Abbychaya Were your tests done under the same circumstances ie were both done at the earliest possible appointment in the morning, fasting overnight with water only to drinking and NDT left off for 24 hours so that you can get an accurate comparison?
Were you retesting after a dose change, as it's usual to leave 6-8 weeks before re-testing.
As NDT contains T3 then that will usually lower FT4. Where is your FT3 result? That needs to be tested when on NDT. You may need to increase NDT but as you should keep FT3 within range then you need to know that result before deciding to increase.
Even though your Vit D is in the replete range, it is not optimal. Recommended is 100-150nmol/L.
B12 is not optimal either. Recommended is very top of range, even 900-1000. Under 500 and there's a risk of neurological problems so increasing your level would be a good idea.
What about your ferritin level? That needs to be at least 70 for thyroid hormone to work properly, normally it's recommended to be half way through range, and I've seen it said 100-130 for females. Low ferritin can cause hair loss.
As you have raised antibodies this means you are positive for autoimmune thyroid disease aka Hashimoto's. Are you addressing this and trying to reduce the antibody attacks by adopting a strict gluten free diet and supplementing with selenium L-selenomethionine 200mcg daily?
Hi there.. thanks for your reply... I didnt do any of that the tests were done in the afternoon..
No FT3 as doctors never test that. But, can I ask them to?
Ferritin is now 74 after many years of being very low
Even though I have antibodies (at one time much higher) my doctors have never diagnosed me with Hashimotos.. and as such never considered me worth treating
my question is: I've been on Ostrogeon only HRt since Nov18 - and my thyroid function seems to be declining. Could the ostrogen be interfering in uptake from thyroid meds. My Ft4 has declined slowly from 18 pmol (2013) to currently standing at 9
I am eating 2 brazil nuts a day (approx for selenium) but can address this by supplementing. I've been on and off a gluten free diet for a while
Vit D.. Will the doc's recognise that this result is not optimal then? they just say it's 'normal'
Abby, I can't really comment on whether the Oestrogen HRT is affecting uptake of thyroid meds. It's not something I've looked into as it is not something I would have taken. I have a very long history of fibrocystic breasts and oestrogen is too much of a cancer risk in those circumstances. I am long past menopause, recently had a full hormone panel done, discovered all my sex hormones were on the floor, along with a bit of an adrenal problem, and the hormone consultant I used (privately) recommended adrenal support and bioidentical progesterone cream to help balance everything.
Your GP will not recognise that your Vit D isn't optimal. They don't know what optimal anything is, they're taught that if something is in range then that's it, problem solved. Unfortunately it's not that simple. You'd be hard pushed to get a decent Vit D supplement off your GP if you were severely deficient! If you want to nudge your Vit D into the optimal range then just buy a decent supplement, and as Vit D has important co-factors it might be best to combine what you can in one supplement. Vit D and other vitamins and minerals:
Vit D aids absorption of calcium from food and K2 directs the calcium to bones and teeth rather than arteries and soft tissues.
D3 and K2 are fat soluble so should be taken with the fattiest meal of the day.
Magnesium is also important when taking D3 and most of us are deficient in it anyway. It comes in different forms so you can check here and see which would suit you best:
Brazil nuts, unless the packet states they have been grown in selenium rich soil, will have undetermined amounts of selenium, if any at all. Supplementing is the best way to know what you are getting. I use this one as there is no unpleasant smell to it which a lot of selenium supplements have:
I'm not Hashi's but many members report great success in reducing antibodies by being strictly gluten free, and report set backs if they do ingest gluten.
You really need to get your B12 up to the very top of the range so I'd suggest Solgar or Jarrows sublingual methylcobalamin lozenges 1000mcg daily, dissolve under the tongue to get directly into the bloodstream, don't chew or swallow as stomach acid destroys it. And to balance all the B vits when taking B12 you need to take a good B Complex containing methylfolate rather than folic acid.
Don't start all supplements at once, start individually, adding the next one after a week or two if there's been no adverse reaction.
As for testing FT3, are you self treating with NDT? With Doctor's knowledge? Or is your NDT prescribed by your GP? If prescribed then FT3 should be tested as a matter of course because you are taking T3, they should know that test is important when taking T3 to keep an eye on your level.
