A little advice needed ☺️: Hi All Happy... - Thyroid UK

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A little advice needed ☺️

Henson1980 profile image
18 Replies

Hi All

Happy Christmas!

I’m looking for a bit of advice as iv posted on here before and members/admin have always been very helpful.

I was diagnosed with an underactive thyroid over 10yrs ago. I have hashimotos so my levels don’t seem to stay normal for long. I assume that’s the hashis? Anyway, I was on 100mcg of Levo but still feeling tired/achy joints, they tested my TSH which I know those figures alone don’t tell an awful lot with all the other readings but my TSH was around 3.5. In the past when they upped my dosage to 125mg iv ended up going hyper very quickly so they suggested just doing 125 3 times a week and 100 on the other days. That’s what I have done the last 2-3 months but my latest test results show that I’m hyper again. My problem is that apart from a few night sweats I have felt so much better so really don’t want to drop back to 100. However my doctor has said that I must reduce the dose then retest in Feb. I’m baffled as when I’m just on 100 my levels are off but just 3 days a week on 125 my levels go into overdrive. I really don’t want to drop the dose as I do feel so much better…I have 1 pack of 25’s left and I’m tempted to just take one a week as a little boost. Any advice that might help with my little conundrum?

T3 is 5.3

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Henson1980
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18 Replies
Jaydee1507 profile image
Jaydee1507Administrator

Your TSH might be slightly below range but your results are not showing that you're hyper or over replaced.

Your FT4 is only 55% of range and no FT3 result. So long as free hormone results are within range then TSH doesnt matter, although most doctors dont understand this.

What time of day was your test taken? Highest TSH is at 9am or earlier.

Are you testing and supplementing low vitamin levels?

What are your latest results for ferritin, folate, B12 & D3?

Your GP needs to take your wishes and opinion about your results into consideration. Do show your GP this and you can take responsibility for your low TSH.

The first paragraph in the NICE (NHS) Thyroid Disease, Assessment and Management guidelines says :

nice.org.uk/guidance/ng145

"Your responsibility”

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian. “

nice.org.uk/guidance/ng145

SlowDragon profile image
SlowDragonAdministrator

Just testing TSH and Ft4 is completely inadequate

Free T4 (fT4) 11.8 pmol/L (7.7 - 15.1) 

Ft4 only 55.4% through range

Your results show Ft4 is well within range

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)

is this how you did your test

Do you always get same brand levothyroxine at each prescription

Exactly what vitamin supplements are you taking

ESSENTIAL to test and maintain GOOD vitamin levels

Night sweats suggests low B12

joint pain low vitamin D

Testing options and includes money off codes for private testing

thyroiduk.org/testing/

Medichecks Thyroid plus BOTH TPO and TG antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes BOTH TPO and TG antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

Medichecks and BH also offer private blood draw at clinic near you, or private nurse to your own home…..for an extra fee

Only do private testing early Monday or Tuesday morning.

Tips on how to do DIY finger prick test

support.medichecks.com/hc/e...

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

Monitor My Health (NHS private test service) offer thyroid and vitamin testing, plus cholesterol and HBA1C for £65

(Doesn’t include thyroid antibodies)

monitormyhealth.org.uk/full...

10% off code here

thyroiduk.org/testing/priva...

Randox FULL thyroid test including both thyroid antibodies just £29

Test at home or in clinic

randoxhealth.com/en-GB/at-h...

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

TiggerMe profile image
TiggerMeAmbassador in reply toSlowDragon

fT3 5.3 snook in right at the bottom of post but no range given, I can't even offer a guess as the other ranges are new to me 🫤

Henson1980 profile image
Henson1980 in reply toSlowDragon

Thanks slow dragon I tested before 9am on an empty stomach only water and stopped takin Levo 24hrs before. I made sure I stopped biotin a week before as I know this can affect results. I take vid d, but b complex and selenium xx

SlowDragon profile image
SlowDragonAdministrator in reply toHenson1980

What’s the range on Ft3 ?

Henson1980 profile image
Henson1980 in reply toSlowDragon

5.3

SlowDragon profile image
SlowDragonAdministrator in reply toHenson1980

Ranges - figures in brackets after the result

Henson1980 profile image
Henson1980 in reply toSlowDragon

Serum free triiodothyronine level 5.3 pmol/L [4.3 - 6.8]

SlowDragon profile image
SlowDragonAdministrator in reply toHenson1980

Free T4 (fT4) 11.8 pmol/L (7.7 - 15.1) 

Ft4 only 55.4% through range

Free T3 (fT3) 5.3 pmol/L (4.3 - 6.8)

Ft3 only 40.0% through range

So this shows that if anything you have room for dose INCREASE in levothyroxine

With low Ft3 low vitamin levels are likely

Henson1980 profile image
Henson1980 in reply toSlowDragon

Wow that’s really interesting…I feel so let down by my doctor, since iv reduced back down to 100 I feel like my energy has been zapped! She wants to wait until Feb to review me which means a good two months of feeling like this! If my own doctor doesn’t understand my thyroid results then what hope do I have 😩

SlowDragon profile image
SlowDragonAdministrator in reply toHenson1980

Rare to find a GP (or even endocrinologist) who isn’t TSH obsessed

But many, many thyroid patients have sluggish or poor response TSH

TSH is NOT a thyroid hormone, it’s merely the message from pituitary to thyroid. If you are on adequate replacement dose TSH is frequently low

The most important results are Ft4 and Ft3 plus GOOD vitamin levels and essential to test correctly……early morning for highest TSH

Last dose levothyroxine 24 hours before test

You could write to GP giving Ft4 and Ft3 results and ranges and also give results as percentages through range

Say you would like vitamin levels tested and that you don’t wish to reduce dose levothyroxine at this stage as Ft4 and Ft3 are well within range

If they won’t test…..test privately

Optimal vitamin levels

Vitamin D at least over 80nmol

Serum B12 over 500

Active B12 over 70 (private test)

Folate at top of range

Ferritin at least over 70

Henson1980 profile image
Henson1980 in reply toSlowDragon

Thank you for your detailed responses. This might sound like a silly question but what does ‘through range’ mean?

Coppernob profile image
Coppernob in reply toHenson1980

All NHS doctors seem to be under orders to reduce thyroid meds. I self medicate. You could do that. Or find a functional doctor.

SlowDragon profile image
SlowDragonAdministrator

You could say you are going to get full testing yourself on your current dose BEFORE considering reducing dose

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).

If GP says " I have to reduce your dose because the guidelines say i can't let you have a below range TSH" .....

The first paragraph in the NICE (NHS) Thyroid Disease, Assessment and Management guidelines says :

nice.org.uk/guidance/ng145

"Your responsibility

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian. "

sparkly profile image
sparkly

Hi, sorry to throw a spanner in the works. Could you possibly be perimenopause with having night sweats and body aches. It also made me think, if your username is your birth year, then that about at the right age. It's so difficult when both thyroid and peri/ menopause can have similar symptoms

Believe me, ive been there!

Henson1980 profile image
Henson1980 in reply tosparkly

Thank you and you are right to think that but I’m on HRT and my levels are all good x

SlowDragon profile image
SlowDragonAdministrator in reply toHenson1980

HRT frequently results in needing change in dose of levothyroxine. Usually an increase in dose

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 who are aware TSH can be low and look at Ft4, Ft3 instead

Ideally choose an endocrinologist to see privately initially and who also does NHS consultations so that might eventually transfer to NHS

thyroiduk.org/contact-us/ge...

Henson1980 profile image
Henson1980 in reply toSlowDragon

Amazing thank you I’ll. check list out! Have a wonderful Christmas and new year!

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