I've just had my private blood test results back and have the following:
TSH: 3.7 (TSH levels normal (normal range 0.27 - 4.2 mU/L). Increased from 0.98 6 months ago.
FT4: 18.6 (normal range 12 - 22 pmol/L). Was 19.3 6 months ago.
FT3: 4.8 (normal range 3.1 - 6.8 pmol/L). Was 4.9 6 months ago.
So, it looks as though my TSH has increased quite a bit. I've previously not been impressed by my doctor, who considers that everything is fine if in normal range and won't change Levo dose. When I've tried to convince him TSH should be closer to 1 he's refused to change it (this is when my TSH was closer to 2.39).
I'm currently taking 75mcg/day of Levo - 50mcg prescribed by my doctor, and an extra 25mcg I get privately and added a year ago to get it closer to 1, which was working.
Now that I've gone back up to 3.7 I figure I should increase my Levo from 75mcg, but not sure how much by. I appreciate its trial and error but need somewhere to start. What do folks reckon, an extra 25mcg? An extra 50mcg? And then retest obviously
Cheers in advance,
Mids_thyman.
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mids_thyman
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so increase to 100mcg daily and retest including vitamin levels at next test
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
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins
You have type 1 diabetes, so presumably your hypothyroidism is autoimmune too ?
Low vitamin levels are especially common with autoimmune thyroid disease
14 stone = 89 kilo approx
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 (typically 1.6mcg levothyroxine per kilo of your weight per day)
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
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).
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