Hi I am 36 and have been taking levothyroxine for 10years. My TSH since 2014 has been low, free T4 within range, free T3 mostly low. I have just had some private blood tests as I am shattered despite 125mcg levo. They showed (in different units from NHS tests) that my TSH is within range 1.88 mIU/L (0.27-4.20), my free T4 is 61.2nmol/L (59-154), Free T3 is low at 2.7pmol/L (3.10-6.80), TGAb is <10IU/ml (0-115) and TPOAb is 25.8IU/ml (0-34). I have been seeing a nutrionist and she has suggested I see an endocrine specialist as she thinks that the TPOAb may indicate an autoimmune issue. I also have a history of endometriosis. My vitamin D is also borderline but no Vit b/folate/ferritin issues .
My questions are - what does a low free T3 mean? And the presenance of TPOAb even though it is within range? Does anyone have any advice please as I am finding it all really confusing.
Thank you!
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TPOab is negative for autoimmune thyroiditis (Hashimoto's). Most people have some thyroid peroxidase antibodies but yours are low and have no significance. Hashimoto's can't be conclusively ruled out though as some people are negative for TPOab but positive for thyroglobulin antibodies (TgAb). There is no cure or treatment for Hashimoto's, any treatment is for the hypothyroidism it causes.
TSH 1.88 and FT3 below range indicates you are undermedicated. Can you check your Medicheck records - you have given total T4 result, the Free T4 result range will be something like 12 - 22.
My history for the last 4 years show that my TSH is always low and they keep wanting to lower my levo. I was at 150mcg, now on 125mcg and have been for over a year.
FT4 is bottom of range so your GP ought to raise Levothyroxine dose even if it makes TSH low.
The goal of Levothyroxine is to restore the patient to euthyroid status. For most patients that will be when TSH is 0.27 - 1.0 with FT4 in the upper range. FT4 needs to be in the upper range in order that sufficient T3 is converted. Sometimes this will mean that TSH will become suppressed. Read Treatment Options in thyroiduk.org.uk/tuk/about_... Email dionne.fulcher@thyroiduk.org if you would like a copy of the Pulse article to show your GP. The Thyroid UK office opens on 3rd January.
VitD 50 is insufficient. Replete is 75 and optimal is 100-150. I would supplement 5,000iu D3 for 6 weeks and then reduce dose to 5,000iu alternate days and retest in April. Take vitD 4 hours away from Levothyroxine.
Hi Clutter thank you so much for the info. My GP told me that 50 for VitD was acceptable, despite it being taken in the height of summer and rechecked last month by medicheck. I will take the article to show my GP but I don’t hold out much hope. How do they determine how much levothyroxine to put people on?
VitD 50 isn't acceptable but it isn't deficient so your GP probably won't prescribe. You can buy vitamin D3 without a prescription. If you buy on Amazon please use the affiliate link healthunlocked.com/thyroidu...
Thyroid levels determine the Levothyroxine dose required that's why dose is sometime a little under while a little over at others.
We are all different and react differently so that isn't possible plus all increases should be by 25 mcg then retest etc so if you get an increase test after 6 weeks then retest again etc. It can be dangerous just 'to throw more' at the problem. Some take a while to settle on a new dose so giving extra could give problems plusxyou may miss and sail past you sweet spot andxthen you can easily become overmedicated as often it can be difficult to pin down your symptoms as either under or over medicated. Slow is always the best policy.
No, it doesn't work like that, we're individuals not machines. Dose adjustments are usually in 25mcg increments at 6-8 week intervals as it takes time to metabolise dose changes.
Low t3 is a problem. Some people can't convert t4 (thyroxin) to t3 very well. Only endocrinologist can prescribe t3 on mgs. Insist on seeing one. Take someone with you to your GP if neccessary. Don't give up. I had a very hard life 40 to 60 without t3.
I may well ask to see an endo. Imagine I’ll have to pay privately though and that will require some Saving. I’ve been told by a couple of people ( chiropractor and nutritionist that they suspect I am coeliac as I have thyroid and endometriosis issues. I’m not convinced but they think it is all auto immune
TSH is largely irrelevant on Thyroid replacement hormone. The most important test results are FT4 and FT3. Both your are too low so you need dose increase back up to 150mcg
Vitamin D is much too low. Aim for around 100nmol. Suggest Better You vitamin D mouth spray at 3000iu or 5000iu daily
Resting after 2-3 months. Vitamindtest.org.uk £28. Likely to need maintenance dose once get level up. Trial and error what you need.
What are actual results for folate, ferritin and B12. Just because in range doesn't mean it's necessarily enough
Dr Toft, past president of the British Thyroid Association and leading endocrinologist, 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)."
You can obtain a copy of the articles from Thyroid UK after Jan 3rd
email dionne.fulcher@thyroidUK.org. print it and highlight question 6 to show your doctor.
Prof Toft - article just published now saying T3 is likely essential for many or suppressed TSH and high FT4
Hi thank you so much formhe information. I’m not sure exactly what my ferritin was but my folate was high. This was put down to my recent pregnancy. My active Vit b12 was 58.9 (25.10-165). I have emailed Thyroid UK so hopefully will get a copy of the article .
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