TSH levels

[Vernon123X]

Taken off T3 few months ago.Tests in Oct

T3 4.20

T4 12.60

TSH 10.9

GP has increased levothyroxine and am due endo appt shortly.

Any thoughts why TSH so high please

[Jaydee1507 Administrator]

Welcome to the forum.

What were the results where your doctor thought were too high?

How do you take your blood tests?

Recommended blood test protocol: Test at 9am (or as close as possible), fasting, last levo dose 24hrs before the blood draw, last T3 dose 8-12 hours before blood draw & no biotin containing supplements for 3-7 days (Biotin can interfere with thyroid blood results as it is used in the testing process).

Testing like this gives consistency in your results and will show stable blood levels of hormone and highest TSH which varies throughout the day. Taking Levo/T3 just prior to blood draw can show a falsely elevated result and your GP/Endo might change your dose incorrectly as a result.

How much Levo are you on now and how much T3 did you stop taking?

Please add reference range for each test - numbers in brackets after your result.

How do you take your Levo?

Always take Levo on an empty stomach an hour away from food or caffeine containing drinks & other meds. Many people find taking it at bedtime works well for them.

TSH can be high if noton enough thyroid hormone or if there are absorption issues. Taking Levo with coffee or tea for instance or with other meds can cause poor absorption.

When hypo we get low stomach acid which means we cannot absorb vitamins well from our food, regardless of a great diet. For thyroid hormone to work well we need OPTIMAL levels of vitamins.

Have you recently or could you ask your GP to test levels of ferritin, folate, B12 & D3? Private tests are available, see link for companies offering private blood tests & discount codes, some offer a blood draw service at an extra cost. thyroiduk.org/testing/priva...

There is also a new company offering walk in& mail order blood tests in London, Kent, Sussex & Surrey areas. Check to see if there is a blood test company near you. onedaytests.com/products/ul...

Only do private tests on a Monday or Tuesday to avoid postal delays.

It's ideal if you can always get the same brand of levo at every prescription. You can do this by getting GP to write the brand you prefer in the first line of the prescription. Many people find that different brands are not interchangeable.

[Vernon123X in reply to Jaydee1507]

Thank you for all this detail.I have never been asked to do a fasting thyroid blood test but when I was on T3 I was told not to take it on the same day as a test but have never been told not to take levo.Was on 20mcg T3 then reduced to 10 and then stopped.Currently on 25mcg Levo everyday except Mon,Wed and Fri when I am now taking 50mcg on those days

I always take levo early morning before any food or drink.

Have endo appt in 10 days - will try and get another blood test beforehand

Main reason for this is due to problems with Cal. Level.Am.already on B12 injections. D3 level was min at 75. On GF diet but very careful with this.

At present suffering cold symptoms and fizzyness in my body which could also be due to Cal. and sore mouth.

Think I will have a lot to ask endo.

Thank you again for information.

[Jaydee1507 Administrator in reply to Vernon123X]

25/50mcg dose of Levo is very low indeed and no wonder your TSH is high. You need a dose increase of 25mcgs.

I suspect you have had your dose reduced is due to low TSH and when on T3 it almost always is below range as it stops the pituitary calling for more thyroid hormone.

Presumably you were on T3 due to poor conversion which isnt likely to get better. You might benefit from finding a new Endo to treat you.

B12 injections have cofactors in order to work well. Most people need a good methyl B complex that also includes folate.

Suggest you get ferritin & folate tested and start a new post with results.

[Vernon123X in reply to Jaydee1507]

Thank you so much.i think we are going to have to start from scratch with this.Apart from a private endo appt as the NHS waiting list was so long I haven't seen an endo for years .Apparently with Hypopara I should probably have had a more regular review with one.I have been very lucky generally but obviously now need to sort out a variety of different levels so life is more balanced!

Help from Hypopara UK and yourselves has been so good and I am very grateful.

Thank you

[SlowDragon Administrator in reply to Vernon123X]

I always take levo early morning before any food or drink.

When testing thyroid levels…..test early morning, ideally before 9am and most IMPORTANTLY delay taking levothyroxine until AFTER test

[SlowDragon Administrator]

Currently on 25mcg Levo everyday except Mon,Wed and Fri when I am now taking 50mcg on those days

That’s a tiny dose

What’s the ranges on Ft4 and Ft3

Results look very low

Levothyroxine doesn’t “top up” failing thyroid, it replaces it

On just Levo standard STARTER dose is 50mcg

Typically dose is increased slowly upwards over 1-2 years until on approx full replacement dose, usually around 1.6mcg of levothyroxine per kilo of your weight per day

Unless very petite that’s like to be at least 100mcg per day

How much Levo were you taking BEFORE T3 was added

Adding T3 it’s extremely common for TSH to drop very low or become suppressed. Dose should be monitored by testing Ft3 and Ft4 ……not TSH

Likely low vitamin levels as you are currently very hypothyroid

Get levothyroxine increase to 50mcg daily

Retest in 6-8 weeks

Likely ready for next increase after that

If not…..retest again in further 6-8 weeks

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)

T3 ….day before test split T3 as 2 or 3 smaller doses spread through the day, with last dose approximately 8-12 hours before test

Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins

Post all about what time of day to test

healthunlocked.com/thyroidu...

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

[Vernon123X in reply to SlowDragon]

Thank you too for all this. Much appreciated. Hopefully the endo appt will help resolve things particularly as I now have extra knowledge.Nobody else has suggested that low thyroid could be responsible for low cal levels.Will spread out vit d3 too. Already careful when I take it.

Thank you again!

[SlowDragon Administrator in reply to Vernon123X]

How low was vitamin D at last test

How much vitamin D are you taking

Are you taking vitamin k2 as well

And a separate magnesium

Test twice yearly when supplementing

Can test via NHS private testing service

vitamindtest.org.uk

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

Vitamin D may prevent Autoimmune disease

newscientist.com/article/23...

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

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

[Vernon123X in reply to SlowDragon]

Last test for Vit D was 75. Hypopara patients should be between 75 and 100. At this point was only on 800iu which was included in my calceos tablets but have added extra 1000iu as we should take up to 2000iu during the winter.Not been checked recently but will include it next time.

Magnesium was OK too.

Did not know about K2 but already using Better you B12 spray in the few days before my 6 weekly B12 injection.

Will need to look carefully at timings for meds.

Thank.you again

[SlowDragon Administrator in reply to Vernon123X]

All things about parathyroid here

parathyroid.com

parathyroid.com/hypoparathy...

Great parathyroid app here made by same people

Test vitamin D, calcium and pth together

Blood test needs to be organised by GP/specialist at large phlebotomy dept at PTH test must be processed immediately

calciumpro.com

[SlowDragon Administrator]

Extremely important to take calcium at least 4 hours away from levothyroxine

Also vitamin D tablets or gels and magnesium at least 4 hours away

Low vitamin levels likely directly linked to being hypo

How low was vitamin D at last test

How much vitamin D are you taking

Low vitamin D is often cause of low calcium

Levothyroxine is an extremely fussy hormone and should always be taken on an empty stomach and then nothing apart from water for at least an hour after

Many people take Levothyroxine soon after waking, but it may be more convenient and perhaps more effective taken at bedtime

verywellhealth.com/best-tim...

markvanderpump.co.uk/blog/p...

markvanderpump.co.uk/blog/p...

No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.

Some like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away

(Time gap doesn't apply to Vitamin D mouth spray)

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