Blood test results help needed

[Jellybabyhead]

Hello. I had half my thyroid removed several years ago and was on 50mg levo for a few years. Symptoms suggested an increase was needed and although reluctant, GP agreed. Most recent tests show TSH is now 0.96 (0.55 - 4.78) and has come back marked as “normal” but I wonder if it’s now too low.

B12 is slightly high but I’m on supplements - 914 (180 - 900); folate 19.6 (>3), ferritin 30 (15 - 300) which I know needs to be higher. I’m on 420mg ferrous fumarate a day which doesn’t seem to be helping.

Curiously under the FBC my red blood cell distribution width is marked with ! as it’s 15% (11.0 - 14.8). No clue what this means.

Symptoms: fatigue, irritability, headaches, anxiety, palpitations, dizziness, hair loss, weight gain, sleep disturbance.

I’m also on Venlafaxine for anxiety and HRT so it’s fun over here.

Further blood tests have now come back - see attached. Any help much appreciated.

[GlowCoach Administrator]

Free T4 (fT4) 16.2 pmol/L (11.5 - 22.7) 42.0%

Free T3 (fT3) 4.8 pmol/L (3.5 - 6.5) 43.3%

FT4 needs to be higher which will also raise your FT3 more where it needs to be.

Suggest you push GP for a trial increase of Levo.

You could buy your own and better iron supplement which may well work better. This product has helped many members raise ferritin.

threearrowsnutra.com/en-uk/...

If you take a look at low ferritin symptoms I'm sure you will identify with many of them.

low ferritin

[Jellybabyhead in reply to GlowCoach]

Yes I definitely identify with many of those symptoms!

[SlowDragon Ambassador]

So these test results are after at least 2-3 months on 75mcg?

Which brand of levothyroxine

Was test early morning ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test

75mcg is low dose unless you are extremely petite

Free T4 (fT4) 16.2 pmol/L (11.5 - 22.7)

Ft4 only  42.0% through range

Free T3 (fT3) 4.8 pmol/L (3.5 - 6.5) 

Ft3 only 43.3% through range

Shows you have good conversion rate but low Ft4 suggests you need further increase in levothyroxine

When adequately treated likely to have Ft4 at least 60-70% through range

Guidelines suggest 1.6mcg Levo per kilo of your weight per day

Low ferritin is often result of being under medicated for thyroid

Low ferritin levels will lower TSH

[Jellybabyhead in reply to SlowDragon]

Tests are after about 18-20 months of 75mg. Taken at 8.30am, over 24h since last levo and having drunk only water.

Brand is Aristo - vencamil. This is one I’ve been given for about 3 months now, before that it was always Teva.

[SlowDragon Ambassador in reply to Jellybabyhead]

Many members find Vencamil by far the best

It’s lactose free and mannitol free

If you prefer it get GP to specify brand on all future prescriptions

How to get prescription written for Vencamil

healthunlocked.com/thyroidu...

How to get Vencamil stocked at your local pharmacy

healthunlocked.com/thyroidu...

Posts discussing Vencamil

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu....

[SlowDragon Ambassador in reply to Jellybabyhead]

See/contact GP for next increase in levothyroxine up to 100mcg daily

If GP is reluctant ask for it as “3 months trial “

You might initially increase only as 75mcg and 100mcg on alternate days for few weeks before increasing to 100mcg daily

[SlowDragon Ambassador]

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.

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