Help with Thyroid test results

Hi all, I have had my blood tests done again and was hoping I could have some help with them? These were done at 8.30am having taken no medication and I had not eaten:

TSH <0.05 (0.2-4.2)

FT4 23.6 (11-22)

T3 4.74 (3.1-6.8)

I am still waiting on the anti body test results.

I am currently on 125mg of levothyroxine a day. I am still extremely tired all the time but I am just about coping. The specialist wants to reduce my dose down to 125mg/ 100mg on alternate days due to the T4 being above range, and I can understand that. However I have tried reducing several times before (either 100mg per day or 125mg/100mg on alternate days and feel extremely unwell every time I do (severe hypo symptoms and like I just cant function). This is the first time I have had my T3 tested and I am wondering if it is because of this? I have read T3 and T4 need to be in the upper half of normal range, which even on 125mg my T3 isnt. I am also wondering; when I reduce the levothyroxine would my T3 reduce even more and could be the reason I still feel extremely unwell? Any advice would be much appreciated.

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  • Yes, your FT3 would drop if you reduce your T4. Your FT4 is over-range because you're not converting very well. Your FT3 is not quite mid-range. And it's low T3 that causes symptoms.

    However, increasing your levo isn't really a solution, either, because that would leave a lot of unconverted T4 sloshing around causing trouble - possibly converting to rT3. You do need a decrease in levo, but with the addition of a little T3. But, I don't know if you'll be able to persuade your endo of that!

    It could be that you're converting badly because of nutritional deficiencies - which are very common in hypos. So, ask your doctor to test vit D, vit B12, folate and ferritin. Don't expect him to understand the results, though. They don't do nutrition in med school! Just post your results here - with the ranges - and members will advise you what to do next. :)

  • Hi greygoose. Thanks very much for your help! Its good to finally understand why I am still feeling unwell despite my T4 being optimal on the lower dose. I see that the T4 needs reducing, and will speak to her about the T3. The specialist did do some some of those other tests (although I don't have those results), but I'm not sure exactly which ones or what the results were. She definitely didn't do vit D (but I do take supplements) or B12. I will make sure these are looked into too. My sister also has pernicious anemia so I'm definitely going to ask her to double check B12.

  • What supplements are you taking? Not a good idea to take vit D without knowing your level.

  • Hi greygoose. I didn't know that! I take the 'Skin, Hair and Nail' tablets from Holland and Barrett, which includes some vit D. How would you go about knowing how much vit D to take?

  • Cjtunnicliffe You need to get a Vit D test to know your level and if you post it on the forum someone will suggest a dose if you are deficient. vitamindtest.org.uk/vitamin... costs £28

    Can I make a comment about your H & B skin, hair and nails supplement? My advice is to put it in the bin. H & B are renowned for putting cheap and the wrong form of ingredients in their supplements to make them cheap. The one you are using contains -

    Calcium carbonate - you shouldn't supplement calcium unless you are deficient.

    Magnesium oxide which is the cheapest and least absorbable form and one to avoid. naturalnews.com/046401_magn...

    Ferrous Fumarate - are you deficient in ferritin? You shouldn't take iron if not deficient.

    Folic acid - synthetic and cheap form of folate, the natural methylfolate is the better form.

    B12 is cyanocobalamin which we shouldn't take, we should take methylcobalamin naturalnews.com/032766_cyan...

    D3 is 100iu which wouldn't be a maintenance dose for a gnat. A normal winter maintenance dose would be around 1000-2000iu for someone with the normal recommended level of D3

  • Thanks very much SeasideSusie. That is all very alarming! As you can tell I really don't know much about any of this; I am just starting to research and there is an awful lot of information! I really appreciate your advice - I will stop taking them immediately. I'm so glad I have found this group and for your advice as I wouldn't have known any of this otherwise. Thanks again!

  • Cjtunnicliffe,

    FT4 and FT3 will drop if Levothyroxine dose is reduced. Read Treatment Options in thyroiduk.org.uk/tuk/about_... Email louise.roberts@thyroiduk.org.uk if you would like a copy of the Pulse article to show your endo.

    Some people do need FT3 higher in range to feel well so ask your endo whether some Liothyronine (T3) can be added to a reduced dose of Levothyroxine to raise FT3. I0mcg T3 is equivalent to 30mcg Levothyroxine.

    ______________________________________________________________________________________________

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

  • That's great, thanks Clutter! I think it may be difficult getting T3, but Im definitely going to try!

  • Cjtunnicliffe My results were similar to yours but with a higher FT4. I have a GP who only goes by TSH and I have given up with her. I just take my prescription for Levo and now do my own thing.

    You are not converting very well. For good conversion to take place the FT4: FT3 ratio should be 4:1 or lower. Yours is 4.97 : 1. You need some T3 whilst tweaking Levo.

