Blood test

[Trotter76]

Hi New to the group. I'm going for a full panel blood test for thyroid tomorrow at 11:30. As GP will only do TSH. Feel pretty rubbish at the moment pins and needles. Breathless on walking and fatigue and feels like my heart in racing intermittently.Am I best waiting to take my levothyroxine after my bloods tomorrow. I took my 125mcg this morning. TIA

[SlowDragon Administrator]

welcome to the forum

Yes don’t take levothyroxine until after blood test

Ideally you would get tested before 9am, only drinking water between waking and test and last dose levothyroxine 24 hours before test

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)

Essential to test vitamin D, folate, ferritin and B12

Lower vitamin levels more common as we get older

For good conversion of Ft4 (levothyroxine) to Ft3 (active hormone) we must maintain GOOD vitamin levels

What vitamin supplements are you taking

Also VERY important to test TSH, Ft4 and Ft3 together

What is reason for your hypothyroidism

Autoimmune?

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

Post all about what time of day to test

healthunlocked.com/thyroidu...

Testing options and includes money off codes for private testing

thyroiduk.org/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

[greygoose]

Hi Trotter76, welcome to the forum.

You should ideally leave a gap of 24 hours between your last dose of levo and the blood draw. Sounds like it's going to be longer than 24 hours for you but it won't make an awful lot of difference, just know that in reality, the FT4 would be slightly higher than it's going to be on your results.

11.30 is really not a good time for the blood draw because the TSH will be coming up to its lowest point. And as doctors only look at TSH, we want it as high as we can get it. It's highest before 9 am. And, ideally, you should fast over-night, have breakfast after the blood draw because eating can lower the TSH. But I don't suppose you'll want to fast until 11.30. Just know that your TSH is probably higher than the result you're going to get had you don't the test the way we recommend.

What will be interesting in this test - and nothing can interfer with it - is your FT3 level. And comparing your FT3 with your FT4, seeing how well you convert.

[SlowDragon Administrator]

breathlessness suggests low iron/ferritin

Pins and Needles suggests low B12

When were vitamin levels last tested

What vitamin supplements are you taking

Which brand of levothyroxine are you taking

Do you always get same brand

[Trotter76 in reply to SlowDragon]

blood test was taken at 11:30 had nothing to eat before hand only sips of water

The results came back as well controlled

TF4 17.1

TGAB 57.5

TPOAB 21.6

TSH 0.395

T4 106

TF3 4.5

[SlowDragon Administrator in reply to Trotter76]

What’s the range on Ft4, Ft3 and total T4

[SlowDragon Administrator in reply to Trotter76]

no B12, folate, ferritin or vitamin D results?

Assuming test was Medichecks or BH?

was last dose Levo 24 hours before test

TSH would have been higher at 8-9am

Free T4 (fT4) 17.1 pmol/L (12 - 22) 51.0%

Free T3 (fT3) 4.5 pmol/L (3.1 - 6.8) 37.8%

Shows you are not on high enough dose levothyroxine and poor conversion

Low vitamins result in poor conversion

Poor conversion results in low Ft3 and low vitamins

Most people when adequately treated will need Ft3 at least 60% through range

Usually on JUST Levo Ft4 will need to be 70-80% through range

Next steps

Get vitamin levels tested and start working on improving

Many members find they need to take vitamin D, vitamin B complex and magnesium supplements daily and continuously to maintain good vitamin D, folate and magnesium

Some also need separate B12, especially initially

And significant numbers struggle to maintain good ferritin

Meanwhile

Request increase in dose levothyroxine from GP

Initially to 137.5mcg average (125mcg and 150mcg on alternate days)

[Trotter76]

Hi many thanks for all your replies I really do appreciate your advice. I’ve booked myself in at Superdrug for the test it’s quite interesting to see my local ones don’t do early morning test. So defo note to self for next time to change where I get them done.

I can go till 11:30 without eating that’s not a problem for me as I can happily go without breakfast if need to.

I haven’t been taking vitamins but I know my OH keeps telling me too…so will start doing this.

In regards to brands I just get what I’m given I’m defo not regularly given the same brand makes will look into this if I need too.

