I've recently received my results from Medicheck and I wondered if someone would be kind enough to decipher them for me please?! I am currently taking 25mcg levothyroxine daily, have been for some years now! TIA
Help with blood results please: I've recently... - Thyroid UK
Help with blood results please
Written by
Littlebuddha
To view profiles and participate in discussions please or .
Read more about...
10 Replies
•
SlowDragonAdministrator
was test done 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)
What is your TSH
You need immediate 25mcg dose increase in levothyroxine and retest in another 6-8 weeks
Which brand levothyroxine are you taking
ESSENTIAL to test vitamin D, folate, ferritin and B12
What vitamin supplements are you taking
When were vitamins last tested
Low vitamin levels likely as direct result of being left on inadequate dose levothyroxine
Low vitamin levels tend to lower TSH
How old are you
Standard STARTER dose levothyroxine is 50mcg
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)
cks.nice.org.uk/topics/hypo...
bnf.nice.org.uk/drugs/levot...
nhs.uk/medicines/levothyrox...
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
gponline.com/endocrinology-...
Graph showing median TSH in healthy population is 1-1.5
web.archive.org/web/2004060...
Comprehensive list of references for needing LOW TSH on levothyroxine
healthunlocked.com/thyroidu....
onlinelibrary.wiley.com/doi...
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).
Thank you so much for prompt reply. Yes test was done before 9am and only a glass of water taken before test. My TSH is 6.09. Don't take any vitamins, very first time I've had them tested. Vit D is 45.9, Folate serum is 8.7 and B12 is 52.8. I'm 67.5 years old. I weigh too much!! Approx 90 kilos! The brand of levothyroxine I take is Wockhardt. My GP was having none of it when I questioned my results, told me everything was normal !!!
see different GP with these results
On Levo TSH should ALWAYS be low in range…..ideally around one, definitely below 2
Appalling lack of care from your current GP
Politely but firmly INSIST on increase in dose Levo to 50mcg daily
Vitamin levels
No ferritin result?
Vitamin levels are poor as direct result of being left on inadequate dose levothyroxine
Only add one supplement at a time
Then wait 10-14 days to assess any changes before adding another
Start improving vitamin D first
Then magnesium
Then B12
Then vitamin B complex
I didn't get to see a GP! It was a telephone consultation, I asked him to go through my results, he just more or less said there is nothing to discuss as the results are normal, you need to be more bothered about being borderline type 2 diabetic and put the phone down on me! I havent seen or heard from a GP since, just keep re ordering my levothyroxine and venlafaxine and I get them with no questions asked! I'm sure there was a ferritin result, il get back to you on that one.
So can you make an appointment with different GP
Email or post copy of results in
Explain that you are still only on 25mcg dose Levo
Tgat you have of hypothyroid symptoms
List all that apply (but don’t mention weight as main issue)
Symptoms of hypothyroidism
thyroiduk.org/signs-and-sym...
Blood sugar issues likely to improve significantly once you are on higher dose levothyroxine
ncbi.nlm.nih.gov/pmc/articl....
Baseline HbA1c levels were found to be significantly higher in hypothyroid patients, which reduced significantly after achievement of euthyroidism without any change in glucose levels
Print out guidelines on dose Levo
cks.nice.org.uk/topics/hypo...
The NICE clinical guideline recommends:
Consider starting LT4 at a dosage of 1.6 micrograms per kilogram of bodyweight per day (rounded to the nearest 25 micrograms) for adults under 65 years of age with primary hypothyroidism and no history of cardiovascular disease.
Consider starting LT4 at a dosage of 25–50 micrograms per day with titration for adults aged 65 years and over, and adults with a history of cardiovascular disease.
The British National Formulary (BNF) recommends:
For adults aged 18–49 years — initially 50–100 micrograms once daily; adjusted in steps of 25–50 micrograms every 3–4 weeks, adjusted according to response; maintenance 100–200 micrograms once daily.
For adults aged 50 years and over, with cardiovascular disease, or severe hypothyroidism — initially 25 micrograms once daily; adjusted in steps of 25 micrograms every 4 weeks, adjusted according to response; maintenance 50–200 micrograms once daily.
Request “trial” increase to 50mcg
As you currently take Wockhardt, they only make 25mcg tablets so request prescription is increased to 2 x 25mcg tablets per day
If you still can’t get dose increase from new GP
See endocrinologist or thyroid specialist doctor
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
Vitamin D 45.9nmol
GP should prescribe 1600iu everyday for 6 months, but you’re better off just taking supplements yourself
NHS Guidelines on dose vitamin D required
panmerseyapc.nhs.uk/media/2...
GP will often only prescribe to bring vitamin D levels to 50nmol.
