Hi Everyone, I'd appreciate some help understanding my test results. As far as I can see my TSH looks high and the others look low. I've been on 50mg levo for about 2 years. My GP has added 'no further action' under the results. Is this right?
I had expected my dose to be increased this time, as I've been feeling tired recently. I'm regularly supplied different brands of levo. In the past, I have sent messages to the surgery (via the NHS App) requesting the same brand, but it's not changed. However, as i don't seem to be adversely affected by any of the brands, I don't push my request.
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Maz-57
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Your TSH is much too high for someone on thyroid hormone replacement. I means you're still very hypo. It should come down to 1 or under. But I expect that just because it's still within the range - although only just! - your GP thinks it has to be OK. Your GP knows nothing about thyroid.
FT3: 4.2 pmol/l (Range 3.1 - 6.8) 29.73%
FT4: 15.2 pmol/l (Range 12 - 22) 32.00%
Both your Frees are too low. You'd probably be better with them up in the top quartile of the range. You really do need an increase in dose - probably several increases! 50 mcg is just a starter dose and should have been increased to 75 mcg six weeks after starting it.
Than you Greygoose, I'm trying to make a telephone appointment to discuss with the doctor now. Any advice on how I approach her? I don't want to suggest to her she knows nothing but I'd obviously like her to take my concerns seriously and review my meds.
I cannot imagine how you would approach someone who knows so little about thyroid. But maybe insist very heavily on how you still feel unwell and have a lot of hypo symptoms. I'm really not the right person to ask that question because I'm not the most tactful of patients. 🤣 I wouldn't recommend my methods to anybody!
So this is the reply I received by text from a GP at my practice. I couldn't get a f2f appt., so i used the App to email my concerns re my blood results. No phone call to discuss my symptoms or concerns - just this badly written text!
Print these guidelines out and be ready to quote them
You urgently need 25mcg dose increase in Levo and retesting again in further 2-3 months
Likely to need increase in dose after this
Guidelines of dose Levo by weight
approx how much do you weigh in kilo
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 somewhere near full replacement dose (typically 1.6mcg levothyroxine per kilo of your weight per day)
Adults usually start with a dose between 50 micrograms and 100 micrograms taken once a day. This may be increased gradually over a few weeks to between 100 micrograms and 200 micrograms taken once a day.
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).
Or go over their heads and see thyroid specialist
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 so that might eventually transfer to getting T3 on NHS
Thank you very much for taking the time to post these links. I'll digest it all and hopefully be equipped to argue my case. I've already asked the doctor who text me to refer me to a specialist. Failing that, I'll book an appointment with a privately with one.
Your results show you are in desperate need of dose increase to 75mcg daily
Request “trial” increase if GP is reluctant
Which brand of levothyroxine do you prefer
Be prepared to push hard for increase
Guidelines of dose Levo by weight
approx how much do you weigh in kilo
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 somewhere near full replacement dose (typically 1.6mcg levothyroxine per kilo of your weight per day)
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 again 6-8 weeks after increase in dose
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)
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 and especially if been left on inadequate dose levothyroxine
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
Thank you for replying SlowDragon.Yes, I believe my hypothyroidism is due to autoimmune as antibodies were detected when first diagnosed.
I weigh 58 kilos and am 67. My test was done at 9am having taken last dose at midnight and I'd only drank water on waking (as previously advised on this forum).
I don't take any supplements, but I will ask for a vitamin test and get one privately if not.
I've emailed my practice asking for a doctor to review my dosage, as I couldn't get a telephone appointment any time soon.
Do you know if under medication can cause the occasional shakes, cold feet, pins and needles in feet and palpitations? As I've been experiencing these on occasions in recent months. Along with tiredness as mentioned above.
My test was done at 9am having taken last dose at midnight
Advice on here (and via endocrinologists) is to take last dose levothyroxine 24 hours before test
So your Ft4 result is falsely high if last dose was only 9 hours before test
So in reality your Ft4 would be even lower if had left 24 hours
If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test
If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal
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