High TSH normal t4

[Lou9998765]

I've recently had an increase from 100 mg to 125 alternative days of levothyroxine due to my tsh being raised but my T4 is normal. Since the increase I feel awful palpitations and jittery like I'm over medicated, the Dr has put the dose back to 100 even though my TSH is still high. I don't understand why the increase makes me feel over medicated when the blood results are showing I need more. ? Any ideas thanks

[GlowCoach Administrator]

How are you taking your Levo?

A high TSH suggests some sort of absorption issue such as eating or drinking something other than water within an hour of taking Levo, or taking it with food, other meds or supplements.

Levo is an extremely fussy hormone and to absorb and work well it has to be taken under strict conditions.

Your FT4 is only 63% of rnge which may mean you stillneed more Levo.

Have you tested and now supplementing key vitamin levels ferritin, folate, B12 & d3?

[Lou9998765 in reply to GlowCoach]

Thanks for your help I haven't tested anything else like vitamins. I will ask thanks

[GlowCoach Administrator in reply to Lou9998765]

If GP won't test vitamin levels then private tests are available. We get low and even deficient levels due to low stomach acid.

For thyroid hormone to work well we need OPTIMAL levels of vitamins. 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.

[Lou9998765 in reply to GlowCoach]

Thanks for your help 🙂

[greygoose]

Could be that you're a poor converter and your FT3 is low, which keeps the TSH raised. But the only way to tell that is by having your FT4 and FT3 tested at the same time.

i do not think you have an absorption problem because your FT4 is 62.5% through the range on quite a small dose - 100 mcg is a small-ish dose. So, it's probably a conversion problem.

[Lou9998765 in reply to greygoose]

Thanks I'll get my T3 tested, I'll have to do it privately as drs won't do it

[greygoose in reply to Lou9998765]

No, I know. They just don't understand the importance. They say T3 is irrelevant when it's actually the active thyroid hormone. LIke to see how well they'd feel if they didn't have any!

[Lou9998765 in reply to greygoose]

Thanks for your help

[SlowDragon Ambassador]

Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine

Do you always get same brand of levothyroxine at each prescription

Was 25mcg same brand as 100mcg

For full Thyroid evaluation you need TSH, FT4 and FT3 tested

Also both TPO and TG thyroid antibodies tested at least once to see if your hypothyroidism is autoimmune

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease

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)

Essential to test vitamin D, folate, ferritin and B12

Lower vitamin levels more common as we get older

For good conversion of Ft4 (levothyroxine) to Ft3 (active hormone) we must maintain GOOD vitamin levels

What vitamin supplements are you taking

VERY important to test TSH, Ft4 and Ft3 together

What is reason for your hypothyroidism

Autoimmune?

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)

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

[Lou9998765 in reply to SlowDragon]

Hi thanks for your help, I've been tested for hashimotos I haven't got it, I developed an under active thyroid as a child after having whooping cough. My vitamin d is good. Not sure about the others. I always have accord brand I can't tolerate Teva. I'm perimenopause so not sure if that's affecting it. Thanks again

[SlowDragon Ambassador in reply to Lou9998765]

I've been tested for hashimotos I haven't got it,

Have you tested BOTH TPO and TG antibodies

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

NHS only tests TG antibodies if TPO are high

And had ultrasound scan

20% of Hashimoto's patients never have raised antibodies

healthunlocked.com/thyroidu...

Paul Robson on atrophied thyroid - especially if no TPO antibodies

paulrobinsonthyroid.com/cou...

[cabro2]

1. I would ask for a re-test. Lab errors happen.

2. I would insist on a dose of 112mcg, then that re-test. A jump to 125 is a 25% increase, which is huge. The jump over 112 is why you are having side effects. Dose changes should be incremental.

[Lou9998765 in reply to cabro2]

Hi thanks I was given 25mh alternative days which makes it 12 mg extra. That's why I'm struggling to understand the side effects. Thanks for your help

[SlowDragon Ambassador in reply to Lou9998765]

Better for many patients to cut 25mcg tablets in half and take 112.5mcg daily

[Flora-Boo]

hi there. This happens to me. I seem to only ever have “normal” blood tests when I feel awful - jittery, anxious, palpitations. When I feel ok my T4 is normally fine but TSH is always higher. It’s very annoying and confusing. I have also been given 125 /150 alternate days but like someone else said, I feel it’s too big a jump so I quickly feel over medicated. I was originally hyper then had Radioiodine treatment so know the feelings very well. I didn’t realise until recently 12mcg tablets are now available in the U.K. so I might request them to lessen the jump in meds. Good luck.

[Lou9998765 in reply to Flora-Boo]

Thanks for your reply,yes that's exactly it I feel better when my TSH is high? Doesn't make sense 😕

[GlowCoach Administrator in reply to Lou9998765]

Probably due to low vitamin levels. Suggest you get them tested and start a new post when you have the results.

[Lou9998765 in reply to GlowCoach]

Thanks I'll ask the dr