GP's ( or Endo's) monitoring treatment for hypothyroidism with Levothyroxine should aim to adjust dose to keep TSH in the lower part of the range ie. 0.4 /0.5 to 2.0 / 2.5 . This is supported by several references , some of which were written specifically for GP's : healthunlocked.com/thyroidu.... my-list-of-references-recommending-gps-keep-tsh-lower-in-range
ignoring an over range TSH is not acceptable for treated patients, even the most basic NHS guidelines for treating monitoring hypothyroidism say that they should be aiming to keep the TSH within range.
Tests for follow-up and monitoring of primary hypothyroidism
1.4.1
Aim to maintain TSH levels within the reference range when treating primary hypothyroidism with levothyroxine. If symptoms persist, consider adjusting the dose of levothyroxine further to achieve optimal wellbeing, but avoid using doses that cause TSH suppression or thyrotoxicosis.
1.4.2
Be aware that the TSH level can take up to 6 months to return to the reference range for people who had a very high TSH level before starting treatment with levothyroxine or a prolonged period of untreated hypothyroidism. Take this into account when adjusting the dose of levothyroxine.
Adults
1.4.3
For adults who are taking levothyroxine for primary hypothyroidism, consider measuring TSH every 3 months until the level has stabilised (2 similar measurements within the reference range 3 months apart), and then once a year.
1.4.4
Consider measuring FT4 as well as TSH for adults who continue to have symptoms of hypothyroidism after starting levothyroxine. nice.org.uk/guidance/ng145/...
so whoever is in charge of your dose should be increasing it based on this latest result ... i'm not sure if that is GP or endo in your case , as you were/ are ? on an NHS trial of T4/T3.
Thank you Tattiebogle, for all this detailed information, lots to think on.
I was amazed how my TSH had shot up from a yearly almost a steady +/- 2.56 to 4.22! Within a year.
I’d always thought T4 was a slow worker eg a fortnight or so before movement! This near doubling in a month ,,,,any thoughts I’d appreciate.?
I think there may be some politics going on! I’m writing a letter to my doc about this TSH /T4 situ and he can pass it onto my Endo. If he cares to!!
As my Endo has been contacted on my problem. It has been used by my health centre to make a point with the blood labs that there are patients who are an acceptation, as they would be on both Ts 3+4 , so only giving a TSH Blood is NOT a helpful answer.
Free T4 can change within minutes of swallowing a levothyroxine tablet!
It's value from a test depends on the balance of how much you take and how much your body needs/uses. And that test result is only a snapshot of that moment in time.
It varies through the day. It can vary because of a change of make of levothyroxine tablets. Or time of blood draw. And many other factors.
helvella - Scheduling Blood Draws
Factors to consider when choosing time for blood draws. Includes links to several documents/webpages and previous HealthUnlocked posts.
Thank you for all this info Helvella, hot off the press. Sorry I’m slow at the moment responding.
Yes I now understand ‘the span ‘of the Bloodtest, and how important it is to be consistent when choosing a time to take it, if you need to do comparisons.
I’ve still more to read. As biotin is not the only thing to interfere with T4.
Even the way I diluted it, and used a syringe to take off the required mixed solution. Sediment residue in glass and even in the syringe mechanism! A past method.
Last dose levothyroxine should be 24 hours before test and day before test split 10mcg as 2 x 5mcg with last dose 8-12 hours before test.
Why such a very very low dose of Levo?
Have you ever been on just levothyroxine?
Typically dose levothyroxine is increased slowly up to approximately 1.6mcg per kilo per day
And essentially GOOD vitamin D, folate, ferritin and B12
Once Ft4 is up around 70% through range, if Ft3 remains low, then small dose T3 is added to Levo. Typically Levo doesn’t need reducing much, possibly by 25mcg reduction daily …….but often not as much as that
I hope this message works. Life is never straight forward….
Prior to the 26-11-24 blood test. I missed the previous nights T4. That might be why at 10 past 8 am I was a bit vague in my thoughts? . Resulting in the high TSH @ 4.22…..This I researched was the earliest taking of my bloods this year.. On 30-10- 24 that had been at 8.20 am others were late morning. In future… Before 9 am as you say . But this T4 is still below the preferred initial level as it was 8.9pmol/L! Should be near 12!
