for an increase?

[greygoose in reply to Bridkid67]

You probably will need to push, yes. And it should come down to 1 or under.

[TiggerMe Ambassador]

Yep, they get marked up, though it shouldn't make any difference to the testing 🤷‍♀️

It does seem the Labs have been given the powers to test or not as they please 😕

[TiggerMe Ambassador in reply to TiggerMe]

Worth getting a full thyroid panel via Monitor My Health with discount code THYROIDUK10 (NHS Lab) so you know what your actual thyroid hormone levels are and if you are converting as this will add some weight to your discussion and hopefully educate your GP.... generally they don't accept private tests but it forces them to test themselves 🤷‍♀️

thyroiduk.org/testing/priva...

[SlowDragon Administrator]

Strongly recommend you get FULL thyroid and vitamin testing yourself privately

As recommended in previous post

healthunlocked.com/thyroidu...

Essential to test early morning, ideally before 9am, only drinking water between waking and test and last dose levothyroxine 24 hours before test

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).

[Nighttimer]

The protocol in our area is that blood is tested for TSH. Only if that is out of range are further tests done. My partner is borderline and the GP can't get T3 tests. Old to come back in a year when TSH will be high then we can get T3 T4 measured. GP not interested until then.

[SmallBlueThing]

A recent one of mine:

Serum TSH level 5.8 miu/L [0.3 - 5.0]; Probably under-replaced; Outside reference range.

When my TSH was suppressed, the note read: Ideally aim to normalise TSH.

I think the notes are from the lab, as sometimes technicalities to do with the test are referred to. Too many times I get a text saying no further action, only for my GP to get round to looking at the results. Twice over a about a decade (with different GPs) I've had TSH a bit below the upper limit of the range and it's been declared OK. On the most recent occasion there was a trainee GP so I referred her to GPnotebook, and a dose increase was agreed to. Sad to think of others, most likely new to treatment, left to fester with a TSH > 4.0.