Thyroid Blood Test Results Interpretation

[K1V1]

I just had Thyroid blood test done privately. The results are as below.

TSH - 3.42

Total T4 - 75

Free Thyroxine (FT4) - 10.4

Free T3 - 4.7

FT4/ FT3 Ratio - 2.3

Reverse T3 (rT3) 0.23

Thyroglobulin(TG) <20

Peroxidase (TPO) 19

My GP also did NHS test, and he says results are fine. He is going to refer me to Endocrinologist just to be sure. May I request anyone on forum to give me some advise what next step to take. I am on t3 only hormone 6.25mg once a day just after 4:00am. Many Thanks.....Kadir

[Clutter]

KadirVankalwala, do you have the lab ref ranges (the figures in brackets after the results)?

[K1V1 in reply to Clutter]

Hello Clutter (Administrator), Many Thanks for replying. They are as below

Total Thyroxine (T4) 75 75 ( 58 - 161 nmol/L)

Thyroid StimulatingTSH 3.42 3.42 (0.40 - 4.00 mlU/L)

Free Thyroxine (FT4) 10.8 10.8 (11.5 - 22.7 pmolU/L)

Free T3 (FT3) 4.7 4.7 (2.8 - 6.5 pmol/L)

Ratio FT4 : FT3 Ratio 2.3 2.3 ( 2.0 - 4.5)

Reverse T3 (rT3) * 0.23 0.23 (0.14 - 0.54 nmol/L)

Thyroglobulin (TG) <20 <dl ( <=40IU/mL )

Peroxidase (TPO) 19 19 ( <=35IU/mL )

I hope that may be of to your help. Thanks Kadir

[Clutter in reply to K1V1]

Kadir, out of interest, did your GP test FT4?

Taking T3 only can suppress T4 but I doubt 6.25mcg T3 is enough to suppress your FT4 below range. TSH 3.42 is within NHS range but FT4 below range is hypothyroid and will usually command a NHS diagnosis and treatment which is Levothyroxine. FT3 4.7 is respectable, probably thanks to your slightly elevated TSH and the 6.25mcg T3 you are supplementing.

Most people on Levothyroxine are comfortable with TSH around 1.0 but TSH will often be lower on T3. There is plenty of scope to raise your T3 dose to reduce TSH and raise T3. A 6.25mcg dose increase will lower TSH and raise FT3. 12.5mcg might tip FT3 over range, it's generally recommended FT3 should remain within range. If you raise to 12.5mcg please have a follow up FT3 test 6-8 weeks later to check.

[K1V1 in reply to Clutter]

Hello Clutter, Many Thanks for replying, really appreciated. I have tried to increase my dose of t3 with 6.25mcg of Levothyroxin a few months ago but it causes Depression, drowsyness, aches & pain etc hence I had to stop it. Even increasing t3 to 12.5mcg causes more heart beat etc but no increase in energy level and disturbs sleep cycle.

However, Since last Thursday I started additional dose of 6.25mcs of t3 and that seems to gave me slight increase in energy level and recovering sooner from tiredness. I have also started about a month ago taking additional dose of Swanson Hydrocloric Acid supplement at Luch or dinner time. Centrizine Hydrochloride 5mg + Swanson Gluten - Peptide Enzyme in the morning.

I think I may have problem of converting t4 in to t3 for which I think I should get DIO2 (Deiodinase 2 Gene) Genetic Test.

I still suffer from being cold all the time, but since last one year with t3 supplementing it has improved.

Let me have your views and advise as I think you are more experienced than I am. I am still trying, a lot to learn but not enough energy, but have not given up. Many Thanks. Have great day.

[Clutter in reply to K1V1]

Kadir, Low TSH, high FT4 and low FT3 indicates a conversion issue. You are lacking sufficient T4 to convert. It's not a problem if you take T3 with Levothyroxine or T3 only.

25mcg Levothyroxine is the smallest dose available so taking a quarter tablet won't help at all. I'm surprised such a small dose caused adverse effects.

The extra 6.25mcg T3 will be helpful and will reduce your TSH. You are already noticing improvement in energy and recovery from fatigue and you won't feel the full impact of the dose increase for another 3-4 weeks. Have a thyroid blood test in 6-8 weeks to check FT3 remains within range. The supplements and enzymes you are taking should improve digestion and that will eventually improve absorption of nutrients and medication.

It may be worth asking your GP to check ferritin, vitamin D, B12 and folate. Low stomach acid in hypothyroid patients means they are often low/deficient and can present musculoskeletal pain, fatigue and low mood similar to hypothyroid symptoms.

[K1V1 in reply to Clutter]

Many thanks Clutter, really appreciate your help. I have had feeling that it can be conversion issue, and you all have suggested same. I have sent for DIO2 test to confirm and awaiting for results to come. At present I only take t3 6.25 mcg. In the mean time I will try to increase t3 as suggested and also try some t4 to see what it can improve.

Thank you.

[Clutter in reply to K1V1]

KadirVankalwala,

Either add T4 or increase T3 but don't do both. If you have a conversion issue you can take T3 only or T4+T3 to over come it.