The T 3 as I take it first thing in the morning I left off taking until after the blood sample was taken.
****
I was on NDT, in Eire, when that ended, I came to England so asked to go on T 4 . That started slowly, the transisition, but I realised I needed NDT, to help my verbal dexterity. I was on a combination as I tried to change over.
I got as far as 75mcg of T4, only, when less than a month in I had awful hives, I couldn’t sleep. Doc advised Antihistmines.
Not good, as my system was already choc a bloc with them. They dried me up TOO much. I’d been given all sorts over past 10 yrs for 9 mths of year, for hayfever!
We got out of that and I went to see the Endo. Who put me on 10 mcg T3 & 12.5 mcg T4, a trial. 3 months in things settled into being comfortable and I could hold fluent conversations without post it’s!! I needed the T3 to get to this stage.
The Endo diagnosed me as subclinical, but the T3 was needed because of the way my thyroid problems started. ( also have a younger sister who went through Thyroid cancer! She won’t talk about it.)
The initial effects of my Thyroid problems were like a spanner in my brain, I just lost words, I’d be talking, then void no more words. A bit later I could continue. …..!!!
But as time passed lots of lost words they increased & tiredness increased . This was for brief periods then I was like a cat just wanted to sleep on. I needed the medication but the Irish Endo had to ok me before I could have their T4, on prescription….2 yrs passed before that happened!
Meanwhile I found Dr Barry Durrant- Peatfields book in the Library and put myself onto NDT. Sanity!
*********
Could a fall landing on my head compress my hypothalamus ? I had such a fall in1993, and this thyroid problem emerged in 2007!!
Prior to the 26-11-24 blood test. I missed the previous nights T4. That might be why at 10 past 8 am I was a bit vague in my thoughts? . Resulting in the high TSH @ 4.22…
TSH does not react suddenly to missing a dose
It’s more like an average speed check on the motorway
Thank you Slow Dragon v. much for the sign posts and logic.
After trying to raise T4 meds & the T 4 fogging . I felt never again did I want to fall into that tired T4 trap.
So it’s T3. + retest in 6-8 weeks, and I eat into my new 4 mths of T3 due at the end of this week! It’s only 5mcg, just what I felt ,a sprinkle .
Does T3 keep diluted for several days?
But I suspect if I do buy meds for myself eg, T3, the NHS will pull out their financial support and say I can finance all the T3 myself.! As this health centre runs on a shoestring!
Mother of a Suicide: The Battle for the Truth Behind a Mental Health Cover-Up
by
Joanna Lane
Well, there had been some progress. I’d learnt a lot about hypopituitarism, for a start. I’d built up a collection of papers that filled a whole filing cabinet drawer, throwing out all my teaching papers to make room for them. I’d persuaded a couple of important medical websites to include the crucial information. I’d made slight inroads into the medical press — a couple of letters in magazines for GPs. I’d had encouraging replies from some of the hospitals I’d written to. I’d learnt that Dr Tara Kearney at Salford Royal Hospital in Manchester was ‘addressing the issue’ of PTHP. Thanks to one of my brothers-in-law and a nephew I had a_ website, Headinjuryhypo, that set out the salient facts, but all this was like throwing bread on the water. I did not know where the ducks were, or if they were eating any of it. I was reaching out into the void, desperate to find somebody like Chris (I always visualised a young man, though I knew it wasn’t only men who suffered) who would learn about PTHP and get his life back.
It is nice to get a Like just so I know you have seen a reply. And, of course, you can reply if you wish, but most of the time I'd only expect a reply if you want to.
what multi vitamins am I taking. You won’t …. approve it’s a multi vitamin, ….Biotin 50ug per tablet, so I stopped it 4 days before bloods.
It also has per tablet:- Vit D 10ug. Iron 7mg iodine 150ug , selenium 110ug , zinc 10 mg + zinc picolinate 22mg , separately etc etc. could these be a problem,?
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