If you are self treating and your GP doesn't know what you are taking then TSH and FT4 tests only aren't enough, you will need to get private fingerprick tests done with Blue Horizon to include FT3. You can get the basic TSH/FT4/FT3:
Thanks for all that helpful info Susie... I'm self treating so will have to get pinprick tests - although as I have antibodies shouldn't they test for T3??? I'm worried that my FT4 has declined so much in the last few years. When I started feeling rotten in 2014 it was 18.... now 9... however my energy is better, it's just the weight and hair
I will look for all these supplments, I agree Vit D and Magnesium right away... and will get B12 lozenges...
I haven't got anywhere with the NHS and my health, it's all been with forum's like this that I've become educated... doesn't that say something?
thanks again.. I'm seeing one of the practice GPs on WEds and will suggest that they probe my thyroid a bit more, but doubt I will get anywhere.. if I had the money I'd go private and see an endo or functional medicine doc
although as I have antibodies shouldn't they test for T3???
Not necessarily Abby. FT3 is usually only tested for by the lab when TSH and FT4 are way off their mark! A GP can request a FT3 test but it's the lab who decides if it gets done.
Doctors don't take much notice of positive antibodies anyway. It just means 'hypothyroidism' to them although caused by antibodies rather than something else. Autoimmune hypothyroidism is the most common form though anyway.
As for your lowering FT4 - T3 taken in any form (synthetic T3 or in NDT) will lower FT4 and TSH. But you can't compare your results because they weren't taken under the same circumstances.
By the way, your GP is never going to make sense of your tests, or be of any help, unless he is aware of what you are taking. It's your choice whether you tell him, of course (I have added T3 to my Levo but my GP doesn't know, but then again I've not been called for a repeat test at the surgery for 3 years, I just collect my prescription for Levo and keep quiet!). If you do tell him only you know how he will react. He may know nothing about NDT so wont understand the results of the tests anyway.
For future reference, always have your blood drawn (or do your fingerprick test) as early as possible in the morning, no later than 9am. Fast overnight, you can drink water only. Do not take your thyroid hormone for 24 hours, take it after your blood draw.
The reason for this is, if you were looking for a diagnosis, an increase in thyroid meds, or to avoid a reduction in meds, those circumstances give the highest possible TSH. TSH is highest early morning, lowering during the day. TSH also lowers after eating.
Also, when circumstances are the same every time, you have a proper and accurate comparison for your results. There's no point in comparing results when one blood draw was done in the afternoon, after eating lunch and taking that day's dose of thyroid meds, to results when the blood draw was done at 8am, fasting and no meds for 24 hours. The results would be vastly different and couldn't possibly be compared.
Weight loss should start to happen when you are optimally medicated and your FT3 is at it's optimal level, usually high in it's range. Hair loss should generally start to get better, again when optimally medicated, but also when ferritin is optimal.
Are you taking your NDT on an empty stomach, one hour before or two hours after food? If you are splitting the dose, are you keeping the second dose away from food as mentioned? This is needed for proper absorption. Also, keep supplements two hours away from thyroid meds, iron and Vit D four hours away. In fact, iron four hours away from everything as it affects their absorption.
I haven't got anywhere with the NHS and my health, it's all been with forum's like this that I've become educated... doesn't that say something?
If it wasn't for help on forums, I would be in a right state. I've had no help from the GPs currently at my surgery. TSH rules! My TSH has always been suppressed, despite FT4 and FT3 being in range - it doesn't matter, TSH is suppressed so your dose must be decreased! No investigation into why I have symptoms still, even though I was diagnosed over 40 years ago and am a bit of an expert in how I feel, it doesn't matter, only the figures matter, they don't care! But I've done lots of tests privately, I've learned where some problems are, I'm addressing them myself. I'm not there yet but hopeful that I might get a few years of feeling relatively OK before I pop my clogs!
If you go and see an endo privately, make sure you email louise.roberts@thyroiduk.org.uk and get the list of thyroid friendly endos, then ask on the forum for any feedback on the one you choose (replies must be by PM). Most are NHS endos as well and toe the NHS line by following their guidelines. A functional medicine doctor might possibly be a better bet, again as for recommendations or feedback.
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the tests were done in the afternoon..
Blood results back confused 
Confusing results and symptoms 
Results are in - dosage levo / vits - confusion
Latest results, confused again, 
