I have had hyperparathyroidism for many years and had a left thyroid lobectomy last year. My endocrinologist tested my thyroid levels in June as she suspected I might have an under active thyroid.
Results in May
TSH 6.67 (0.27 - 4.2)
T4 10.3 (10.8 - 25.5)
T3. 4.6. ( 3.1 - 6.8)
Was put on 50 mcg Levothyroxine
Re tested lasted week ( same ranges as before)
TSH 1.38
T4 17.1
T3 4.3
Care has been given over to GP. Anything I should query? I feel I have a bit more energy since starting thyroxine although I am still gaining weight but otherwise I feel fine. No other symptoms.
B12, ferritin, folate and vit D all tested in April and were in range.
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Bluesew
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I had surgery last year and they removed 2 parathyroid glands and what they thought were adenomas but turned out to be a hurtle cell neoplasm. Awaiting possible further surgery.
Thank you. Looking at other posts I was expecting this to be your advice. Unfortunately my GP thinks everything is fine and would prefer me to get an appointment with my endocrinologist who I see for hyperparathyroidism for any change in dose. I will try to do this. Vitamin levels were in the lower end of range - I only take vitamin D so I guess I could start taking other supplements? I did test at 9am but had taken thyroxine at 4am and had breakfast - I will follow advice for next time.
Vitamin levels were in the lower end of range - I only take vitamin D
how much vitamin D are you taking
What were actual vitamin results
I did test at 9am but had taken thyroxine at 4am and had breakfast
Ft4 falsely high as you took Levo 4-5 hours before test
Very, very likely Ft4 would have been BELOW range with last dose levothyroxine 24 hours before test
Can you see different GP and request “trial “ increase in Levo to 75mcg
Which brand levothyroxine are you currently taking?
Levothyroxine doesn’t “top up” failing thyroid, it replaces it
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).
Retest thyroid and vitamin levels 2-3 months after starting vitamin supplements and getting dose increase in levo
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