I have battled to get my bloods tested and have managed to get a blood test tomorrow but it is at 11.40am. I have always had them before 8am following the advise given on here.
What is the best thing I can do with taking my medication? I took them today (Sunday) at 6am so should I take them as normal tomorrow morning or delay taking them until after my blood test?
Advixe gratefully received as I don't want to mess up my results.
As you’re looking for dose increase in Levo you really need to test as early as possible
healthunlocked.com/thyroidu...
Can you rebook an 8am appointment
If not be prepared for GP to still refuse to increase the dose
You may need to test privately and see endocrinologist
Here’s link for how to request Thyroid U.K.list of private Doctors emailed to you, but within the email a link to download list of recommended thyroid specialist endocrinologists
Ideally choose an endocrinologist to see privately initially and who also does NHS consultations
thyroiduk.org/contact-us/ge...
I would have had to wait over 4 weeks to have a blood test before 9am or they offered me this one to have tomorrow. Not sure what to do now as I will probably be waiting another 4 weeks if I try to rearrange and I am not in a position to pay privately.
Looks like I am stuck! I am so done with this battle and always feeling like I am losing or getting it wrong.
So have test tomorrow but TSH will be lower than if tested at 8am
How much lower…..impossible to say
Definitely do NOT take levothyroxine until after blood test
You need vitamin D, folate, B12, ferritin tested
Plus TSH, Ft4 and Ft3
GP incorrectly often only tests TSH
The new doctor that has requested these bloods argued on the phone appointment with me that he didn't need T4 and T3 tested! I explained why and he still refused. But for the first time since my diagnosis someone has finally agreed to test for so many ones I have historically requested. This is my bloods sheet from off the NHS App:
HbA1C
Vitamin B12 and Folate
Calcium (includes albumin)
CK
CRP
Full Blood Count
Ferritin
Folate
Iron Studies
Liver Profile
Renal & eGFR (UE)
TSH
It is one of those situations where I feel like I have won by my vitamins being tested but the time and no T3 and T4 is a loss.
You've done well to get all of those tested and it could highlight things that need optimising to make the best use of your levothyroxine dose... don't give up hope, let's see what these results look like and come up with a plan 🤗
Just looked back at your history and see that you are still on a child's dose of 25mcg, you would likely feel better without it than being on this dose, worth asking why they think this is acceptable
I feel like this is an opportunity to maybe get a better understanding of what else is going on.
With regards to my dose he was not keen to increase it and I had explained that I had done research and 50 would be a better starting point but these blood were as much as I could get out of him.
Is there any chance you can change go? I know this isn’t always an option hence the question really … x I hope you get somewhere with your bloods xx
I live in a very rural area and our doctors are part of a partnership that cover a considerable distance. Frustrating but does give me the option to request to see another doctor but you just start all over again.
When I called to book my bloods initially I asked the receptionist if they had a doctor who specilsed in thyroid as they have them for menopause diabetes heart conditions? Her answer was no sorry we don't x
Levothyroxine doesn’t “top up” your own thyroid output, it replaces it
Essential to be on high enough dose
If GP won’t increase dose after testing
Get TSH, Ft4, Ft3 and both thyroid antibodies tested via Medichecks or Blue horizon BEFORE booking another consultation
Looking for Ft4 (levothyroxine) at least 60-70% through range and Ft3 at least 50-60% through range
Take along printed copies of guidelines
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).
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...
If still no progress book to see endocrinologist
Here’s link for how to request Thyroid U.K.list of private Doctors emailed to you, but within the email a link to download list of recommended thyroid specialist endocrinologists
Ideally choose an endocrinologist to see privately initially and who also does NHS consultations
Understood and that sucks - very frustrating for you 😞
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Why do we test blood before thyroid medication is taken?
