Genova Urine Thyroid Profile - please help

Genova Urine Thyroid Profile - please help

Hello,

I'd appreciate advice and next steps on this test result which I received today. I have a whole host of hypothyroid symptoms but most of all right now I am terribly forgetful and I'm finding it difficult to articulate my thoughts. I lost my job last month as I couldn't concentrate and remember the most basic things.

Thanks

8 Replies

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  • Hi Serendipitious - just a couple of questions first.

    Were you on 75mcg Levo only when you did the test?

    Did you take just one dose of Levo during the 24 hours of the test?

    Did you (assuming a time here, obviously it's your time that matters) empty your bladder at (say) 8am and NOT collect that urine, then collect your last urine at 8am the next day?

    Assuming you say yes to those questions then my thoughts are (if I've assumed wrongly, let me know and I will edit my post) -

    Firstly, taking your October blood test results (I haven't used November as you said blood was drawn at 6pm)

    October 2016 (75mcg)

    Total Thyroxine (T4) 144 nmol/L (58-161) - A decent amount of T4 is showing in your blood.

    TSH 2.01 mIU/L (0.40-4.00) - Too low for a treated hypo patient

    Free Thyroxine (FT4) 17.0 pmol/L (11.5-22.7) - 49% through range (upper third is usually best)

    Free T3 (FT3) 4.2 pmol/L (2.8-6.5) - 38% through range (upper quarter is usually best)

    FT4 : FT3 Ratio 4.0 (2.0-4.5) - Good conversion takes place at 4 or less, so your conversion is reasonable

    And

    Thyroglobulin (TG) 221 <= 40 IU/mL

    Peroxidase (TPO) 155 <= 35 IU/mL

    Are you doing anything about your Hashimoto's, as confirmed by your positive antibodies? Have you adopted a gluten free diet? Are you supplementing with selenium?

    As for your urine test -

    There is very little T4 and virtually no T3 getting into your cells. Not really worth doing a percentage as the scale shows it all, but T4 is actually 11% and T3 is 7%. In a patient optimally treated, the T3 should be over on the right hand side of the scale.

    You can't compare blood and urine tests as they are measuring different things, but your urine test clearly shows there's not much getting into your cells. I don't know anything about why the hormone isn't getting into the cells, that's something you'll need further guidance on.

    At this point, my opinion is that I don't see any need to add T3 as your conversion is reasonable. What I do see, from both your blood and urine tests, is that an increase in Levo is needed - your blood test most definitely shows this and if your private London Professor endo knows his stuff he should know that a treated hypo patient generally needs TSH around 1 or below or wherever it's needed for FT4 and FT3 to be in the upper part of their respective reference ranges. A tiny bit of T3 might be useful but a higher dose of Levo means that more will be converted anyway.

    Have you got the Dr Toft article about blood levels, where he wrote in Pulse Online magazine:

    "The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.

    In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance.

    But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

    This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."

    If you email louise.roberts@thyroiduk.org.uk she will let you have a copy of the article which you can print out and show your GP or Endo.

    So, get an increase in your Levo and get blood re-tested after 6-8 weeks. If another increase looks as though it's needed, then re-test again 6-8 weeks after the second increase, and a new urine test would be useful at that time to see whether more is getting into your cells with a higher dose.

    However, you do have a problem with high cortisol in three of your samples, and very low DHEA. Have you discussed this with your private endo?

    Have you got the results of your vitamin and mineral tests yet? All need to be optimal for thyroid hormone to work.

  • Hello SeasideSusie

    First of all I really appreciate the fact that you've looked at my previous posts/results before responding. Thank you.

    As per Dr P's instructions, at the time of the test I had lowered my Levo from 75mcg to 50mcg (and also taken Adrenavive iii two days before). I'd only taken one tablet during those 24 hours.

    I completed the Urine Thyroid Profile test as per your advice. In hindsight, perhaps I shouldn't have done the test when I did because I'd also taken Adrenavive iii two days before and lowered Levo but I was so unwell I felt I had to do something. I also shouldn't have also gone from seeing the London Professor to Dr P. Too many cooks springs to mind but I've been trying everything to feel better but clearly that hasn't helped so far!

    I didn't collect the first urine of the day, which was around 8.30am. However, I collected all the urine from then onwards until the following morning. Roughly 8.30am the following day. I tend to wake up a few times during the night as well to go to the loo but I collected it all. A very tricky thing to do!