I was originally diagnosed with hyper with Graves’ disease however since having the iodine tablet I’ve swung the other way and gone hypo

My vitamin and mineral levels were done in May when I had an operation so I’m guessing everything was ok then. Only symptoms I had then was the start of the pins and needles in my feet and hands.

Once I get the results I’ll let you know. Thank you again for your feedback

[SlowDragon Administrator in reply to Trotter76]

My vitamin and mineral levels were done in May when I had an operation so I’m guessing everything was ok then.

you are legally entitled to copies of those results

I haven’t been taking vitamins but I know my OH keeps telling me too…so will start doing this.

Test vitamin levels first to see what the results are before starting any supplements. Only take what’s necessary

[greygoose in reply to Trotter76]

Did the pins and needles start after the op? Because a general anesthetic can reduce B12 levels, and low B12 causes all sorts of neurological symptoms like pins and needles. So, it woud be a good idea to get that checked again.

[Trotter76 in reply to greygoose]

about a week before the operation the pins and needles started

[greygoose in reply to Trotter76]

Ah, ok, well, worth getting it rechecked, anyway.

[pennyannie in reply to Trotter76]

So you are with Graves Disease and post RAI thyroid ablation - when was the RAI please ?

[Trotter76 in reply to pennyannie]

About 2 1/2 years ago. Since then I’ve just taken 125mcg of Levo and had annual bloods just tsh and taken what ever brand they gave me at the chemist.

But about ever 4 months ish I have these flair ups where I become lathergic extremely breathless feeling of rapid heartbeat. I go to doctors get fobbed off my bloods are all ok. I just carry on everything settles and the process repeats its self

When I went to hypo I was told I know longer have Graves’ disease because I’ve gone the other way from hyper ….I don’t even know if that information is correct either

[pennyannie in reply to Trotter76]

Yes - that sounds about right - I've been there too - & welcome to the forum :

Graves is an Auto Immune disease - and there is no cure for this AI disease.

But without a working thyroid in situ this immune system response is somewhat defeated as the main target of the immune system attack - the thyroid - has been removed by having had surgery - a thyroidectomy or disabled in situ by ingesting a toxic substance - Radio Active Iodine.

So it's a bit like being between a rock and hard place when you have Graves as the suggestion is either have your throat sit open or swallow something that kills your thyroid gland from the inside out.

After RAI the HPT axis - the Hypothalamus - Pituitary - Thyroid feedback loop - on which the TSH relies on as working well - is broken - and a very unreliable measure of anything - and you must be dosed and monitored on your Free T3 and Free T4 readings - which I fully appreciate does not happen in primary care as I've been there myself.

The most most recent research is detailed below :

pubmed.ncbi.nlm.nih.gov/338...

ncbi.nlm.nih.gov/pubmed/306...

The most well rounded of all I researched ( 10 years after RAI - when much more ill than I ever was when diagnosed Graves 2004 ) is that of Elaine Moore's books and website - elaine-moore.com

Let's wait for these blood test results but you will likely do better on a ' fuller ' thyroid hormone replacement - containing some form of T3 thyroid hormone - Liothyronne - than your current prescription for T4 Levothyroxine.

You can read my thyroid journey - if interested - as you can anybody's - just press the icon alongside anything they write.

Similarly if you get lost reading around on the forum - just press your Profile which sits alongside your My Hub - Chat - Post - Alerts and Menu buttons - which on my laptop are all top right facing me - so on a phone maybe somewhere else !!

[Trotter76 in reply to pennyannie]

blood test was taken at 11:30 had nothing to eat before hand only sips of water

The results came back as well controlled

TF4 17.1

TGAB 57.5

TPOAB 21.6

TSH 0.395

T4 106

TF3 4.5

[pennyannie in reply to Trotter76]

Good morning :

Can you please add the ranges - otherwise it's impossible to give you an accurate explanation of what is going on and when did you take your last dose of T4 x 125mcg

[SlowDragon Administrator in reply to Trotter76]

My vitamin and mineral levels were done in May when I had an operation so I’m guessing everything was ok then.

Once I get the results I’ll let you know

You need to see actual results

Did you get copies yet?

GP only obligated to treat vitamin deficiencies

Eg B12 range is typically 180-670

If your B12 result was 190 GP would say it was fine

In reality many people have symptoms if B12 drops under 400. Advice on here when on levothyroxine is to maintain B12 at least over 500