Blood results?

[Pillpusher]

Hi, was diagnosed a while back and been on 75mcg of levothyroxine for a while. My last 3 blood results have come back with increasing TSH but the T4 is within range but at the upper end of normal ( tsh 6.7, t4 18.1) My gp says that cause the t4 is within range, and the tsh not too high, its ok. Has anyone had similar results? I still have all the hypo symptoms so feel something isn't quite right???

[greygoose]

Hi Pillpusher, welcome to the forum.

I suspect that your doctor is wrong, and that everything is not alright. I suspect that you are a poor converter of t4 to T3 and that your FT3 is much too low. And that is why your TSH is high (telling the thyroid to make more T3) and your FT4 high (not being used up by conversion) and why you still have hypo symptoms, because hypo symptoms are caused by low T3. But your doctor probably doesn't even know what T3 is! Not many of them do. And the only way to find out how well you convert is to have FT4 and FT3 tested at the same time and compare them.

A few questions, if you don't mind:

- What time of day was the blood draw for this test?

- How long was the gap between your last dose of levo and the blood draw?

- Do you have any nutrient test results: vit D, vit B12, folate, ferritin?

[Pillpusher in reply to greygoose]

Thanks for responding, in answer to your questions,The sample was taken at 11am

And it had been 24hrs since my last dose the previous day.... I've been reading a lot of the posts here on the subject!

I'm waiting to get more blood tests which include most of the vit/iron tests but not any more thyroid tests, I will have to ask about the T3 but like you the fact that my T4 has been quite high made me wonder if it was actually being metabolised.

[greygoose in reply to Pillpusher]

So, having the blood draw at 11 am would mean that the TSH would have been nearing its lowest point. It would have been higher before 9 am, but impossible to guess by how much.

Unlikely you will get FT3 tested on the NHS. Even if your doctor asks for it, the lab can refuse to do it - they all think that it's unnecessary and that T3 is irrelevant! So, most people get it done privately. Would that be possible for you?

[Pillpusher in reply to greygoose]

Already looking at getting my blood tested privately as its a 5/6 week wait for nhs blood tests here!

[greygoose in reply to Pillpusher]

That's terrible! Here in France you just pop along to the lab and as long as you get there well before 10 am, they do it on the spot - but they don't take blood after 10. And you get your result around 6 pm. I guess you just don't have enough labs. Here there's at least one on every high street.

So, getting a private test would be a very good idea. Have you seen this:

thyroiduk.org/testing/priva...

[Pillpusher in reply to greygoose]

Hi greygoose, yes I've been looking at their website for advice and noticed they have the links for blood testing so I will give it a go.

Thank you for the advice and for responding

[greygoose in reply to Pillpusher]

You're welcome.

[SlowDragon Ambassador]

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 do your tests ?

Which brand of Levo are you currently taking

TSH is far too high

Ask for “trial” increase to 100mcg Levo

ESSENTIAL to also test and maintain GOOD vitamin D, folate, ferritin and B12

Please add most recent results

What vitamin supplements are you taking

[Pillpusher in reply to SlowDragon]

Hi, thanks for the reply.I was aware of the discussions around times of testing etc and had omitted my morning dose on the day of the blood tests.

Brand of levo does vary, and I did wonder if this was adding to my problems of poor symptom control.

My dose was increased to 100 a year ago, but because I also had a high T4 back then, I very quickly developed cardiac side effects and went back to 75 after 2/3 wks on the higher dose.

Awaiting vitamin tests, not taking any supplements at the moment

[SlowDragon Ambassador in reply to Pillpusher]

Many, many thyroid patients find they need to supplement vitamin D, magnesium and vitamin B complex daily

Quite a lot initially need separate B12 before adding B complex

And significant number struggle to maintain good iron/ferritin

Essential to test at least annually. Test more frequently if results are low and supplementing to improve

Work out which brand Levo suits you best then request GP specify that brand by name on prescription

Government guidelines for GP in support of patients if you find it difficult/impossible to change brands

gov.uk/drug-safety-update/l...

