Blood test results

[Foggy73]

I am under an Endocrinologist for my Hashimotos Hypothyroidism and I have been taking Liothyronine (T3) for 2 months which is amazing. I take the following medication:

Day 1 - Levothyroxine 25mcg and Liothyronine 20mcg in the morning, Levothyroxine 25mcg in the evening

Day 2 - Liothyronine 20mcg in the morning, Levothyroxine 25mcg in the evening

Day 3 - same as day 1

Day 4 - same as day 2

And so on with alternate days. This has been done because when I took Levothyroxine twice a day every day I had heart palpitations but this new regime is working well.

I had a blood test 9/5/16 on a morning when I had taken the Liothyronine and Levothyroxine 2 hours before my blood test and got the following results:

T4 - 7.2 (range 12 - 22)

T3 - 8 (range 3.1 - 6.8)

TSH - 0.5 (range 0.3 - 4.2)

On 20/6/16 I had another blood test and I didn't take any medication that morning and got the following results:

T4 - 6.2

T3 - 4.6

TSH - 6.3

My GP says I'm under medicated but I have no symptoms and comparing my previous results when I took my meds and this result when I didn't take any I would have said that it's because I had nothing in my system and if I was to do another blood test after taking my meds it would show are ok again and no under medicated. Any thoughts?

[greygoose]

Well, you're exactly right. And that's exactly what you want to avoid - if you don't want your dose reduced.

If you test 2 hours after you've taken your pills, all you are measuring is what you're taking, and that's not very helpful, because it won't last. The levels will quite soon go down again.

If there's nothing in your system, that's what they want to know. What they need to know to keep you on an adequate dose. It is always advised that you leave 24 hours between T4 and your test, and 12 hours between your T3 and the test. And that you do that every time so that you can compare results. If you sometimes take it and sometimes don't, it's like comparing apples and oranges - there is no comparison.

Also, did you have both these tests at the same time of day? I have a suspicion that you didn't, because of the difference in that TSH. And were they both fasting? TSH is highest early in the morning and after eating. It drops when you eat, and also drops throughout the day. You need consistency in your testing to be able to plot your progress - or lack of it.

Have you ever tried taking your levo all in one go, either in the morning, or at night? It's rather unusual to take it twice a day, because it's a storage hormone, not active like the T3.

[Foggy73 in reply to greygoose]

Both my test where taken roughly the same time about 9.15am. The test where I took my meds before my test was not fasting and the one the other day with no meds before was fasting because I did a fasting test for something else. So like you say the two tests were completely different and extreme ends of the spectrum, which is what I expected.

I can't take my Levothyroxine in one go as my Endo suggested I did it this way and it seems to work for me as even though my T4 is under medicated I am not having any of my awful symptoms of exhaustion and brain fog....I feel normal again.

If my GP goes into panic mode and suggests increasing my Levothyroxine I can explain why my results have come back the way they have with fasting and no Levothyroxine for 14 hours and no Liothyronine for 24 hours.

[Clutter]

Foggy73,

T4 and T3 peak in your serum up to 6 hours after ingestion. Taking T4 and T3 2 hours before your blood draw means that peak levels of FT4 and FT3 have been measured although it won't affect TSH which takes weeks to change. Your GP is correct, you are under medicated to have TSH 6.3, it's nothing to do with delaying taking T4 and T3 for a few hours until after your blood draw.

Leaving 24 hours between last T4 dose and 12 hours since last T3 dose and blood draw should give you a reasonable estimate of normal circulating levels. Many doctors will immediately reduce dose when they see T4 or FT3 over range which is why members are advised not to take thyroid meds until after their blood draw.

[Foggy73 in reply to Clutter]

Trouble is when I took Levothyroxine 25 mcg twice a day with my Liothyronine 25mcg once a day every day I was over medicated on T3 and had palpatations at night so my Endo took the decision to reduce my Levothyroxine to 25mcg twice a day alternative days and 25mcg once a day alternate days which reduced both my T4 and T3 but stopped my palpations and I feel absolutely fine even with the low T4 and high TSH

[Clutter in reply to Foggy73]

Foggy73,

It doesn't follow that increasing dose when TSH is high will cause adverse effects again but it is likely you won't feel well for long unless you do accept a dose increase. It is, of course, entirely your decision.

[Foggy73 in reply to Clutter]

Thanks Clutter. Although I am under the Endo and not seeing her for 6 months should I discuss putting my Levothyroxine back up a little bit again then? I'm just paranoid that it's taken 5 years of battling to get the T3 added and since then I have felt normal again and I don't want the GP messing around with my meds and removing the Liothyronine now I have it and it's proved that the Levothyroxine alone didn't work

[Clutter in reply to Foggy73]

Foggy73,

Your Levothyroxine or your Liothyronine dose needs increasing. Usually Levothyroxine dose will be increased. There's absolutely no reason for Liothyronine to be removed. I would certainly discuss increasing Levothyroxine dose with your GP. Your GP can consult with your endo if required.

[Foggy73 in reply to Clutter]

Thank you Clutter. The only reason the Levothyroxine was reduced was because I had hilucinations and heart palpations at night in bed for a few days and she the Endo took my bloods he found my T3 over at 11, so he decoded to reduce the T4 instead which stopped the problems

[Clutter in reply to Foggy73]

Foggy73,

If TSH is >6 your T3 and T4 are likely to be low in range.

[Foggy73 in reply to Clutter]

T4 - 6.2

T3 - 4.6

So T3 is good and T4 is low

[Clutter in reply to Foggy73]

Foggy73,

What is the FT4 range? 6.2 looks like it could be below range. FT3 looks mid-range assuming 6.8 is top of range. I can't believe a 25mcg T4 dose increase could possibly overmedicate you.

[Foggy73 in reply to Clutter]

T4 range 12 - 22

T3 range 3.1 - 6.8

TSH range 0.3 - 4.2

When I was on the extra 25mcg Levothyroxine a day my results were:

T4 - 11.1

T3 - 11.7

TSH - 0.08

My Endo was happy with them as he said that some people function better above range on T3 so wasn't worried it was just my symptoms of heart palpations when lying in bed as I went off to sleep concerned him.

Before I was put on Liothyronine I was on 125 mcg Levothyroxine per day and my results were all with normal range but I had very bad symptoms. Since adding Liothyronine I have my life back

[Clutter in reply to Foggy73]

Foggy73,

I think TSH is high now because your FT4 is so far below range.

I wasn't well on Levothyoxine only either. Adding T3 seemed to calm the adverse effects as well as raising FT3.

[Foggy73 in reply to Clutter]

Is any damage being done to my body by having high TSH and very low T4 if not I'm not worried about my results because I feel good with these results thanks to the Liothyronine

[Clutter in reply to Foggy73]

Foggy73,

Yes there can be which is why it is wise to increase dose even if you aren't symptomatic.