Understanding blood results

[Lasagnebread]

Hi everyone,

My first blood results have come back since starting 50mg levothyroxine in June.

They are now:

TSH- 3.78 (normal range 0.55 to 4.78)

T4 - 13.5 (normal range 11.5 to 22.7)

Previously in May:

TSH - 11.16

T4 - 12.9

I can't get a gp appt until mid September so wondered if anyone had an idea if this is going as it should or if there was anything specific I should follow up with the gp?

I don't know if it matters that my t4 is slightly higher as this is still within range.

I still feel as crappy but assume that's from other things as my tsh is now normal.

I've asked if they can specify a different brand on my prescription to try (currently teva). I was also flagged as having high blood pressure at one of those NHS heart health vans. I've been monitoring it at home and it's fluctuating between normal/elevated and high. Again not sure what role my thyroid has here but I'm going to check this with the GP when I see them.

[tattybogle]

"I still feel as crappy but assume that's from other things as my tsh is now normal."

Hi lasagnebread

getting TSh 'anywhere in range' is not the same as 'optimal for the individual' .

In healthy people with no thyroid disease it is by far the most common to have TSH around 1 ish.... very very few healthy people will have TSH over 3 ... (a few do , hence the range going up to 4 ish , but it's highly unusual)

So when discussing your latest results with GP , they should be offering a dose increase to raise your still very low fT4 level ( and lower your TSH a bit).

it is to be expected that you would still have symptoms of hypothyroidism with such a low level of fT4. They should improve gradually ( with some ups and downs) as you get closer to the optimal dose for your body's needs.

This post may help make it easier to understand :

healthunlocked.com/thyroidu... explanation-of-what-*high-tsh-is-telling-us-when-our-ft4-level-is-normal-on-levothyroxine-the-shoe-size-analogy.-*-over-2.5-3-ish

This post is useful if you get a GP who thinks TSH 'anywhere in range' is 'good enough' ... (it's not) .... it also has a link to a graph illustrating how uncommon it is for healthy people to have TSH over3 :

healthunlocked.com/thyroidu.... my-list-of-references-recommending-gps-keep-tsh-lower-in-range

[Lasagnebread in reply to tattybogle]

Thank you that's really helpful!

[Jaydee1507 Administrator]

You're ready for the next dose increase. Aim for TSH at or just below 1 where most people feel well. Ask for the increase as a trial if GP is reluctant.

Have you tested key vitamins yet and started supplementing to optimal? We need optimal levels of vitamins for our thyroid hormone to work well.

[Lasagnebread in reply to Jaydee1507]

They've not been tested since May. I have been taking supplements but not sure where things are sitting atm. I'll ask the gp if they can re-do that as I was low in iron in May.

[SlowDragon Administrator]

was test done early morning, ideally before 9am, only drinking water between waking and test and importantly last dose Levo 24 hours before test

Free T4 (fT4) 13.5 pmol/L (11.5 - 22.7) 

Ft4 only 17.9% through range

Clearly showing you need next increase in dose to 75mcg daily

Most people, when adequately treated on just levothyroxine will have Ft4 result at least 60-70% through range

Essential to maintain GOOD vitamin levels

I'm using the BetterYou B12 and Vit D spray and have just been taken off prescription folic acid

now you have finished Folic acid prescription……starting a daily vitamin B complex to maintain good B12 and folate

Your GP should be treating your anaemia as discussed in previous post

healthunlocked.com/thyroidu...

And you need coeliac blood test if not done BEFORE considering trial on gluten free diet

You mentioned you are on Teva

Teva is currently only brand that makes 75mcg tablets

If want to change brand you would need 50mcg and 25mcg tablets

Bloods should be retested 6-8 weeks later after each dose change or brand change in levothyroxine

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)

[Lasagnebread in reply to SlowDragon]

Test was done 8.50am just water from waking and last dose of levothyroxine was over 24 hours beforehand. Thank you for that information as I wouldn't have known to do that otherwise!

I haven't changed my diet yet but will aim to do this. Everything has been a bit chaotic recently so my diet in general has been terrible and probably largely made up of crisps and toast which won't have helped things!

[SlowDragon Administrator in reply to Lasagnebread]

Most important next step is get next dose increase in levothyroxine to 75mcg daily

Retest again in another 2 months