After more than 5 yrs on 150mg Levo my dose has been reduced to 125. I was surprised.

[JennyC2]

I still have problems feeling tired, insomnia and putting on weight. I now have two sets of results and would be really grateful for help in understanding them and for any thoughts on why I still seem to have symptoms.

Value Units Range ABN

30 May 2012

SerumTSH level 3.207 iu/L (0.300 - 5.000 U)

Serum free

T4 level 19.1 pmo1/L (9.0 - 24.O U)

12 Mar 2013

SerumTSH level 0.137 mU/L (0.300 - 5.000 U) LO

Serum free

T4 level 25.3 pmo1/L (11.0 - 23.0 U) HI

Please note new reference range from 19 June 2012

Many thanks

Jenny

[helvella Administrator Thyroid UK]

I'd like to see a couple of extra details, please:

Had you taken your levothyroxine in the hours before the blood draw?

What time of day did you have blood drawn?

Rod

[JennyC2]

Hi Rod

Yes for the most recent one. I took my thyroid medication (150mg) around 7.30am and my blood was taken about 3.30 in the afternoon. I'm afraid that I can't remember the timings for 2012.

[helvella Administrator Thyroid UK in reply to JennyC2]

Taking your levothyroxine six hours before a blood test could well explain the high FT4.

We usually suggest not taking it until after the blood draw.

Also, TSH tends to be lower in the afternoon.

So a doctor looking at your results sees low TSH, and quite high FT4 and jumps to the conclusion you are over-medicated. Understandable but possibly untrue.

If you had skipped the 7:30 dose, had blood drawn as early as possible (I aim for 08:00 but whatever you can do), taken levothyroxine straight after that. You might have seen TSH a bit higher and FT4 within range - doctor happy and, hopefully, you happy.

Maybe go and discuss with GP again and suggest you were a bit off-colour that day and could you have another test in a few weeks?

Rod

[JennyC2 in reply to helvella]

Many thanks Rod - I am due to go back for a test in May. The two sets of results seem quite dissimilar. Do you think that is usual?

[helvella Administrator Thyroid UK in reply to JennyC2]

If the other test was early in the day, then quite possible.

Typically FT4 peaks somewhere around two hours after taking it. Assuming the same, that would be 09:30 or so - could you have had the blood taken before that?

Rod

[JennyC2 in reply to helvella]

I usually try to get appointments before work so that seems reasonable. Assuming that the most recent test was an anomaly do the earlier results suggest that it it is reasonable for me still to have the various symptoms?

Many thanks

Jenny

[helvella Administrator Thyroid UK in reply to JennyC2]

Sadly, many people have better blood test results but still have symptoms.

You certainly could have a lower TSH and a slightly higher FT4. In my opinion, certainly you should not reduce your dose!

But I encourage you to also consider what we call our usual suspects:

vitamin B12

folates

iron/ferritin

vitamin D

Might be worth at least reading this page:

thyroiduk.healthunlocked.co...

Rod

[JennyC2 in reply to helvella]

Thanks - I posed an earlier question about the timing of the medication and I switched to taking it just before bedtime and I think there may be a little improvement.

Sorry to embroil you in a personal debate but it is really good to discuss this with someone. Since you mention vitamins - I have taken a standard Boots multivitamin for many years. Looking at a different page on the Thyroid UK website there seems to be a suggestion that this may not be a good thing. If this is the case would I be better trying to tailor my additional vitamin intake to those that you have listed above?

[helvella Administrator Thyroid UK in reply to JennyC2]

That is a simple list of issues that occur all too often. Best advice is get tested then decide.

Don't change in a panic!

Rod

[JennyC2 in reply to helvella]

Ok thanks - last question. Is this something that I can expect my doctor to test for?

Jenny

[helvella Administrator Thyroid UK in reply to JennyC2]

B12, folates, iron/ferritin and vitamin D are ALL reasonable to ask for. Whether your GP will agree or not is another matter!

Best of luck.

[JennyC2 in reply to helvella]

Thanks very much for your help. I'm off to take my meds!

Jenny

[isisis in reply to helvella]

OMG I had no idea - my tests are always early morning, soon after taking my tablets. I've never been told not to take them before the test. Thank you for writing this!

[helvella Administrator Thyroid UK in reply to isisis]

You and at least dozens, maybe hundreds, of others here.

TSH changes through the day.

FT4, if you have one, would tend to reflect the short-term peak.