Feedback please on latest test results?

[ShinyB]

I finally managed to get the Endo's PA to answer the phone and got my test results from mid December read out over the phone to me this morning. I was on 100mcg of Levothyroxine, and my bloods were taken at 9am on an empty stomach. I think, from memory, that I forgot to not take my levo dose the night before, so it was 12 hours after a dose. I'm thoroughly confused, as my T4 seems to be down whilst my T3 seems to be up. I'm also thoroughly despondent as I've felt progressively worse since upping my levo dose and am really struggling with energy and mood, concentration and memory. Advice and suggestions welcomed please

Results 15th Dec 2017:

TSH 0.51 (0.38 - 5.3)

FT4 12 (5.6 - 21)

FT3 4.7 (3.7 - 7)

9am Cortisol: 3.39 (1.38 - 6.92)

Vit B12 695 (180 - 915)

Folate 24 (4 - 20)

Prolactin 189 (50 - 500)

Haemoglobin 129 (115 - 160)

White Blood Cells 7 (4 - 10)

Platelets 301 (150 - 400)

IGF1 (insulin-like growth factor-1, just looked it up and this could be to evaluate pituitary function) & THYROID PEROXIDASE ANTIBODIES Still awaiting results.

Results 14th Nov 2017:

THYROID STIMULATING HORMONE 1.49 mIU/L 0.27 - 4.20

FREE THYROXINE 17.9 pmol/L 12.00 - 22.00

FREE T3 3.17 pmol/L 3.10 - 6.80)

Results September 2017:

THYROID STIMULATING HORMONE 1.62 mIU/L 0.27 - 4.20

FREE THYROXINE 14.9 pmol/L 12.00 - 22.00

TOTAL THYROXINE(T4) 66.1 nmol/L 59.00 - 154.00

FREE T3 *2.77 pmol/L 3.10 - 6.80

REVERSE T3 16 ng/dL 10.00 - 24.00

REVERSE T3 RATIO *11.27 15.01 - 75.00

THYROGLOBULIN ANTIBODY <10 IU/mL 0.00 - 115.00

THYROID PEROXIDASE ANTIBODIES <9.0 IU/mL 0.00 - 34.00

ACTIVE B12 *> 256.0 pmol/L. 25.10 -165.00

FOLATE (SERUM) 19.27 ug/L. 2.91 -50.0025 OH

VITAMIN D 86.4 nmol/L. 50.00 -200.00

Inflammation Marker CRP -HIGH SENSITIVITY 0.9 mg/l 0.00 -5.00

Iron Status FERRITIN 129 ug/L 13.00 -150.00.

[Clutter]

ShinyB,

TSH is low-normal, FT4 and FT3 are less than halfway through range. There is scope to increase Levothyroxine dose to raise FT4 and FT3 if you are still symptomatic.

Cortisol is within range.

B12 and folate are good.

Prolactin, haemoglobin, WBC and platelets are within range (normal).

[ShinyB in reply to Clutter]

I really struggle with these ranges I just look and see numbers and my brain shuts down (not that my brain is working well fullstop at the moment!) How does this latest FT4 12 (5.6 - 21) compare to the last one of FREE THYROXINE 17.9 pmol/L 12.00 - 22.00?

[SeasideSusie Remembering in reply to ShinyB]

FT4 12 (5.6 - 21) - are you certain that range is correct? Normally much narrower, eg 7-17, 12-22. If correct you are 41% through range.

FREE THYROXINE 17.9 pmol/L 12.00 - 22.00 - 59% through range.

FREE THYROXINE 14.9 pmol/L 12.00 - 22.00 - 29% through range.

But they can only really be compared if conditions the same every time, eg same time of day for blood draw, length of time since last dose of Levo.

[ShinyB in reply to SeasideSusie]

It did sound wrong to me, but I asked her to repeat it twice. I also asked if she would put the print out in the post to me - she said she "would have to ask if it's ok to do that." Pah.

Sorry to ask you to do my maths for me (dyscalculia) but if the range should have been 12-22, what percentage would that make the latest test?

Thank you.

[SeasideSusie Remembering in reply to ShinyB]

FT4 12 (12- 22) = 0%

How to calculate

Z = result

X = bottom of range (12)

Y = top of range (22)

Formula =

Z - X ÷ Y - X x 100

So -

Z - X = 12-12 = 0

Y - X = 22-12 = 10

0 ÷ 10 x 100 = 0%

Compare with

FREE THYROXINE 17.9 pmol/L 12.00 - 22.00

Z - X = 17.9 - 12 = 5.9

Y - X = 22 - 12 = 10

5.9 ÷10 = .59 x 100 = 59%

[ShinyB in reply to SeasideSusie]

Thank you. So it's an even worse result..

[Clutter in reply to ShinyB]

Shinyb,

When you have different ranges the only way to make a comparison is to calculate what percentage through the the range the results are. For instance:

FT4 12 is 42% through range (5.6 - 21).

FT4 17.9 is 59% through range (12-22).

So your FT4 12 is not as good as your previous test.

[ShinyB in reply to Clutter]

As per my answer to SeasideSusie, I'm not sure the secretary got the range right. Would you mind awfully telling me how you work out the percentages? I have a real problem with maths and numbers.... Thank you.

[Clutter in reply to ShinyB]

ShinyB,

I did it on a calculator.

