Hi,

I received my first blood tests back 2 weeks ago since I was first diagnosed hypothyroid.
Originally, my levels were 9.8 and then after taking 50mcg levothyroxine they read 5.6. My doctor has advised increasing meds to 100mcg so issued a new prescription for me.
This time the pharmacist despensed the meds in a bottle. I took them, but did not feel that much better! Which I thought was strange considering I doubled my dosage.
I began to wonder if it could be the brand so I had a look at the tablets and noticed the following: Instead of having a TX on them they have an E.
I was reassured by the pharmacist that these are thyroxine. Can anyone help with this? What does the E stand for???
I have actually switched back to the other brand until I find out what they are.

Scrummy which test did you have done? From the sounds of it I'd say it was only a TSH, which really is NOT enough to determin dosage needs. Although I would say with a TSH of 5.6 you're not on a high enough dose. How off your dose is would depend on your actual thyroid tests. TSH doesn't measure thyroid function, it measures how well your pituitary gland thinks your thyroid is working. TSH is thyroid stimulating hormone. Your thyroid hormones would be expressed as tests like FT3 or T3 and FT4 or T4 (T4 and T3 being the two thyroid hormones your body makes)

That being said, your pills are likely both thyroxine, but they are from a different manufacturer. "E" might mean Eltroxin, which is a form of synthetic T4 (other brand names are synthroid and unithroid and there are countless generics which are also comparable). It's generally not a good idea to be switching brands as we often react negatively to the fillers / binders used in various meds. I would ask my pharmacist to make sure you always got the same generic and not to switch your brands around.

When you increase your dose of T4 you won't feel the effects for a few weeks, it's not because it's a different brand that you aren't feeling any better, it is because it takes at least 2 weeks before the levels in your body increase. Increases in doses of this type of hormone should be made every 6 weeks to ensure you don't end up with too much.

If I might, I would suggest you talk to your doctor about checking your actual thyroid hormones and not just your TSH; if he goes by just the TSH you'll never know for sure how well the meds are working.

Cheers,
Nat

Thank you for the response.

Makes sense about switching brands. I will be more savvy when dealing with the pharmacist next time!

I just called the surgery to find out what tests I have had and I now have all my results:

As follows:
First test which brought about the diagnosis
TSH 9.4
T4 12.6

Second test after taking levothyroxine for 3 months 50mcg.
TSH 5.7 (sorry, I wrote this wrong earlier)
T4 13.8

No T3?

I am due a blood test in about 2 weeks time to check to see if the 100mcg is an improvement. I will request a new form for my blood test and request I am checked for TSG, T4 and T3...is that right??

When I increase my dosage I tend to headaches almost immediately, is this likely to be the fillers/binders or a reaction because the dosage is a shock to the system? Does anyone else get headaches like this?

Scrummy, did they give you the lab ranges for those numbers? W/o an actual range to see where you fall the numbers just dont mean as much. Typically women feel best when their FT levels are in the upper 3rd of the lab range (men do best at around midpoint). So the size of the lab range for "normal" is important vis a vis your actual test result.

I can see that your T4 has improved, however T4 is not as good an indicator as FT4 (T4 is the total amount of T4 in your system, FT4 is the amount of T4 that is freed from the binding proteins and is available for your body to use, it's possible to have a high/ normal T4 but not have adequate FT4). T4 is also suseptible to false readings, high levels of estrogen can elevate T4 results. Also, did you take your thyroxine before the test? This could also have elevated the number.

To get an accureate measure of how well the dose is working for you, you should wait 6 weeks after the increase for the test. Don't take your meds the morning of the test and go as early as possible for the blood draw. Also, ask if they can test your FT4 instead of just your T4 (more accuracy).

It's unlikely they will test your FT3, they don't like to do that (they'll tell you there's no reason since you're not on a med with T3 in it). But I would push for it anyway; your FT3 level will tell you if your body is converting T4 into T3 or not.



Did you always have this reaction, or is it new since you switched brands? It's not uncommon to have some physiological symptoms when you increase your dose (often feeling flushed, warmer, more rapid heart rate) but it usually abates w/in a week. If it continues it could be a reaction to the binders/fillers.

Nat

Hello again,

You mentioned that estrogen can elavate results, so does it matter what time of the month blood tests are performed?

To answer your question: I take thyroxine in the morning and I had the blood test early evening.
My last test was taken when I felt my absolute worse right before my period. I currently only have two good weeks a month. The week before a period I have a sugar frenzy and feel very very tired and then during the week I am just totally exhausted, cannot function properly for the entire week and then back to "normal" slowly for my two "good" weeks.


With regards to ranges:

The ranges I was given are as follows:

TSH 0.4 - 4.0 (My doctor said she would like to see me being about 1.0)

The T4 had a much much wider range from something like 10 to 20+. I will obviously get this information next time and I will push for the T3 too. (and anything else that I find out about it between)

About the reaction:

Yes, I do always have a reaction. I started on 50 mcg and after 5 days had the most awful headache. The only change was the introduction of thyroxine. I went back to the doctors and she cut it down to 25mcg with a gradual increase back to 50mcg.

I also got the headache when I increased the meds again from 50mcg to 100mcg.

Thank you for all your help.

Ack, I just lost a very long post

The worry with high estrogen is usuallly related to taking BCPs, scrummy. If there were any impact from the hormones your body was making naturally I would suspect the worst time to be tested would be right before ovulation, when estrogen is highest.

Re the timing of your tests; having TSH drawn later in the day results in a lower reading. This hormone is highest late at night and shuts off when you go to sleep, so you want it tested as early as possible after you wake up. Re the T4 being elevated from the meds; an 8 hour window usually takes care of this problem, your test should be OK (it should be accurate)

This is really common among women with thyroid disease. Our thyroids would, under normal conditions, be pumping out more hormones to handle the increase in metabolism that comes with TOM, but as we're dependent on the meds we just can't keep up. It should abate some when you get to your optimal dose level.

Great news; this is where you want to be. However you also want her concerned with your FT readings (the thyroid hormones) they should be in the upper 3rd of the range; if not you could have a TSH below 1.0 and still feel like crap.


Sounds like too much, too soon. I would take half the new increased new dose (50mcg + 25mcgs = 75mcgs) for a few weeks then go up to 100mcgs. I guess she didn't learn from what happend to you last time!

You're very welcome