Should I be worried?

[mistydog]

I had a recent blood (last minute) test done and the results are back. The test was at 1pm and I had taken 2 grains of NDT in the morning.

TSH lower than 0.02 (0.25-4.00) (below low reference limit).

Free T4 14 (12.0-22.0)

Free T3 9.4 (3.1-6.6) (above high reference limit FT3 added by laboratory. Suppressed TSH and high FT3 consistent with excessive T3 replacement). (Lab comments)

I am taking 3 grains of thyroid-s per day. 2 in the morning and 1 early afternoon.

I am thinking to reduce to 1.5 in the morning and one in the afternoon, because I do feel slightly over medicated, but when I dropped to 2, my carpal tunnel started to come back.

My blood pressure is a little high, I feel a bit shaky, but I have other issues which may be contributing (anxiety about various things).

Can I have your thoughts?

[Hidden]

In my experience, the TSH is practically useless when on drugs containing T3 as it tends to be suppressed although this does not automatically mean you are overmedicated.

Do you feel hyperthyroid on this dose? That is the most important question.

I know it's difficult to disregard what the lab and your doctor say but, when on NDT, you cannot go by the lab's reference ranges concerning TSH and, possibly, not even FT3. Others will be able to comment more on this aspect.

Your FT4 levels are close the lower normal limit which is also to be expected when on NDT.

[mistydog in reply to Hidden]

I wasn't worried about the TSH, I knew it would come back low. My GP is sweet but feels constrained by the NHS not to promote NDT. He calls me a rebel but secretly is encouraged by me taking my health into my own hands! LOL.

I feel slightly hyperthyroid, and I do feel that I could reduce, my concern was really about the high T3 and does it matter? I explained to him that I had taken my meds and he asked for the tests anyway, he said that T3 would still be raised if I had not taken my meds so it didn't affect it, IS HE RIGHT?!

[Clutter in reply to mistydog]

Mistydog,

No, He's wrong. People who normally have FT3 within range have seen the level treble when testing a couple of hours after they've taken a T3 or NDT dose.

See how T3 peaks after a dose in the graph in this link tiredthyroid.com/blog/2015/...

[greygoose in reply to mistydog]

Well, you'll never know, will you. Unless you do a new test where you don't take your NDT in the morning. And, at the same time, get it done early in the morning, having fasted over-night. There really isn't very much T3 in three grains of NDT, but it also depends on how well you convert. And we don't know that, do we.

[mistydog in reply to greygoose]

I will do, thank you. As I said, I wasn't really going for a thyroid test, he just checked it anyway.

[greygoose in reply to mistydog]

Yes, I know, they just don't understand, do they. So many doctors have told me it makes no difference, but it really does.

[Angel_of_the_North in reply to mistydog]

Shame you couldn't have refused the test

[mistydog in reply to Angel_of_the_North]

I wasn't worried about the thyroid results but I was worried about the tumour markers.

[Clutter]

Mistydog,

You've skewed FT3 result by taking 2 grains NDT before the test. T3 can peak in the blood for up to 6 hours so your FT3 result is reflecting the dose you took rather than normal circulating levels. Next time take NDT after your blood draw.

If you feel over medicated then try a dose reduction. If you can, retest 6-8 weeks after the dose reduction.

[mistydog in reply to Clutter]

Thanks, Clutter - I knew that he was wrong! I wouldn't have taken anything if I had known that he was going to send me for a test, he was actually testing CRP for tumour markers but added that to the list. I might drop half a grain for a while and retest.

[Angel_of_the_North in reply to mistydog]

It isn't CRP that tests for tumour markers (CRP is inflammation), but hCG or CA125 (and a few others - eg calcitonin for thyroid) AFAIK.

Also having elevated tumour marker levels doesn't necessarily mean the condition is malignant

NOT having elevated tumour marker levels doesn't necessarily mean you don't have cancer

See labtestsonline.org.uk/under...

[mistydog in reply to Angel_of_the_North]

Since I have had breast cancer, I was concerned about bone mets. I am now having a scan which should be more conclusive, but crp was good. Ca125 is a cancer specific marker.

[silverfox7]

When I was working my way up with NDT I read that after 2 grains to go up in quarters and I actually stopped at 3 and I was over medicated but on new endo's advice because he was new and I wanted to keep him onside I did what what he suggested and cut back. I'm now on 2 grains one day and then 1.75 for two days and I feel very good so may you increased too much towards your end result and although you feel good short term you may now actually need it.