Thyroid check help please

[Nemesis123]

I'm on 50mg Levothyrixin. Have been for yearsRecent blood test for serum TSH is 4.82

Free T4 is 17.6 pmol/L

Should I be on a higher dose of Levo?

Thanks

[Buddy195 Administrator]

Yes you need an increase in Levo Nemesis123, as TSH should always be under 2, with many members reporting they feel best with TSH under 1. Do you have a range for FT4, as this can differ between laboratories? Was FT3 checked?

When were key thyroid vitamins last checked (ferritin, folate, B12 and vit D)? Having these optimal supports thyroid health.

If your GP is unable to complete all the above (eg if TSH is within range, some surgeries may not be able to access FT4 and FT3 tests), you could look to do this privately, as many forum members do, for a better picture of your thyroid health:

thyroiduk.org/help-and-supp...

[Nemesis123 in reply to Buddy195]

Thanks. It says for T4 level normal range is 11.9 to 21.6Mine is 17.6

FT3 has never been checked?

I will have to look again at FBC

[Buddy195 Administrator in reply to Nemesis123]

Are you experiencing any adverse symptoms? As 50mcg is usually a starter dose of Levo, I’m surprised you haven’t been offered an increase.

As FT4 not at top of range, you have plenty of room for an increase in Levo . I would ask for an increase of 25mcg and ensure your GP retests levels after 6-8 weeks on a new dose. It’s worth asking GP for FT3 to be tested, plus thyroid antibodies (to see if your condition is auto immune- AKAHashimotos) and for key thyroid vitamins- then look to test privately if you can’t access these.

[Nemesis123 in reply to Buddy195]

Thank you. She will be calling later I assume regarding these results. How does one go about getting these tests done privately?

[Buddy195 Administrator in reply to Nemesis123]

Click on the link in my first reply. Many forum members use Medichecks and Blue Horizon/ MMH. The Advanced thyroid test will ensure antibodies and key vitamins are tested, alongside full thyroid panel.

A patient to patient tip regarding your next thyroid blood test is to get the earliest possible test (before 9am) as TSH highest early morning and ensure you do not take your daily dose of Levo until after the test.

Do share all test results with us- we are here to help! 🦋

[Nemesis123 in reply to Buddy195]

Thank you. I will do all you have suggested

[SlowDragon Ambassador]

ALWAYS test thyroid 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?

How old are you ?

What are your main hypo symptoms

Request 25mcg dose increase to 75mcg daily

HOWEVER, as been left on inadequate dose years suggest you increase SLOWLY to 62.5mcg daily initially

cut 25mcg tablet in half to get 12.5mcg and just add half a tablet per day initially for 6-8 weeks

Assuming that is ok

Either retest then

Or increase dose to 75mcg daily

Retest in 2-3 months

Request GP test vitamin D, folate, B12 and ferritin levels now if not been tested in last year

Exactly what vitamin supplements are you taking

Have you ever had thyroid antibodies tested

About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high TPO and/or high TG thyroid antibodies

Autoimmune thyroid disease with goitre is Hashimoto’s

Autoimmune thyroid disease without goitre is Ord’s thyroiditis.

Both are autoimmune and generally called Hashimoto’s.

Significant minority of Hashimoto’s patients only have high TG antibodies (thyroglobulin)

NHS only tests TG antibodies if TPO are high

20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis

In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)

[Nemesis123 in reply to SlowDragon]

Thank you. I obviously got it all wrong! Appointment in afternoon after levothyroxine in morning. Bloods not done for vit D, B12, ferritin, folate. I only got treated because of private blood test years ago and nothing treated since (not due to covid, just my inefficient practice). I'll see what said later by GP, but really don't hold out much hope for help/treatment. Tx

[SlowDragon Ambassador in reply to Nemesis123]

So TSH would have been higher if tested at 8-9am

Ft4 would have been lower with last dose levothyroxine 24 hours before test

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

This is why almost everyone on levothyroxine should eventually be an approximately full replacement dose

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)

cks.nice.org.uk/topics/hypo...

bnf.nice.org.uk/drugs/levot...

nhs.uk/medicines/levothyrox...

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 always be below 2 on levothyroxine

gponline.com/endocrinology-...

Graph showing median TSH in healthy population is 1-1.5

web.archive.org/web/2004060...

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).

sciencedirect.com/science/a...

The optimal daily dose in overt hypothyroidism is 1·5–1·8 μg per kg of bodyweight, rounded to the nearest 25 μg.

[carer999]

If my GP requested FT3, it would not be done as that's local policy. FT4 only if TSH out of range.