Blood test results - but T3 refused by lab!

[MrsPFrost]

Hello all, I hope you had an enjoyable Christmas. I was very fortunate as my thoughtful husband and daughter brought me a hot stone massage along with a electric blanket (didn't realise these still existed!), new fluffy dressing gown, slippers and hot water bottle

From my doctors I received my latest blood test results. I have been trying to get an appointment with the same helpful doctor who requested all the advised blood tests but have been unsuccessful, so have an appointment with another doctor. Any advice on how to proceed would be gratefully received.

Autoimmune profile Thyroid perox.abs: 1091 iu/mL (0.00-60.00)

Serum TSH: 0.34 mu/L (0.35 - 5.00)

Serum free T4: 16.6 pmol/L (9.00-20.00)

Serum ferritin: 99ug/L (20.00-275.00)

Serum folate: 4.9 ug/L (2.70-34.00)

Vitamin D (analysis performed by immunoassay which detect 100% Vit D3 and 82% Vit D2): 56 nmol/L (50.00-150.00)

Serum T3: No action

Serum free T3: FT3 is not routinely available for the monitoring of hypothyroidism.

(The doctor was very clear on the form she required these to be completed, when I expressed concern they may refuse she said she had every faith in the lab who are very good and respect a fellow colleague and professionals request especially when additional information relating to the request was provided!)

I'm worried that as my TSH is suppressed they will want to reduce my medication, I'm currently on 125mcg Levothyroxine.

Should I seek an endo referral as the doctor felt that as I'm still symptomatic and have gilberts there could be a T3 conversion problem. Would being symptomatic with a suppressed TSH and current T4 levels support this?

I believe from what I have read on here I should look at supplementing my Vit D, can anyone advise how and by how much?

I have also read on here that my ferritin would benefit from being higher, however as I have beta thalassaemia minor I cannot take iron tablets. I will see what the doctor suggest and ask them to take advice from a haematologist but as I'm currently will be unlikely to get a referral to one.

Apologies for the long post and lack of knowledge/understanding, any comments or advice people can offer would be gratefully received.

Wishing you all a healthy New Year.

[jimh111]

The labs are told not to do the fT3 assay when a doctor requests it. The only way to change things is to make a very polite complaint (to the lab / hospital) and if that doesn't work complain more forcefully. This problem arises from arrogant endocrinologists who say the fT3 isn't needed. My experience is that every such endocrinologist always requests and gets an fT3 assay for their private patients.

[Clutter]

MrsPFrost, the doctor who ordered the FT3 needs to pick up the phone and insist the lab does the test as she needs the results in order to make a diagnosis. Labs usually hold samples for a week or two so they may be able to use the original sample.

Your TSH is a smidgeon below range but it isn't suppressed (<0.04) and your FT4 is mid-range so you aren't overmedicated and there shouldn't be any reason to reduce your dose.

Some say ferritin 70-90 is optimal while others suggest half way through range. Yours is good, even if not optimal.

Try 4,000iu vitD3 softgel capsules, spray or patches for 4/6 weeks to build levels and then cut back to 2,000iu daily until April when ultraviolet light will stimulate natural vitD.

Your folate is low so it may be worth taking a B Complex which contains the RDA of folic acid for 3/4 months. Was B12 tested?

[greygoose]

Can't tell whether you're converting or not without the FT3. Such a rediculous situation where a lab tech can over-rule a doctor!!!