Help with blood test results

[Hypogirl74]

Hi-I'm new to the site. Love reading all your posts as a comfort that I'm not going mad!

I was diagnosed with graves in the late 90's and subsequently had a sub total thyroidectomy. I have been taking thyroxine ever since. As usual took a while to get my dose right and I've been taking 125mg for years now. Since the summer I've noticed some changes, difficulty sleeping, extra weight loss all signs of hyperthyroidism however also experienced complete exhaustion late afternoons itchy eyes, throat feels like it's swelling, cold hands and feet, muddle words in sentence. After a new set of bloods the doctors decided (as usual) to reduce my dose. I was concerned that this would have a negative impact given the exhaustion (I've lived with this long enough to know my own body and symptoms) we agreed to alternate my dose. 125mg and 100mg alternated daily. After 4 days I started to experience really bad hypo symptoms like never before. Mental slowness-I couldn't work out how to pay for my carpark. Never experienced that before. So v quickly decided to go back to my usual 125 and am slowing getting back to normal. But something is clearly not right. As other symptoms were before dose reduction

Bloods show

t4 as fine 17pmol/L (8.0-21.0)

tsh really low 0.01 mu/L (0.35-3.5) so guessing that's why they want to reduce thyroxine but

my free t3 is also low 3.4 pool/L (3.8-6.0) so thinking that I need to push docs for t3?

Am I right in thinking that as my t4 is fine but t3 is low my body is not converting the t4 correctly which could be why I've been out of sorts? And in part explain the low tsh? And that perhaps my tsh will go back to normal if my t3 improves?

Until now Ive never had details if results so will be asking for historic ones at my next appointment.

My liver function test are all at the lower end of the scale with my serum alkaline phosphate XE2px below range (37 u/L (38.0-126.0))

I'm in on monday with a female doc as they seem more amenable to compromise and to actually listen to the symptoms and not just blinded by results

I would appreciate any thoughts input- I've struggled to do my job properly this year and desperately need to get back to normal. My husband says its like living with someone that is always stoned!

Ever hopeful :o) thanks in advance

[greygoose]

"Am I right in thinking that as my t4 is fine but t3 is low my body is not converting the t4 correctly which could be why I've been out of sorts? And in part explain the low tsh? And that perhaps my tsh will go back to normal if my t3 improves? "

You are right in thinking that you don't convert very well, yes. And, no matter how 'fine' your FT4 is, if you can't convert it to T3 then you are still hypo. It's low T3 that causes symptoms, not the T4.

However, increasing your FT3 will not make your TSH rise. It works the other way : TSH is supposed to rise when FT3 is low, and decrease when the FT3 increases. But, because you have had Graves, your TSH will probably never rise, even when your FT3 is very low. But, it doesn't matter.

TSH = Thyroid Stimulating Hormone - and that's about all it does. It stimulates the thyroid gland to make thyroid hormone. But, as you don't have a thyroid to stimulate, you do not need TSH, and it wouldn't serve any useful purpose if you did. So it is unimportant if your TSH is low. And, you should never accept a doctor changing your dose according to your TSH for that reason. The important number is the FT3, and yours is low, and that's what they need to look at.

[Hypogirl74 in reply to greygoose]

Thank you so much! They didn't remove all of my thyroid so still have some left but it still makes more sense to me. Doctors never seem to go in to detail but I won't let this go. It's been a rubbish summer and one I don't want to repeat! Thanks again ☺️

[greygoose in reply to Hypogirl74]

They may not have removed all of the thyroid, but chances are that the bit that's left has stopped making hormone now that you're on levo. That's the way it usually works. Unfortunately, doctors think they are just 'topping up' your T4, when in fact, the T4 they give you is all you have to live on. And, if you can't covert it, then you really do need some T3, too.

[Hypogirl74 in reply to greygoose]

Thank you that's so helpful. I can feel a fight coming on and I feel more ready now ☺️

[greygoose in reply to Hypogirl74]

You're welcome.