I have now had test results: TSH - 0.11 (0.27-4.20) Free Thyroxine - 17.21 (12.00-22.00) Total T4 - 89.8 (59.00-154. 00) Free T3 - 3.74 (3.10-6.80) Reverse T3 - 22 (10.00-24.00) Reverse T3 ratio - 11.07 (15.01-75.00.
So the T3 has been withdrawn and the consultant is saying that I may not have a thyroid problem at all. These tests were done after I had taken my T4 medication (125.00mcg) as I did not realise that they should be taken 24 hrs after taking the medication. What advice can you give me as to how I now proceed. Many thanks for your help and other stories, all of which are important and interesting to read.
Ann-Simpson
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Ann-Simpson Why does the endo say you may not have a thyroid problem after all?
When we're you diagnosed? Do you have the results from then? I'm sure you wouldn't have had a diagnosis if you didn't fit the criteria.
Your FT4 is half way through range but FT3 very low in range. The aim of a treated hypo patient generally is for TSH to be 1 or below or wherever it is needed for FT4 and FT3 to be in the upper part of their respective reference ranges. Your free Ts are too low, and also show poor conversion so withdrawing your T3 was wrong.
From ThyroidUK's main website > About the Thyroid > Hypothyroidism > Treatment Options:
"Dr Toft states in Pulse 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)."
Dr Toft is past president of the British Thyroid Association and leading endocrinologist. You can obtain a copy of the article by emailing louise.roberts@thyroiduk.org.uk to show your endo.
Dr Toft also wrote the following booklet for the British Medical Association mentioned under Treatment Options, which states:
"According to the BMA's booklet, "Understanding Thyroid Disorders", many people do not feel well unless their levels are at the bottom of the TSH range or below and at the top of the FT4 range or a little above."
It might be worth getting the booklet, it's about £4.95 from Amazon or your local pharmacy.
Do you have Hashimoto's- ever been tested for high antibodies?
Obviously if we are taking Levo, then blood tests are within range. Your results don't show you are over medicated at all. They show you have rather high T4 and low T3, which is typical of a poor converter.
Did an NHS endo originally prescribe T3. Do you have old test results from before adding T3 and also a record of what improvements it gave you.
You should not have it withdrawn on grounds of costs. If you were doing well & health stable on it, you are entitled to remain on it with NHS prescription
Just read your reply again, and apologies for the spell maker on my phone sending some rather weird words in my first reply.I have considered having the D102 test done, but the consultant dismissed that too. The two consultants I have seen one on the NHS and one privately both refuse to test for the conversion, or the T3 at all. Ann Simpson
Another result was given Thyroid peroxidase antibodies 62.9 (0.00 - 34.00 but the consultant dismiss this result also. It is like banging your head against a brick wall. But the NHS consultant did take note of a test she did and has indicated that I can stay on T4 although at a lower level so am now on 125mcg rather than 150mcg. This has not made any difference to my wellbeing, and I am beginning to think that the T3 is more important to me than the T4. Do some people just need the T3? I am so perplexed and it is such a complicateed subject.
So you have high TPO antibodies, this means you have Hashimoto's. Anyone ever told you that?
Extremely common with Hashimoto's to have low vitamin D, folate, B12 or ferritin.
Have you had these tested? If so put a new post up with results. If not ask GP to test
Hashimoto's is gut related, it affects our ability to absorb nutrients, leads to leaky gut, and most commonly gluten intolerance, sometimes other intolerance like dairy
Don't expect you GP or endo to acknowledge any of that. They dismiss the autoimmune aspect, consider it irrelevant. It isn't.
Yes likely you might also need T3 too, but usually best to get vitamin levels at top of range first
See The Thyroid Pharmacist website for masses of info about Hashimoto's
Also by same girl Izabella Wentz- on you tube The Thyroid Secret - excellent docu-series all about Hashimoto's
Just seen you mention Folate mine was 6.7 (2.91 - 50.00) and the ferritin was 45.16 (13.00 - 159.00) and B12 was 311.4 (140.00 - 724.00) neither of these results was flagged up but would be pleased to have your views. And I will research the other suggestions you make thank you very much. Ann Simpson
Folate 6.7 (2.91 - 50.00) - this is low. Folate should be at least half way through the range.
