I had bloods done last week and expected them to be the same as the last bloods I had done because I feel no different, but my tsh has gone from 2.39 to 0.75 in 3 months with no changes to my levothyroxine, I only take 25mcg
Im just so confused about how it’s dropped so much, to the point where I feel like they might have switched my blood sample with someone else’s by accident
(Also they didn’t test my free t3 or free t4)
Was the blood draw at the same time of day as the last one?
the 2.39 one was at 9am and the 0.75 was 2pm and I didn’t take my levothyroxine before either
Well, there you are, then. That's why it appears to have dropped so suddenly.
TSH levels vary throughout the day. Highest around midnight, dropping slowly until 9 am, then dropping rapidly until around midday when it's at its lowest. It then starts to slowly rise again.
around 1-3pn is the lowest level of TSH in every day .
so , on the same day It is going to be higher at 9 am than it is at 2pm.
See this graph showing the TSH of 33 healthy people. (TSH is the black line)
Some people will have a bigger difference than this, and some will have smaller,
So the circadian rhythm of TSH explains at least some of the difference in your TSH results .
TSH will be at lowest after lunch
TSH has pronounced diurnal variation……highest in morning
ALWAYS test early morning, ideally before 9am, only drinking water between waking test and last dose Levo 24 hours before test
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
Just testing TSH is completely inadequate
Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine
For full Thyroid evaluation you need TSH, FT4 and FT3 tested
Also both TPO and TG thyroid antibodies tested at least once to see if your hypothyroidism is autoimmune
Very important to test vitamin D, folate, ferritin and B12 at least once year minimum
Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease
About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high TPO and/or high TG thyroid antibodies
Autoimmune thyroid disease with goitre is Hashimoto’s
Autoimmune thyroid disease without goitre is Ord’s thyroiditis.
Both are autoimmune and generally called Hashimoto’s.
Significant minority of Hashimoto’s patients only have high TG antibodies (thyroglobulin)
20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis
In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)
Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins
Post all about what time of day to test
healthunlocked.com/thyroidu...
Testing options and includes money off codes for private testing
Medichecks Thyroid plus BOTH TPO and TG antibodies and vitamins
medichecks.com/products/adv...
Blue Horizon Thyroid Premium Gold includes BOTH TPO and TG antibodies, cortisol and vitamins
bluehorizonbloodtests.co.uk...
Only do private testing early Monday or Tuesday morning.
Link about thyroid blood tests
thyroiduk.org/testing/thyro...
Link about Hashimoto’s
thyroiduk.org/hypothyroid-b...
Symptoms of hypothyroidism
thyroiduk.org/signs-and-sym...
Tips on how to do DIY finger prick test
support.medichecks.com/hc/e...
Medichecks and BH also offer private blood draw at clinic near you, or private nurse to your own home…..for an extra fee
BEFORE booking any private consultation absolutely ESSENTIAL to get FULL thyroid and vitamin testing
A) vitamin levels likely low and need improving
B) first consultation waste of time and money without full test results
C) extremely important to test correctly early morning
Come back with new post once you get results
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
What vitamin supplements are you taking
You know your hypothyroidism is autoimmune
Are you on dairy free and/or gluten free diet
Guidelines of dose Levo by weight
approx how much do you weigh in kilo
Standard STARTER dose Levo is 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 of approximately 1.6mcg per kilo of your weight per day
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).
TSH and T4 both dropped 
TSH dropped but still feel unwell
TSH dropped but so did T4
Sudden drop in B12
Iron levels and huge TSH drop
