can someone please explain what ideal blood results should be please. People talk about top of range, bottom of range . . .high and low etc and I'm never sure whether they mean a high result is a low number or visa versa.
For example my most recent results were THS 1.86, FT3 8.8 and FT3 4.00. I'm sorry but I don't have the ranges so have not a clue what these results indicate other than they're normal
Thanks in advance. richard
Re: ranges, for example, say the range is given as (3.5 - 4.4), and your result is 4.2. That is near the 'top' of the range, i.e. the higher end value-wise. Likewise, 3.6 would be at the 'bottom'. And something like 5.2 would be 'over range' and 3.1 'under range'.
Without the ranges it's hard to say where your value falls. Usually for hypothyroid you'd want your FT3 value in the top part (higher end) of the range, ditto FT4. For TSH you'd want it closer to 1 or even lower. You need to ask your receptionist for a print out of your results, you're legally entitled to them. You might need to pay a small fee for photocopying.
Well, that's a problem because you do need ranges as laboratories can vary. Make a habit of always getting a copy of your results with the lab ranges.
Addledness is now my word of the week lol. Well, if I can remember it
I have my ranges here now: FT4 : 8.8 range: 9.01-19.5 FT3: 4.0 range: 2.63-5.7 TSH: 1.86 range 0.35-4.95
so should I be trying to get FT4 closer to 19.5 with extra Levo/ Goodness knows what my test would show now as the above were on 1grain NDT and now I'm on 1/2 grain and 20mcg of T3. My main problem is that whether I'm well is a matter of trying to remember what 'well' felt like and everything being masked by bad sleep habits
I have a test in a fortnight but If anyone can guide me in the meantime it would be greatly appreciated.
Just be sure to fast overnite (water OK) and no Levo/NDT for 24 hours prior. Test must be as early as possible as TSH varies thru the day and we want a result that shows high TSH to avoid decrease in dosage.
But what about your nutrient results? Ferritin, folate, Vit D and B12 are often deficient with thyroid as we tend to have malabsorption/gut issues. When we are low or deficient this affects our ability to convert dosage properly. And impacts our wellbeing massively, so all these test results are pretty important to get the bigger picture here.
Its a negative feedback loop, normally when FT4/3 go up TSH goes down and vice versa. With hypo we are aiming for TSH to go down and the frees to go up until we feel well.
You will find most posts relate to T4 only treatment (as it looks like the answers above were) as that is what most of us are on, but when you are on combination treatments then results are read slightly differently hence the long reply. Always state what you are on and how much so you get the right advice or you may get confused when you dont 'fit'.
Normal and fine should never be accepted we all have our own personal optimal place in the ranges where we FEEL well. This is why you see replies like upper part (FT4/3) rather than a number. You need to slowly 'feel' your way to the best numbers for you so you dont over shoot your sweet spot, anecdotally many people seem to feel well when their FT3 is around 5 (3.1-6.8) which gives them a TSH of 1 or below (0.3-4.2) if that helps give you an initial aiming point (I'll have leave you to work out the equivalent for your ranges as Im rubbish at maths snd percentages ☹️)
With combination or T3 therapies TSH is often low or 'suppressed' (well below range) This gives most doctors conniptions and they start banging on about osteoporosis and heart issues. These are only a problem if low TSH is caused by HIGH FT3.
NDT and T3 together will really mess with the FT4/3 ratios depending how much of each you take but they are very likely to be out of balance with T4 lagging well behind FT3, this is not really a problem as long as your FT3 is in a good place for you, It does mean you dont have much of a store to convert if needed but are reliant on taking enough FT3.
It is surprising that your NDT was cut in half (1 grain is quite low anyway) and so much T3 added when your FT4 was already under range. As already said in my other reply ideally the frees should be in balance so you have a store to convert when needed. Your FT4 will now probably be even lower so you wont have much TO convert. Normally you would expect the NDT to have been increased which would increase FT4 and FT3 and then maybe some T3 added if still needed. The only reasons normally would be if FT4 was already high which yours definitely wasnt or you cannot convert in which case why not put you on T3 only?
Might be worth posting another question for those more experienced in combo treatment. If you have them include results (with ranges) on different dosages and treatments with any relevant symptom history. Include the make of NDT or preferably the mcg's of T4 and T3 in it.