    For me there was more involved so I did lots of private tests to try to get to the bottom of it and it may be that you need to see if there is anything else going on.

    My vitamins and minerals showed deficiencies so I have addressed those and now everything is optimal.

    I found out that my adrenals were struggling with 3 of the 4 saliva samples showing top of the range cortisol with bottom/under range DHEA. All my sex hormones were bottom of range. These are all tied up with the thyroid.

    My thyroid blood test showed poor conversion and I did a urine thyroid test which confirmed that. I ruled out any problem with candida and iodine level was fine.

    With the help of a private practioner I have been addressing the problems with adrenals and sex hormones, and I am adding self sourced T3 to a reduced dose of Levo whilst testing to keep an eye on my levels.

    My FT4 has reduced but is still slightly over range, FT3 is now in the top quarter of the range. On paper it looks pretty good but I'm still not right so my next step is to test reverse T3 in January at the same time as retesting the basic thyroid tests after my last tweaking meds.

    Are you seeing a NHS endo? Maybe discuss reducing your Levo but adding in T3. The problem with that is they only seem to ever give 5mg or at the most 10mg which often is not enough to make a difference.

  • Hi SeasideSusie, this is really really useful thank you! Especially knowing about the conversion and ratio. This is clearly a lot more complex than I first anticipated so I will definitely ensure I look into these other related elements (that I had no idea about until now). I am seeing an NHS endo but I am considering speaking to a private endo, especially if I cant get any help with my T3 levels. Do you think I would get further with a private endo?

  • Cjtunnicliffe It depends on the private endo. Most of them are just NHS endos seeing patients privately but still toeing the NHS line by following their guidelines. They are protecting themselves.

    You could email louise.roberts@thyroiduk.org.uk and ask her for the list of endos who members have found to be helpful and are known to prescribe T3. Before you make any appointment it's best to ring the secretary and confirm that the endo does prescribe T3.

  • I know you are waiting for antibodies test results -

    There are two sorts TPO Ab and TG Ab. (Thyroid peroxidase and thyroglobulin)

    BOTH need checking, if either, or both are high this means autoimmune thyroid - called Hashimoto's the most common cause in UK of being hypo.

    NHS rarely checks TPO and almost never checks TG. NHS believes it is impossible to have negative TPO and raised TG. It's rare, but not impossible, there are a few members on here that have this.

    ALWAYS Make sure you get the actual figures from tests (including ranges - figures in brackets). You are entitled to copies of your own results. Some surgeries make nominal charge for printing out.

    Alternatively you can now ask for online access to your own medical records. Though not all surgeries can do this yet, or may not have blood test results available yet online.

    As others have said you also need to check levels of B12, folate, ferritin and vitamin D - these need to be a good levels not just "in range"

    When you get results suggest you make a new post on here and members can offer advice on any vitamin supplements needed

    If you can not get GP to do these tests, then like many of us, you can get them done privately

    thyroiduk.org.uk/tuk/testin...

    Blue Horizon - Thyroid plus eleven tests all these.

    This is an easy to do fingerprick test you do at home, post back and they email results to you couple of days later.

    If you have Hashimoto's then you may find adopting 100% gluten free diet can help reduce symptoms, and lower antibodies too.

    Selenium supplements may help improve conversion too

    You do not need to have ANY obvious gut issues, to still have poor nutrient absorption or low stomach acid or gluten intolerance

    Best advice is to read as much as you can. Vitamin and minerals levels are very important, but standard NHS thinking, doesn't at the moment seem to recognise this. You will see, time and time again on here lots of information and advice about importance of good levels of B12, folate, ferritin and vitamin D, low stomach acid, leaky gut and gluten connection to autoimmune Hashimoto's (& Grave's) too.,

    hypothyroidmom.com/92-of-ha...

    vitamindcouncil.org/tag/aut...

    chriskresser.com/the-gluten...

    Lastly, when & how do you take your Levo. It should always be on an empty stomach and nothing other than water for at least an hour after.

    Some/many find taking at bedtime more effective

    verywell.com/should-i-take-...

    archinte.jamanetwork.com/ar...

    Long research article - final conclusion paragraph below

    "In conclusion, bedtime intake of levothyroxine in our study significantly improved thyroid hormone levels. This may be explained by better gastrointestinal bioavailability at night or by less uptake interference by food or medications. As shown in this study, bedtime administration is more convenient for many patients. Clinicians should inform their patients about the possibility of taking levothyroxine at bedtime. A prolonged period of bedtime levothyroxine therapy may be required for a change in QOL to occur."

  • Thanks very much SlowDragon! This is a great summary and I'm looking into those BlueHorizon tests. This is also really interesting as I have had low vitamin D and iron in the past (but still within range and it was never attributed to my thyroid, even though I had already been diagnosed with hypothyroidism at the time). I have also already cut out gluten entirely due to the reaction I have to it.

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