Help with latest results please for endo appointment

[DaisyTed]

Hi, I recently posted on here and was recommended to get my full thyroid panel done, which I have just done via Medichecks. Test was done at 8am, last dose of Levo 24 hrs before etc.. I have an NHS endo appointment on 24th June. My GP has refused to increase my Levo to date as results are in range. Not sure if an increase is what I need - or a trial of T3? I have had significant fatigue, dizziness/light headedness, palpitations since end of April and have been off work with it- I had put it down to stress (has been a very stressful past 2 years). I feel energy had been reduced for some time prior to this and haven’t had energy to do much exercise. Any advice as to what to say to the endocrinologist when I see her? Does my T4 result indicate I am already on a high enough dose of Levo?? Many thanks 🙏

[Jaydee1507 Administrator]

FT4 is still only 70% of range and your TSH far too high.

FT3 is 51% of range so with an increase or two you should be OK on Levo only.

See this pinned post with links about keeping TSH lower: healthunlocked.com/thyroidu....

What are you supplementing with?

How are vitamins looking? They were very low 9 months ago. Have you changed and upgraded supplements as per this post? healthunlocked.com/thyroidu...

[DaisyTed in reply to Jaydee1507]

Thanks so much for your reply - I haven’t re-tested vitamins since September but took on board the recommendations and now take Better You vit D spray with K2 daily but I can only take 2 sprays as 3 affect my sleep (weird but true!)I also take vit B complex and Floradix for iron (am waiting for Three Arrows to arrive). Also take magnesium at night. I will try for an increase 🙏

[SlowDragon Administrator]

You need to retest vitamin levels

How much levothyroxine are you taking

How much do you weigh in kilo

TSH is far too high

You need next dose increase in levothyroxine

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.

Some people need a bit less than guidelines, some a bit more

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).