Is it absolutely vital that T4 stays within range?

Is it absolutely vital that T4 stays within range?

My dr here in Sweden is basing my treatment on T4 results. The results of my test in August were:

FT4 19.8 (12.0 - 22.0)

FT3 4.6 (3.1 - 6.8)

TSH 7.22 (0.4 - 3.7)

Following this test he kept my dose at 100mcg with another test in 3 months even though TSH is still over range. As I'm not feeling too good I went to the drop-in yesterday and asked for a test and made an appointment to see dr on Friday to discuss the results. I want to ask him for a dose increase, but my question is - if I do get an increase and the T4 goes above the range is it going to do any harm?

I've posted my previous blood tests in case that helps.

Thank you very much for your time.

15 Replies

  • Your TSH is too high for you to feel good it's no wonder you feel awful. You need an increase in medication. For me, this would be the ideal way for doctors to treat their patients and make them well, i.e. treat the patients and not the blood tests:-

    This is the 'old fashioned way' before blood tests were introduced and doctors used their initiatives and it still comes in handy today for ourselves to use. Pulse/temp is a good guideline.

  • Thanks for the links Shaws. Yes TSH is still high although it has come down a lot from the initial blood test when it was 109.1 and, strangely, I did not have so many symptoms as I have now. :-D

  • Yes I definitely believe you as I couldn't understand why, when put on levo, I had so many more clinical symptoms than before. Particularly pain.

    I'm now feeling well, thankfully. I hope you do too will do so soon. Unfortunately we have to find our own way out of the maze, I have found.

  • Thanks for your reply shaws. I'm sure I'll feel well soon...I'm just impatient. lol We had to put off our visit to the UK this year, but I'm determined to get there next year to see family & friends. xx

  • How long a gap between taking your levothyroxine and having your blood drawn for the latest test?

    The quite high TSH togther with a towards-top-of-range FT4 is somewhat discordant. Trying to think why this might be, the most obvious thought is that you are under-dosed but the blood was drawn within about six hours of taking levothyroxine. The peak FT4 from taking levothyroxine typically occurs around two hours after swallowing, and stays raised for around six hours or so.

  • Almost 25 hours, helvella. I take my Levo at 07.30 and the test was at 08.23 the following day. Dr did say to not take Levo before test, but he never mentioned fasting, which I also do after reading this forum. The top-of-the-range FT4 is my concern... if I can get a dose increase and it goes above range will it have any adverse effects? Thank you for your input.

  • In which case, I suspect that you are already over-range on FT4! At least, in the hours after taking your dose.

    Being a little over-range on FT4 is not a particularly important issue. Some people need it.

  • Thanks for that helvella.

  • Leabrook, A 25mcg dose increase is unlikely to raise your FT4 beyond 22.8 and there's not likely to be a problem with FT4 mildly over range, say up to 26. Read Treatment Options in

    Has your GP considered referring you to endocrinology to investigate why your TSH isn't dropping in response to your FT4 and FT3 levels?

  • No mention of a referral, but I'll see him on Friday and get his opinion. Thank for your time Clutter and I'll check out the link.

  • Just read the link Clutter....that spells it out. Thank you very much....just need to convince doc that it's OK for T4 to go slightly over range. :-D

  • doesn't look like you are converting the t4 to active ft3 which is what your body uses. My dr would say that you need to take a t4 t3 combo. I had to do the same and my test were similar. My dr says if your free t3 is not in the top one third of like yours(you are not converting and ...anormal, you will feel like crap..and she advises the ft4 to be a midpoint and if it is inbalancedlike yours, then you are not converting and leads to MANY hypo SYMPTOMS. Some people don't convert t4 from synthetics well.....mine was the same a takes a month or so , but you will be amazed at the difference when your ft3 gets higher but you will pay less attention to tsh on t3 since t3 doesn't have to be converted,acts immediately, last about 6 hours so many split their dosage to keep energy up.....I was also on 100mcg and now doing 1 grain of naturethroid but know I will need to increase to 1.25-1.50 when I get my next blood test....but dr likes to start slow. your dr could also decrease your t4 and give you synthetic t3 hence t3 is 4 times the strength of t4 therefore he he gave you 10mg of t3 it would be the equivalent of 40 t4......and some get a head rush and split it like I said above....the body has to get used to it slowly....

  • Thanks jacrjacr that's most informative. I've kept a copy of that to go with my notes for my appointment with dr tomorrow. Gone are the days when I could have remembered things without making notes. :-D But they will return....must stay positive. :-)

  • I just corrected a typo...t3 is 4 times the strength of T4...I typed t3 in error

  • Thanks jacrjacr. I've amended the script I copied.

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