As you are getting tests amyway, it is worth geting your essential nutrients checked as a lot of deficiency and hypo symptoms overlap and we also need very good levels for proper conversion to occur.
Thank you for your long , comprehensive reply. I understand where you're coming from and the logic therein. Here's my reasoning. For 18 months or do I took 1 grain of NDT and had just, unfortunately, TSH blood test results to guide me . . plus how I felt. Bloods were coming back normal, however I rarely felt well merely ok-ish. Waking up in the middle of the night often in a pool of sweat has made me decide to experiment with meds. . . try to get well and then see what my blood tests reveal rather than visa versa. First I dropped the NDt and tried Levothyroxine . . .no good. Then I tried just T3 and here was something of a revelation . . . hello brain . .. hello world . . .so this is what it feels like to be alive and present and have some reserve fuel in the tank. The problem though was hot feeling thru day and night sweats again. ( have been reg. checking temp. which is up and down between 35.1 and 36.5) On this evidence I figured tone down the synthetic T3, add a little natural T3 and T4 (1/2 NDT + 1 20 mcg) and see how it goes. This forum is great but there seems to be a lot of conflicting info to navigate. E.G many people advocate concentrating on FT3 since, to paraphrase, T3 is all we really need as T4 is just a stepping stone anyway. It was in this spirit that I upped my T3 and lowered my T4 input. Also many folk seem to be advocating Arenal support and have seemingly well founded arguments/evidence for this, so it's in my mind to perhaps try this as well.
You seem to have a knowledgeable grasp on all this and apparently well founded arguments for which I'm grateful as it helps me clarify and learn.
I'd like to add something that comes to mind. Often it's suggested that changing meds won't have a felt effect for a week or 2 approx. However for me it seems I feel it really fast . .sometimes within an hour or so. What this signifies I don't know?
Cheers, richard
P.S. mind if I ask if you have any adrenal support experience/knowledge?
Sorry its going to be another long one, but 'a little knowledge is a dangerous thing'. There is absolutely nothing wrong in principle with experimenting with what suits you, blood results are not the holy grail but they do have their place in conjunction with symptoms. You need to be very sure of what you are doing or work with a Doctor who does or you can get yourself in serious trouble, especially with T3.
Im afraid that if you are having to ask basic questions like how TSH T4 and T3 interact and good levels, then you do not have enough knowledge to titrate yourself properly and safely. You need to learn these things BEFORE you start mucking about with treatments or you could make yourself quite unwell and have a hard time pinpointing where it went wrong. You will then have to start titrating again and take even longer to get sorted. For instance by swapping some synthetic T3 for NDT, if you calculated correctly, then there would have been no reduction in T3 (source doesn't matter) it would take up to 6 weeks for the T4 raise to fully kick in and boost your FT3. If you got it wrong you could have accidently raised or lower by a bigger than required margin so you wouldnt know if the sweats are due to adjustment, over medication, under medication or like some, find they just cant adjust to additional T3. This is why you need tests
T3 is the active hormone, it is ready to go as soon as it is absorbed which is why you feel it as soon as you absorb it. T4 on its own or in NDT needs converting and takes approx 6 weeks to fully assimilate though you may start to feel an improvement after about a week to 10 days on average. You 'woke' up when you added T3 which proves you needed a higher level but if you jumped the gun you dont know if you could have achieved the same on levo or just NDT if you had continued titrating. You probably dont know if you just werent taking enough NDT or levo, if you have a simple nutrient based conversion problem or actually NEED T3 only.
Yes there are a lot of good arguments re adrenal support, and a lot of us do have issues, but did you do a test? If not potentially you could give yourself a problem you did not start with, poor sleep patterns WILL mess things up too. I do not have an adrenal problem so I dont know a huge amount about it, just what I read in passing.
I know feeling like crap is no fun but you HAVE to give adequate time between raises or treatment changes as even with good biochemistry it takes time for symptoms to resolve. You cannot rush when it comes to hormones. Not all makes of levo or NDT are the same, they use different binders and fillers so you may need to try several before you find the one that suits best. Symptoms could potentially be from the tablets themselves not inadequate thyroid levels.