    I have been gluten free for the last few months. Initially because my personal trainer wanted me to but then as a result of learning about my TGO and TP results I've been extremely strict. I haven't been supplementing with Selenium recently. I had a multivitamin that contained it but that ran out and I haven't bought anything since. Do I really need 200mcg a day?

    As a result of my recent poor health, my GP has agreed to test "everything". I asked for thyroid, Vitamin D, cholesterol, B12, Ferritin and Folate. So I had a blood test yesterday and hopefully I'll receive the results in the next few days. They've never tested Folate before but I hope that is included. She was thinking of referring me to somebody who can help with chronic fatigue syndrome!

    I have also decided to go back to the London Professor endo once I get my blood results. Through him I was advised to have an iron infusion as Ferritin was previously 19. Hopefully the iron infusion has helped (even if periods are heavy) and the blood results should reveal the increased number.

    I think I read on an earlier post about this Pulse article and I emailed Louise over Christmas. She has kindly responded today so I'll have a look at that in a bit.

  • I don't know if the Adrenavive will have made any difference to the test, after all it's thyroid hormone it measured not adrenal hormones. So you were on 50mcg Levo at the time of the test. When did you lower the dose? How long had you been on 50mcg?

    Going by the October blood tests, they showed that even on 75mcg you were under medicated.

    You do need selenium, not only does it help with conversion of T4 to T3, it helps reduce the antibodies. This is the one I use and recommend as it has no smell (unlike many makes) and you do need 200mcg a day.

    cytoplan.co.uk/selenium

    I'm off to order some for myself in a minute, stocking up whilst it's on 3 for 2!

    Don't bother with multivitamins, they usually contain the wrong form of ingredients, usually the cheapest, and not much of anything to help very much. Best thing is to test the usual ones recommended here - Vit D, B12, Folate, Ferritin - and supplement where any deficiencies show. Vit C, selenium and magnesium being the exceptions, we all should be having those. Vit C helps support adrenals, selenium already mentioned, and most of us are deficient in magnesium. So when you get the results of your new tests, post them (with ranges) and suggestions can be made for any supplements that may be necessary. Ignore your GP saying they are OK or fine, they may be in range but the betting is they're not optimal and that's what we need!

  • I lowered Levothyroxine from 75mcg to 50mcg on 8th December 2016 and then I took the test on Monday 12th.

    As for being undermedicated on 75mcg, my GP lowered my dose from 100mcg to 75mcg around June 2016. Looking back, from what I recall it must have been because my TSH was probably closer to 0. Typical really, but then I don't think I felt that well on 100mcg either. I'd been on this dose since 2013.

  • I'm not sure that just 4 days on a lower dose of levo will have made too much difference really.

    It sounds as though your GP is like most and doses by TSH only. They really don't know much, life would be so much better for patients if doctors would just understand that it's FT3 that's most important. I don't suppose you know what your FT4 and FT3 were when he reduced from 100mcg to 75mcg??

  • SeasideSusie the results you posted above are the only ones I have which state FT4 and FT3 when I was taking 75mcg.

    October 2016 (75mcg)

    Total Thyroxine (T4) 144 nmol/L (58-161)

    TSH 2.01 mIU/L (0.40-4.00)

    Free Thyroxine (FT4) 17.0 pmol/L (11.5-22.7)

    Free T3 (FT3) 4.2 pmol/L (2.8-6.5)

    FT4 : FT3 Ratio 4.0 (2.0-4.5) Ratio

  • It would have been interesting to see what your free Ts were like on 100mcg, just so it would be possible to say he didn't need to reduce your dose :D

  • Yes it would have been interesting, I wish I did the test 16 years when I was first diagnosed. I've had so many health issues over the years and I often suspected my thyroid but it was only until my personal trainer ordered the Genova test in October which I then googled did I then realise that over the years I've been misled by so many GPs with the words, "Your tests are normal there is nothing wrong". The antibodies result led me to Thyroid UK and healthunlocked and it is only now that I understood that everything is all connected. Lightsensitive skin, impossible to lose weight, high cholesterol, constipation, elevated B12, fatigue, excessive thirst and urination, muscular aches and pains, insomnia, low iron, heavy periods, poor concentration, too cold, too hot the list goes on and on! My medical file is full of letters from dermatologists, gynaecologists, orthapaedic consultants, physiotherapists and endocrinologists.

    SeasideSusie I am very grateful for your support. I hope that one day when I am better I can also help people like you do. It's people like you that keep this forum alive.

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