Hi, been taking 75mcg levo for c12 months. Been feeling pretty symptomatic lately (exhaustion, muscle aches, headaches and weight gain) so GP sent me for blood tests. I have just seen the results on the NHS app and TSH is 3.19, and T4 is 12.60 so GP has just commented “within normal range”.
I’ll speak to the GP on Monday as I don’t believe this is optimal for me, I feel like optimal for me is TSH between 1.5-2…just wondering what other thyroid patients think? My GP is usually not keen to increase my dosage, but I feel like I am living a half life at times as I am just so tired…
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If it were me I'd be asking to trial 100mcg as still symptomatic, it may be in range, just not optimal for you yet.
What time of day was the test? your TSH would be highest at roughly 8am.
Was Levo 24 hours before?
Worth knowing your FT3 too, you could do this privately via Medichecks, Monitor My Health or search Randox Thyroid test on Amazon, its on offer this week. Finger prick first thing in the morning, Levo 24 hours before, no supplements with Biotin for 3-5 days.
test was at 9.10am, had only had water beforehand, however had taken my Lego as usual at 7am! So I now know to not take it before a test. Been thinking about paying g for a private test for T3 so will look into his, thanks
Ah then likely even more under replaced than your results show.
Our nurse phlebotomist often asks when you took Levo when taking the sample. Nowadays I just say this morning as usual ( an actual lie 😣) because it makes zero difference to how the lab interpret the results. As SD says it’s a patient to patient tip. When I’ve been honest in the past they’ve got huffy with me saying you are supposed to take it as normal. Which as we know gives inconsistent results.
TSH is 3.19, and T4 is 12.60 so GP has just commented “within normal range”.
What’s the range on Ft4
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)
TSH is too high for someone on levothyroxine
Typically when adequately treated Ft4 will be at least 60-70% through range when on Levo
See/contact GP
List your symptoms
Request “trial” increase in levothyroxine to 100mcg per day
Retest again in another 2-3 months
ESSENTIAL to test vitamin D, folate, ferritin and B12
What vitamin supplements are you taking
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).
Thank you this is all really useful! Range on FT4 was 7.86 - 14.41. Blood test was 9.10am, had only drank water beforehand but did take my levo as usual at 7am so good to n em for future. Will read your links so I can be fully armed with info for my GP chat!
Vit D, folate, ferritin and B12 were all tested at the same time and all “within normal range.
Ferritin was 71 on a lab range of 22-322 so not sure if this is optimal?
Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption
only add one vitamin supplement at a time, then wait 10-14 days to assess before adding another
Starting with vitamin D
B vitamins
With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a separate B12 supplement
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
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
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
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
Post discussing how biotin can affect test results
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Help with results please
Help with test results
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Test results - help please
Latest test results - help please