T3 is not a magic bullet. Yes it is what our cells actually use but our thyroids naturally produce mostly T4 with some T3 (only about 20%) It makes sense to mimic this and is why many people seem to do much better on combo or NDT treatments and the science seems to back it up (unless you are a doctor apparently). If you tank your FT4 unnecessarily you will have no reserves in storage, so decide to go for a long walk one day and you are likely to crash when your T3 gets used up and it may take days to feel well again.
Are you aware of how to work out the potency of the different treatments? NDT varies in stength from make to make, but mine contains 38mcg T4 and 9 mcg T3. I was taught on here that you multiply T3x3 to reach the T4 equivalent. So for mine 1 grain equates to 38 +(9x3)= 65 mcg plain T4 so you cannot just guess if you want to hit that sweet spot you need to work out the 'value' of the changes you are making.
I read, a lot, on here and links to research. With my GP I titrated my Levo and nutrients up to the point where I felt pretty well, T4 and T3 in balance and both near the top end. It took 16 months and granted I do have a good GP.However, I do have some unresolved muscular issues only acquired since diagnosid which other members have also found only resolved by coming off levo altogether. I know my GP cannot offer me anything else so I am trialing the equivalent amount of NDT with forum advice. I already know that certain makes of levo cause me problems but if a 6 month trial does not give me improvement in those specific areas and/or improved feeling of wellbeing I will return to levo (why buy my own meds, with all the supply difficulties, if I dont have to!) and accept that the remaining issues are unlikely to be thyroid or treatment related and look else where. At least I will know for definite one way or the other.
Please read as much as you can, search the forum for previous answers to questions you have or pose questions. If you are going to take T3 please do adequate blood tests 6 weeks after a dose raise to see where you are. Titrating properly will get you symptom free more reliably and probably quicker than a shotgun approach or pushing too fast. Although you woke up with that extra T3, it sounds like you are reacting to too big leap in T3 in one go hence the sweats etc.
If you decide to drop plain T3 intake you may want to take advice as I believe it is slightly more complicated than adding it due to conversion lag which probably explain some of why you felt so rubbish when you tried to go back to levo last time from NDT
Sorry it turned into war and peace, I just want you to be safe on your wellness journey. Accept my apologies if you know more than I think and I am teaching you to suck eggs 😀
Thank you very much for taking the time and trouble to reply so comprehensively and thoughtfully. I truly appreciate it. Clearly you have a high degree of knowledge and experience. I sense from your words that yours is a cautious, methodical approach and you have made me stop and take stock.
I have learned along the way a little about TSH, T4 and T3 . In particular about their relationships and interactions. Perhaps having read 'Recovering With T3' I'm a bit guilty of seeing what I wanted in the book I gathered, most probably incorrectly, an impression that self medicating is an approach worth experimenting with. I guess I'm getting a bit desperate. My wife is stopping work in a month and has all sorts of plans so I want to get well for both of our sake. I'm fortunate to have a great Doctor ( in so much he didn't hesitate to prescribe NDT or T3 on request even though he might get his knuckles rapped for the latter . . .bless him ) so taking a leaf from your book I will lean a bit more on him for guidance. My plan now is to take 1 grain of WP to get to get some sort of baseline re-established ( I was on 1.5 but perhaps as I was suffering night sweats, etc, it was overly potent . . my very first TSH result being 26.4 0.35-4.94 ) and in due course see what info can be gleaned from blood test results.
Perhaps you wouldn't mind if I get in touch with you at that point for your opinion if it's not too much trouble.
Cheers.
I forgot to add . . . I got a copy of my very first blood test which showed the Hypothyroidism . . . . TSH 26.4 range 0.35-4.94
I'm not sure how extreme, or not, that result was?
Feedback welcome
Thanks
It means "get sorted out quick as you have hypothyroidism".
The problem with ranges is that because people are individuals they can only be used as guidelines.
So when people say your TSH should be below one it is based on the fact most people feel better on thyroid hormone replacement when their TSH is below one. However you may feel fine with it slightly higher.
So if you just post results don't be surprised if you get someone asking you - "How do you feel?"
Partly because some of the signs and symptoms you may answer with may be an indication that you could possibly have something else not quite right e.g. a nutrient deficiency, a common cold, something more serious as well as simply being under medicated.
New bloods and cortisol readings help please 
More advice ahead of GP apt pls?
Making sense of my results
More bloods
Bloods
