No t3 or t4 test this time..

[Cinka]

My recent blood test showed my tsh was within normal range but Consultant didn't request t3 or t4. I have been advised to continue on 15 my carbimazole. Should I have had t3 and t4 tested? I always have in the past but not this time, for some reason.. not feeling particularly brilliant either.. 😒

[pennyannie]

Hello Cinka :

I would think it imperative as with Graves you can't rely on the TSH reading :

I just looked back and see you have been on the AT drug for a couple of years now -

and your dose of the AT drug increased since your previous post -

so you need to monitor T3 and T4 readings against the previous readings - to know whether the AT drug needs adjusting again -

Especially as you say you don't feel too good :

Possibly your thyroid hormones T3 and T4 are now too low in the ranges for you -

and you are starting to experience the equally disabling symptoms of hypothyroidism ?

If your core strength vitamins and minerals are low, these can compound your health issues further as we need optimal levels-

do you get 6 monthly / yearly blood tests for ferritin, folate, B12 and vitamin D -

we can advise where these need to be maintained if you care to share results and ranges.

[Cinka in reply to pennyannie]

Thank you for your reply. I have since had repeat blood tests, including T3 and T4 which appear to be within normal range. TSH is lower this time but - just - within normal range. I am surprised as I really felt that I was tipping into hypothyroidism. I have most of the tests done that you mentioned which, again seem to be OK, so I really don't know. I am taking Prednisolone which I am reducing, so don't know whether that could be having an impact? 😒

[pennyannie in reply to Cinka]

You probably are now hypothyroid and have ' tipped into hypothyroidism ' -

Being in the range does not mean that you are not hypothyroid -

Hypothyroid symptoms will be experienced within the ranges -

as it is more about where in the ranges you need your T3 / T4 to sit to relieve your symptoms of hypothyroidism -

we all have our own unique set point where our T3 and T4 need to be for metabolism to kick in and for our health and well being to be restored.

What are your T3 and T4 readings and ranges - ideally you need to be around midpoint on the T4 with the T3 tracking just behind ?

Short term Prednisolone will have an impact on your ability to convert T4 into T3 -

and longer term Prednisolone will slightly lower both T3 and T4 thyroid hormone production -

so yes, your thoughts concerning this medication are justified.

[Cinka in reply to pennyannie]

Just checked my most recent results: T3 - 4.9 T4 - 18.00

TSH - 0.37

and have been advised to continue taking 15mg Carbimazole daily.

Also, ESR - 16

CRP - 8

Low lymphocytes - 1.1

Any thoughts, pennyannie? 🤔

[pennyannie in reply to Cinka]

Hey there -

So without knowing the ranges - it's all a guess -

If I use Medichecks ranges -

CRP - is inflammation and looks high as we might expect with any thyroid AI attack:

Low lymphocytes are a known side effect when taking Carbimazole - please see your doctor :

There is an alternative AT drug Propylthiouracil ( PTU ) for short :

Your TSH has bounced back into range so this is good news and hopefully this means your immune system has calmed down and this phase of ill health passing.

Your T4 looks a little high at around 60% with your T3 around 49% through the Medichecks ranges -

I think when taking the AT drug the NHS like to see lower levels tof T4 and T3 than these before they suggest titrating down the dose.

How are you feeling ?

[Cinka in reply to pennyannie]

General malaise with what feels like a fluctuating slightly raised temperature. The Registrar I spoke to last week didn't place any significance on the lower lymphocytes in relation to Carbimazole but,unfortunately, from our discussion re my results, didn't seem to have the knowledge that I would have expected. I'll try again and hopefully speak to the Consultant.. I've been taking Carbimazole for around 4 years but the low lymphocytes could still relate to the medication after that amount of time?🙂

[pennyannie in reply to Cinka]

The longer one is taking Carbimazole the more the risk of developing low lymphocytes - this is common knowledge - so yes - understand your reservations with talking this through with the Registrar.

Non optimal levels of core strength vitamins and minerals - especially those of ferritin, folate, B12 and vitamin D can compound your ill health further - maybe get these run and we can advise where these need to be sitting to support you through this phase of ill health and life in general.

Your metabolism is being managed and controlled by the AT drug and when the body runs either too fast as in hyperthyroid or too slow as in hypothyroid it also struggles to extract key nutrients from food, no matter how well and clean you eat, so another area that may need support throughout this process.

I now aim to maintain my ferritin at around 100 - folate around 20 - active B12 125 ( serum B12 500++ ) and vitamin d at around 125.

I can't remember - did I send these to you before -

pubmed.ncbi.nlm.nih.gov/338...

ncbi.nlm.nih.gov/pubmed/306...

The most well rounded of all I researched - though too late for me as I had RAI thyroid ablation back in 2004/5 is that of Elaine Moore - books and website - and there is a section on alternative and more holistic treatment options which might be of interest - elaine-moore.com

[Cinka in reply to pennyannie]

Thank you for the information 🙂

[Cinka in reply to pennyannie]

Thank you for the information 🙂