B12 311.4 (140.00 - 724.00) - this is low. Anything under 500 can cause neurological problems. Recommended level is very top of range, even 900-1000.
You can buy some sublingual methylcobalamin lozenges 5000mcg and take one daily until the bottle is finished, then buy the 1000mcg ones as a maintenance dose. Have a look at Solgar and Jarrow's.
When taking B12, we need a B Complex to balance all the B vitamins. Buy one with 400mcg methylfolate and this will help raise your folate level. Have a look at Thorne Basic B (one daily) and Metabolics B Complex (two daily).
B vits should be taken in the morning, no later than lunchtime as they can be stimulating and could affect sleep if taken later in the day.
**
Ferritin 45.16 (13.00 - 159.00) [I think the upper level should be 150] - this needs to be at least 70 for thyroid hormone to work properly and recommended is half way through it's range.
You could buy some iron tablets and if you do then take each one with 1000mg Vit C to aid absorption and help prevent constipation. Take iron four hours away from thyroid meds and two hours away from any other medication and supplements as it affects their absorption.
Also, eating liver will raise ferritin. Maximum 200g a week, either as a meal or added to any meat dishes such as casseroles, cottage pie, curry, bolognese, etc.
Yes I did have the Vit D tested and the consultant told me that it was ok. but I didn't get a print out of the all the results she took, magnesium, Calcium and phosphate in addition to Vit D. She said the the marker on inflammation is normal. Have had a further thryroxine test done so will collect all the results and print outs to see if we can make more sense. So you think a vit Bcomplex would be a good idea? I thought she took a test on Vit B levels but will check. Am happy to eat liver rather than take iron tablets. Would that help? And what exactly is folate? sorry for my ignorance. thank you Ann Simpson
Folate (folic acid) is one of the B vitamins - B9. Folic acid and B12 work together to form red blood cells. Food sources of folate are leafy greens, beans, oranges, poultry, liver (liver is a super food chriskresser.com/natures-mo... )
If you take B12 then B Complex is needed to keep all the B vitamins in balance.
A B Complex is a good supplement for us Hypos generally, it can help support the adrenals.
I raised my ferritin level by eating liver, (still continue maintain it), I couldn't tolerate iron supplements.
Vit D result is important. Recommended level is 100-150nmol/L. When others are low, Vit D often is too. OK just means that it is in range. If the bottom of the range is 30 and top of range is 200, with <30 deficient and >200 toxic, even if you are 31 you will be classed as normal but actually only one point away from being deficient, similarly 199 is one point away from toxicity level. So 'OK' and 'normal' don't actually mean anything, it's where in the range that matters.
thank you so much for your reply. So I will restart the Vit3 that I was taking all winter. Also will start A B Complex - will that cover all the Vit B vitamins, and start to eat more liver - don't think I can manage iron supplements either. Ann
Some people have, I believe successfully managed to argue for keep their T3 prescriptions when they demonstrate they have DIO2 gene, as it is slowly being recognised that having this gene means you can have impaired conversion
thank you. did have my Vit D test done and the consultant wrote to say that the level was normal. I had been taking Vit D all through the winter but stopped for the summer after her comments. I feel I am going round and round in circles I have also been told that my level or calcium and phosphate are normal. But I was not given a read out of the figures on these tests which I must request to see if I can make sense of all of it. thank you Ann Simpson
As you will often see on here "normal" is not a result, it's just an opinion. With thyroid issues we generally seem to need D levels at least about 70nmol/L
thank you, will restart to take Vit D3 which I was taking all through the winter and just take it all year round. Also have been advised to take Vit B vitamins and eat more liver! Thank you for your advice. All very helpful. Ann
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