Help with interpreting results, please

[Stevie_G]

Some three decades ago, I suffered from and was treated for Graves Disease, which went into remission after a few years, never to return.

For the past two decades I have been treated quite successfully—with only a few minor dose adjustment blips during the first few years—for hypothyroidism.

Then, two years ago, after an annual thyroid test, a GP decided I should increase my daily 1 mg of Eltroxin by an additional 0.05mg every Monday, Wednesday and Friday. (Unfortunately, I have since left that practice and do not have those test results.)

Subsequent tests have apparently shown that I was being overmedicated and now, not only do I feel ill all the time, but I have had two more blood tests as a (new) doctor tries to get the dosage right. He’s very kind but doesn’t seem to know much about hypothyroidism. As for me, I’m completely confused—and still unwell, although that could be due to a recurring UTI.

I would really appreciate it if someone who knows how to read results would comment on my last two lab reports. I’m not sure if they’re the same format as you are used to reading as, although I’m English I live in South Africa.

The codes given on the lab result print-outs are as follows:

H = High; L = Low; *H = Critically High; *L = Critically Low

In October last year, after my dosage had been reduced to 1mg Eltroxin daily plus an additional 0.05mg on Mondays and Fridays, my lab report was as follows:

Free T4 – Result 16.2; (Reference 7.2 – 16.4 pmol/L)

S-TSH – Result <0.10 *L (Reference 0.37 – 3.50 mIU/L)

In the comments section, it was noted: “The thyroid results suggest the following: Subclinical hyperthyroidism.”

I find this comment really confusing as I was still having symptoms of hypothyroidism, including weight gain.

As a result of this report, the doctor decided I should reduce my dose further, to 1mg Eltroxin daily plus an addititional 0.05mg on Mondays.

My latest lab results—after almost 5 months on that dosage—are as follows (please note that I also asked for a T3 test this time since I noted a recommendation on this forum to do so):

Free T4 – Result 18.8 H (Reference 7.2 – 16.4 pmol/L)

Free T3 – Result 4.4 (Reference 3.8 – 6 pmol/L)

S – TSH – Result <0.10 *L (Reference 0.37 – 3.50 mIU/L)

As of yesterday, the doctor has reduced my dosage to 1mg Eltroxin daily, which is what I was taking two years ago when my ex-doctor first decided to mess around with the dose.

I’m quite depressed about the situation, particularly as I still feel unwell and really tired most of the time. I would appreciate it if someone would take a look at the above results and tell me, in plain language, what they actually mean and whether or not my current doctor is on the right track with my treatment.

I'm sorry to be so wordy!

Thanks so much in advance for any help and advice offered.

[shaws Administrator]

I cannot answer your whole question but one of our Admins, Clutter has Graves, and may be able to respond to you later.

The worst thing doctors can do, in my experience, is willy nilly adjust our dose due only to the whereabouts of the TSH. That can cause us to become worse. They believe 'stories' that we will have osteoporosis or other diseases if T4/T3 too high but the reverse is true if we are under-dosed we will develop other problems I'm sure.

Did you have your blood test at the earliest time and fast? Did you allow 24 hours between your last dose of hormones and the test? If not, it can skew results resulting in adjustment in doses.

You take levo after the blood tests and then eat an hour later. Your T4 is high (might be due to time of test) if so, FT3 is on the low side so I would say you need an increase.

hormonerestoration.com/Thyr...

[Stevie_G in reply to shaws]

Hi shaws - thanks for responding. Yes, I should have explained that I waited a full 24 hours after my last dose and took the test first thing in the morning on an empty stomach.

As I said, I'm very confused as yesterday I was told to reduce my dosage to 1mg daily.

[shaws Administrator in reply to Stevie_G]

That's o.k. at least you did the right thing.

He has either reduced dose because your FT4 is high and your TSH very low. It was best before the blood tests were introduced as we were given sufficient NDT to get well.

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[Stevie_G in reply to shaws]

I should tell you that I only did the right thing before these tests because I had been following the advice on this helpful forum. Before that, I would not have known what to do!

Has he reduced the dose incorrectly, do you think? I haven't got a clue what to do for the best any more.

[shaws Administrator in reply to Stevie_G]

Others will respond as bloods aren't my forte, unfortunately. I think he/she should go on how you are feeling when you've been diagnosed. The FT3 is low and it could be that your FT4 is high because it isn't converting properly thus the low FT3.

hormonerestoration.com/Thyr...

[Stevie_G in reply to shaws]

Thanks, shaw. I really appreciate your input - and I hope others who are able to understand bloods will pass on their advice, too.

[Clutter]

Stevie_G, I suspect your doctor reduced dose originally because TSH was suppressed and he wanted to raise it. Your most recent test also shows FT4 mildly over range. I think you may be feeling unwell because FT3 is low. Suppressed TSH, FT4 over range and low FT3 indicates you are a poor converter of T4 to T3. You would probably feel better with FT3 between 5.0-6.0. The best way to achieve this would be to reduce Eltroxin by 25mcg and add 10mcg Liothyronine (T3).

Hypothyroid patients are often low/deficient in ferritin, vitamin D, B12 and folate so it's worth asking your GP to test. Post the results and ranges in a new question for advice.

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I am not a medical professional and this information is not intended to be a substitute for medical guidance from your own doctor. Please check with your personal physician before applying any of these suggestions.