Some areas will prescribe to bring levels to 75nmol or even 80nmol
leedsformulary.nhs.uk/docs/...
GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)
mm.wirral.nhs.uk/document_u...
But improving to around 80nmol or 100nmol by self supplementing may be better
pubmed.ncbi.nlm.nih.gov/218...
vitamindsociety.org/pdf/Vit...
Once you Improve level, very likely you will need on going maintenance dose to keep it there.
Test twice yearly when supplementing
Can test via NHS private testing service
Vitamin D mouth spray by Better You is very effective as it avoids poor gut function.
There’s a version made that also contains vitamin K2 Mk7.
One spray = 1000iu
amazon.co.uk/BetterYou-Dlux...
It’s trial and error what dose we need, with thyroid issues we frequently need higher dose than average
Suggest you start on 2 or 3 sprays per day - that’s 2000-3000iu daily
Retest in 3-4 months
Web links about taking important cofactors - magnesium and Vit K2-MK7
Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine
betterbones.com/bone-nutrit...
medicalnewstoday.com/articl...
livescience.com/61866-magne...
sciencedaily.com/releases/2...
Recipe ideas
bbc.co.uk/food/articles/mag...
Interesting article by Dr Malcolm Kendrick on magnesium
drmalcolmkendrick.org/categ...
Vitamin K2 mk7
SlowDragonAdministrator
Suggest you reread previous post of yours from 4 years ago
With very similar results
healthunlocked.com/thyroidu...
Utterly outrageous that dose wasn’t increased to 50mcg after testing 4 years ago
Most people on levothyroxine, when adequately treated will have Ft4 (levothyroxine) at least 60-70% through range
Currently your Ft4 is BELOW RANGE confirming you need dose increase to 50mcg now
Retest in 2-3 months
Likely to need several further increases in levothyroxine over coming months
SlowDragonAdministrator
Folate serum is 8.7 and
Active B12 is 52.8.
With active B12 below 70 (or serum B12 result below 500) recommended to be taking a separate B12 supplement
Then
A week later add a separate vitamin B Complex
Then once your serum B12 is over 500 (or Active B12 level has reached 70), you may be able to reduce then stop the B12 and just carry on with the B Complex.
If Vegetarian or vegan likely to need ongoing separate B12 few times a week
Highly effective B12 drops
natureprovides.com/products...
Or
B12 sublingual lozenges
uk.iherb.com/pr/jarrow-form...
cytoplan.co.uk/shop-by-prod...
In-depth article on different forms of B12
perniciousanemia.org/b12/fo...
B12 range in U.K. is too wide
Interesting that in this research B12 below 400 is considered inadequate
healthunlocked.com/thyroidu...
perniciousanemia.org/b12/le...
And why aiming to keep B12 over 500 recommended
perniciousanemia.org/b12/le...
Low folate
supplementing a good quality daily vitamin B complex, one with folate in (not folic acid)
This can help keep all B vitamins in balance and will help improve B12 levels too
Difference between folate and folic acid
healthline.com/nutrition/fo...
B vitamins best taken after breakfast
Igennus B complex popular option. Nice small tablets. Most people only find they need one per day. But a few people find it’s not high enough dose and may need separate methyl folate couple times a week
Post discussing different B complex
healthunlocked.com/thyroidu...
Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule) Thorne can be difficult to find at reasonable price, should be around £20-£25. iherb.com often have in stock. Or try ebay
IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 5-7 days before ALL BLOOD TESTS , as biotin can falsely affect test results
endo.confex.com/endo/2016en...
endocrinenews.endocrine.org...
In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate folate supplement (eg Jarrow methyl folate 400mcg) and continue separate B12 until Active B12 at least over 70 minimum
Post discussing how biotin can affect test results
healthunlocked.com/thyroidu...
helvella.blogspot.com/p/hel...
Ferritin is 233.
So ferritin is fine
Updated reference ranges for top of ferritin range depending upon age
healthunlocked.com/thyroidu...
Thank you for your incredible patience while you have been awaiting the outcome of our ferritin reference range review. We conducted this with Inuvi lab, which has now changed the reference ranges to the following:
Females 18 ≤ age < 40. 30 to 180
Females 40 ≤ age < 50. 30 to 207
Females 50 ≤ age < 60. 30 to 264l
Females Age ≥ 60. 30 to 332
Males 18 ≤ age < 40 30 to 442
Males Age ≥ 40 30 to 518
The lower limits of 30 are by the NICE threshold of <30 for iron deficiency. Our review of Medichecks data has determined the upper limits. This retrospective study used a large dataset of blood test results from 25,425 healthy participants aged 18 to 97 over seven years. This is the most extensive study on ferritin reference ranges, and we hope to achieve journal publication so that these ranges can be applied more widely.