If a patient reports persistent symptoms when switching between different levothyroxine tablet formulations, consider consistently prescribing a specific product known to be well tolerated by the patient.

If symptoms or poor control of thyroid function persist (despite adhering to a specific product), consider prescribing levothyroxine in an oral solution formulation.

academic.oup.com/jcem/artic...

Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).

And here

pharmacymagazine.co.uk/clin...

Discussed here too

healthunlocked.com/thyroidu...

Brands

Mercury Pharma make 25mcg, 50mcg and 100mcg tablets 

Mercury Pharma also boxed as Eltroxin. Both often listed by company name on pharmacy database - Advanz

Accord only make 50mcg and 100mcg tablets. Accord is also boxed as Almus via Boots, 

Wockhardt is very well tolerated, but only available in 25mcg tablets. Some people remain on Wockhardt, taking their daily dose as a number of tablets 

July 2024

Crescent levothyroxine. Dosages: 12.5, 25, 50, 75, 100

(Not yet known if all approved dosages are or will be available).

Excipients: lactose monohydrate, maize starch, croscarmellose sodium, gelatin and magnesium stearate.

Lactose free brands - currently Vencamil or Teva

Vencamil is lactose free and mannitol free. originally only available as 100mcg only, but 25mcg, 50mcg and 75mcg tablets became available Sept 2024

Prior to March 2023 Vencamil was called Aristo

Vencamil often very well tolerated/best option for many people

How to get Vencamil stocked at your local pharmacy

healthunlocked.com/thyroidu...

Posts discussing Vencamil

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu....

Teva makes 12.5mcg 25mcg, 50mcg, 75mcg and 100mcg

Many patients do NOT get on well with Teva brand of Levothyroxine.

Teva is lactose free, but contains mannitol as a filler instead of lactose, which seems to be possible cause of problems. Mannitol seems to upset many people, it changes gut biome 

Helpful post about Teva

healthunlocked.com/thyroidu...

Posts that mention Teva

healthunlocked.com/search/p...

Teva poll

healthunlocked.com/thyroidu...

Relatively new ……Hillcross brand

This is a box, rather than a brand. 50mcg and 100mcg are Accord brand….but beware 25mcg is Teva brand

Helpful post about different brands

healthunlocked.com/thyroidu...

List of different brands available in U.K.

thyroiduk.org/if-you-are-hy...

Once you find a brand that suits you, best to make sure to only get that one at each prescription.

[SlowDragon Ambassador in reply to Pillpusher]

Frequently need optimal vitamin levels to help tolerate higher dose Levo

and ensure brands are same

If you found 100mcg daily too much initially, trying slightly lower dose Levo eg 75mcg 4 days and 100mcg 3 days

Fine tuning dose is frequently necessary

As described here

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).

Comprehensive list of references for needing LOW TSH on levothyroxine

healthunlocked.com/thyroidu....

[Pillpusher in reply to SlowDragon]

My last box of levo was teva which I see you have commented on above, so something I will look into.I will definitely look at getting my bloods rechecked and then see if I can get a change in brand but as I am sure most people here will know getting an appointment is a nightmare and getting someone to listen is even harder!

[helvella Administrator in reply to Pillpusher]

helvella - Teva versus the rest

A discussion of the issues surrounding Teva levothyroxine.

Last updated 28/12/2024

Link to blog:

helvella.blogspot.com/p/hel...

[SlowDragon Ambassador in reply to Pillpusher]

Next step is to get full thyroid and vitamin testing

Come back with new post once you get results

Meanwhile work out which brand you prefer and request that brand in named on all future prescriptions

Or if Teva is an issue many patients have note added saying “no Teva” to all future prescriptions

Hillcross 25mcg are also Teva inside the box

[Pillpusher in reply to SlowDragon]

Thanks for all the advice. Will repost when I get some results back🙂