Really high TSH

[Pumpkin04]

Hi

I had a recent blood test and my TSH has come back at 8.7, this is the highest I've ever had.

The docs called me on Thursday and when I said I'm on 200mcg Levo they said they needed to get me in for a review. I'm going today at 10.30am.

TSH attached T4 is 15.3 (11-22.6)

T3 is 4.2 (3.5-6.5)

Any advice on what to ask them?

TIA

[Buddy195 Administrator]

What was the time of the blood draw (for results above)? When did you last take your Levo dose (ie before or after the draw)?

Do you leave a gap between taking Levo & any other medication?

[Pumpkin04 in reply to Buddy195]

Bloods done at 8.15am. Took levo before, no other meds

[Buddy195 Administrator in reply to Pumpkin04]

It’s advisable to leave Levothyroxine until after the blood draw (patient to patient tip). Otherwise readings may be elevated.

Has TSH been elevated in any other blood tests since being on a steady dose of Levo?

[SlowDragon Administrator]

Is your hypothyroidism autoimmune?

Which brand of levothyroxine are you using

Do you always get same brand

Levothyroxine is an extremely fussy hormone and should always be taken on an empty stomach and then nothing apart from water for at least an hour after

Many people take Levothyroxine soon after waking, but it may be more convenient and perhaps more effective taken at bedtime

verywellhealth.com/best-tim...

markvanderpump.co.uk/blog/p...

markvanderpump.co.uk/blog/p...

No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.

Some like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away

(Time gap doesn't apply to Vitamin D mouth spray)

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

If 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

Essential to test vitamin D, folate, B12 and ferritin too

[SlowDragon Administrator]

So first steps are to ensure you’re taking levothyroxine correctly, and all vitamins are optimal

Then look at possible coeliac/gluten intolerance or other causes of malabsorption such as H Pylori or lactose intolerance

Long but interesting research paper on malabsorption of levothyroxine

academic.oup.com/edrv/artic...

[jimh111]

If you are feeling OK it is probably a false result due to assay interference or error at the lab.

[DippyDame]

How do you feel?

Your Frees are very low on 200mcg Levo

This appears to have caused the high TSH.

FT3 is 23.33% through the reference range

FT4 is 37.07% ditto

We aim to have both Frees roughly approaching 75% through the reference range

Your absorption of the hormone is impaired

Did you adhere to testing protocol...

Test just before 9am ( for highest TSH) and at least an hour away fro food and drinks

Are you taking iron and/or calcium supplements which can interfere with how your body absorbs thyroid medications. If so space these and other supplements at least 4 hours apart

Coeliac disease, inflammatory bowel disease, lactose intolerance as well as Helicobacter pylori , infection and autoimmune gastritis can also affect absorption of thyroid hormones.

Do you have Hashimoto's/ thyroid autoimmune disease which can also affect absorption?

Have you optimised vit D, vit B12, folate and ferritin?

200mcg Levo is a large dose, how long have you been taking this?

Are you still taking LDN, it may be a contributing factor?

Either you have an absorption problem or there has been n èrror during testing.

Suggest you test again following correct protocol before altering your dose.