Hello, my TSH level is 2.35, up from 1.49 two years ago. I asked my GP for an increase in Levothyroxine as I felt better when my TSH level was lower. He said I was in the range and if he increased the medication from 100 to 125 he risked pushing me into hyper. Is this correct? I assumed the blood test after eight weeks would show if the new dose was too high or too low and would be adjusted.
I'm thinking of having a private blood test, do you think that is the best plan ?
Thank you.
you are correct
You are currently only on 75mcg ?
Which brand
Unless extremely petite likely not on high enough dose Levothyroxine
Best bet is to get FULL thyroid and vitamin test
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 and if on inadequate dose Levothyroxine
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)
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)
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
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...
Only do private testing early Monday or Tuesday morning.
Link about thyroid blood tests
thyroiduk.org/testing/thyro...
Link about Hashimoto’s
thyroiduk.org/hypothyroid-b...
Symptoms of hypothyroidism
thyroiduk.org/signs-and-sym...
Tips on how to do DIY finger prick test
support.medichecks.com/hc/e...
Medichecks and BH also offer private blood draw at clinic near you, or private nurse to your own home…..for an extra fee
Guidelines of dose Levo by weight
approx how much do you weigh in kilo
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 near full replacement dose
pathlabs.rlbuht.nhs.uk/tft_...
Guiding Treatment with Thyroxine:
In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months.
The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).
The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range.
……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.
The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.
Some people need a bit less than guidelines, some a bit more
NICE guidelines on full replacement dose
nice.org.uk/guidance/ng145/...
1.3.6
Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.
Also here
cks.nice.org.uk/topics/hypo...
TSH should be under 2 as an absolute maximum when 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).
Thank you for replying. I will read through all the links you've sent me. I've done a quick calculation and I should be on around 125mcg. I've looked at the blood tests and will send off for the Blue Horizon one. Thank you again.
Hello Sabby-c and welcome to the forum :
Once diagnosed with hypothyroidism you can't become hyperthyroid in the true sense of the word though, possibly, one could become over- medicated if dealing with Hashimoto's AI thyroid disease.
Once on any form of thyroid hormone replacement the goal is for TSH to be kept under 2 with most of us feeling at our best with a TSH under 1 and towards the bottom of the range.
Do you have online access and can see your TSH, Free T3 and Free T4 readings and ranges -
as if you care to share we can explain things in more practical terms so to better understand the relationship between the TSH and thyroid hormones.
No thyroid hormones work well until the core strength vitamins and minerals are up and maintained at optimal levels - and these are ferritin, folate, B12 and vitamin D :
Do you leave around a 24 hour window from your last dose of T4 - Levothyroxine - and arrange an early morning appointment for the thyroid function blood test -
as the TSH level can change throughout the day - and taking your dose prior to the blood test will give you a ' false high T4 ' reading ?
Hello, I was only tested for TSH by my GP but I'm going to take the Blue Horizon Thyroid Premium Gold test so I'll find out more then. Thank you for replying.
Okey doke :
Read the post above from SDragon as to how to do the blood test etc -
and then post the results and ranges when you have them, in a new question/post and you will be talked through what it all means and advised as to your next best steps back to better thyroid health.
Sabby-C,
You've had some great replies already! But I just wanted to reiterate this "You could become hyperthyroid" is total nonsense that is very common to hear from doctors 
As others have mentioned, a more correct term for what your doctor fears is being over replaced or over medicated, in other words, taking too much medicine. Typically, doctors are much more fearful of over medicating patients than they are of under medicating them, even though the health risks of both are quite similar.
A TSH of both 2.5 and 1.49 are both much too high. To feel well most people will need their TSH to be suppressed, which means below the reference range. A healthy person tends to have a TSH close to 1. But we actually can't tell very much from the TSH, and there is quite a bit of individual variation in how responsive TSH is. You really need to see the full thyroid panel, which consists of TSH, FreeT4, and most importantly FreeT3, so it is great that you are getting a private test which will include those.
It sounds like you have a GP who knows absolutely nothing about thyroid and is going to keep you sick. So you will probably have on your hands the problem of trying to manage your GP, or perhaps sneak around them in order to treat yourself properly.
Thank you for your reply. I had prepared my argument for increasing my levothyroxine but when he mentioned pushing me into hyper, as he put it, it completely threw me. Once I have the results from the private test I'll do as much as I can in the way of vitamins etc and then try again.
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