Thyroid UK
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Help with thyroid results please

My mum has been on levo for 20+ years, and like me never felt it made a difference. Due to my interaction with the forum I have been pushing her to get results and try and get T3 tested by doctor. She saw a new doctor who seemed sympathetic and listened to symptoms, agreed to order T3 and the lab ignored request I presume because TSH 'in range'.

TSH 3.99 (0.30 - 5.50)

Got mum to order medicheck kit and results as follows

Thyroid Function

THYROIDSTIMULATING HORMONE *11 mIU/L (0.27 - 4.20)

FREETHYROXINE 14.2 pmol/L (12.00 - 22.00)

FREE T3 3.66 pmol/L (3.10 - 6.80)

From earlier TSH I interpreted as she could try higher dose of T4 to get TSH under 1. This is confirmed by the low T4 and T3 results from medichecks. Convertion ratio looks about right though.

If doctor won't up levo, I have T3, would you suggest trailing a 1/4 25mcg with her T4.

The other issue is the TSH jumping.

The medichecks test was done early, but 2 days dose of T4 was skipped as she got up late 2 days earlier and I had said leave a full 24hrs clear and she didn't want to do the test late morning.

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tzracer At the moment, with TSH 11, you can't rely on the conversion ratio. TSH needs to be low, down to 1 or below, to be sure.

Your mum needs to see her GP with these results, point out that her TSH is massively over range and she needs an increase in Levo to bring it back into range, preferably 1 or below as that is where most hypo patients feel best.

Get her to take the article in Pulse Onine Magazine written by Dr Toft to support her request:

thyroiduk.org.uk/tuk/about_... > Treatment Options

"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)."

You can obtain a copy of the article by emailing louise.roberts@thyroiduk.org print it and highlight question 6.

Also, because her TSH has jumped from 3.99 to 11, regardless of the reference ranges, I would ask for thyroid antibodies to be checked because it's quite possible that she has autoimmune thyroid disease aka Hashimoto's. As there are two types of antibodies - Thyroid Peroxidase (TPO) and Thyroglobulin (TG) - it's a shame she only did the very basic thyroid test with Medichecks, she could have got both types of antibodies checked at the same time, whereas the GP will only be able to get TPO antibodies checked if he's lucky, the NHS rarely check TG antibodies yet you can be negative for TPO but positive for TG.

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Thanks for swift reply, I have given her the pulse article, it's been hard to get her to go to the doctors as she has no faith in them. And doing so just delayed the results as they wouldn't do T3 anyway. Crazy situation where labs can overrule doctors requests! I'll get her to ask about the antibodies test and if doctor won't will do it with medichecks.

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TSH was 1.18 (0.30 - 5.50) in Jan 16

then 4.51 in Aug 17

then 3.99 a week later in Aug 17

Serum Parathyroid hormone 5.5 pmo/L (1.10 - 6.90)

Serum B12 298 ng/L (223 - 1132)

Folate 4.1 ug/L (3.9 - 20.0)

Don't have Ferritin of Vit D but would expect them to be low in range too.

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Well, B12 and folate are too low. B12 needs to be at the very top of it's range and folate at least half way through it's range.

She can check to see if she has any signs of B12 Deficiency here b12deficiency.info/signs-an... and if she has then post on the Pernicious Anaemia Society forum healthunlocked.com/pasoc otherwise supplement with methylcobalamin sublingual lozenges 5000mcg to start then when that bottle is finished change to 1000mcg daily. When taking B12 we also need a good B Complex to balance all the B vitamins, eg Thorne Basic B which contains 400mcg methylfolate which will help raise the folate level.

No thyroid hormone can work unless ferritin is at least 70 so it would be a good idea to get that tested, also Vit D. Don't supplement either unless you know current levels.

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Thanks will pass all that on

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I don't think that is the cause of the high TSH. The TSH doesn't change that rapidly. What time was the NHS test done?

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Thanks, for reply, it would have been as early as possible, and before her levo. I'll see if there's a time on the printout.

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OK And, were both tests fasting?

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I'll ask but I think I'd told her not to eat.

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OK :)

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