21 - 5.6 = 15.4 x 0.42% = 6.46 + 5.6 = 12.06

[ShinyB in reply to Clutter]

Nope, still can't work it out! But thank you - will come back to the maths a bit later when my head might be clearer

[greygoose]

IGF1 is used to calculate HGH (Human Growth Hormone) which also can give an indication of pituitary function when used in conjunction with other tests. They could be thinking that your pituitary is mal-functioning due to your low TSH compared to your very low FT3 in September. What was your TSH when you were diagnosed?

[ShinyB in reply to greygoose]

TSH Nov 2014 - 1.4; April 2015 - 1.6; Nov 2015 - 1.8; July 2016 - 1.6, August 2016 - 1.6. I don't have test results prior to that, but I was periodically tested for hypothyroidism throughout my life as so many of my symptoms pointed to it, but my results were always "fine" I have never been given a hypothyroidism diagnosis but my GP was told by a psychiatrist to put me on Levo in early 2013 as I was presenting as hypothyroid and it would help boost the effects of the antidepressants I was on (was referred to the psych for treatment resistant depression).

From the endo's letter in December: "Possibly her symptoms are related to her already-diagnosed chronic fatigue syndrome and an element of depression as in my view so far biochemically there are no findings to establish a thyroid related pathology so far. She even asked about pituitary problems, which again is diverging from the real referral issue and they thyroid issue at present as TSH has been normal and doesn't suggest a pituitary related thyroid problem."

[greygoose in reply to ShinyB]

Oh yes! I remember now! lol Stupid endo-ostrich! Missed the whole point of central hypo. The point is that your TSH would be normal if you had a pituitary problem, but your Frees wouldn't be!

Your psychiatrist wasn't much better! It should have been T3 he recommended to boost the effects of the antidepressants, actually. But they totally miss the point that if the antidepressants only 'work' when taking T3, then it was probably lack of T3 that caused the depression!

So, perhaps now they're taking the pituitary thing seriously and are doing some tests! And, about time too! You can't have a low TSH with an under-range FT3 unless there is something actually wrong!

[ShinyB in reply to greygoose]

I'm actually sat here now having a sob. I don't even fully understand what you've said but to read that there IS something wrong has made me cry. I'm so tired of being fobbed off with "it's depression" and "it's Chronic Fatigue". Doing that first private test in September gave me some hope back, but all I've felt is worse since increasing my levo dose.

[greygoose in reply to ShinyB]

Well, to put it simply, as I see it, there isn't a problem with your thyroid, but there is a problem with your pituitary, which isn't functioning well enough to produce enough TSH to stimulate the thyroid to make more thyroid hormone. Therefore, your TSH is low, but so are your FT4 and FT3.

Well, that didn't work out as simple as I intended! lol But, does that give you a clearer idea? I know it's complicated, and I've had a lot longer to get my head round it than you have, so if it's not clear, do say so, and I'll try again.

But, in a nutshell, whether the problem is with your thyroid or your pituitary, the only 'treatment' is thyroid hormone replacement. Which is what you're doing. However, it's still early days, and you're not on a high enough dose, yet, so not surprising you still feel bad. Your FT3 is still too low. And, as you said, this has been going on for a long, long time. So, it's not going to resolve over-night. It's going to take time for your body to readjust to having thyroid hormone. It's going to take time for your body to learn to 'trust' that the supply isn't going to dry up again. In a way, it's like teaching an abused dog to trust humans again. Your body has been 'abused' by lack of thyroid hormone, and it has learnt to adapt. Now, it has to adapt again to having enough hormone. And that takes time. But, I'm sure you'll get there, eventually.

[ShinyB in reply to greygoose]

Stop it, you've made me wail again! Dread to think what my husband makes of me sat here sniffing at the computer! LOL.

I did think I'd start to feel gradually a bit better though, rather than actually worse.... i've not had it retested but have been wondering if taking levo has made my reverse T3 rise even more. I read somewhere (Westin Childs I think) that a rt3 of 15 or more is problematic??

[greygoose in reply to ShinyB]

A good cry does you good!

It happens so often that people feel worse on levo before they feel better. It's just one of those things. Of course, if your levels improve and you still feel bad on levo, then levo probably isn't for you. But, at the moment, you're still hypo, so you need to carry on increasing for a while.

Just taking levo isn't going to cause excess rT3. It's rather complicated, and the jury is still out, but the latest thinking is that rT3 is not the problem it was once thought to be. It's a bit of a red herring, so I shouldn't worry about that. What you do need to know is how well you are converting T4 to T3. But, judging by your December results, you wouldn't seem to have a problem there. Remains to be seen how well you convert when your FT4 gets a bit higher. It isn't even mid-range, yet.

[ShinyB in reply to greygoose]

ugh I'm a bear of little brain.....

So many questions, so little capacity to take it all in! That is definitely my worst hypo symptom

So what might have caused my T4 to reduce, when it had got to 59%?

Sorry to fire further questions at you all the time....! x

[greygoose in reply to ShinyB]

Oh who knows. So many things could have happened. SeasideSusie explains it well above : they can only really be compared if conditions the same every time, eg same time of day for blood draw, length of time since last dose of Levo.

Could be something you ate that day, or maybe you converted a bit more than usual that day. Remember, a blood test is like a photograph, it just reflects what was happening at the moment the blood was drawn, not what happened the day before - or even the minute before - nor what is going to happen in the future. One blood test is not something to obsess over, it's the general trend that counts.

[ShinyB in reply to greygoose]

Be good if they came up with a thyroid test that is like the HbA1c test that looks at average blood glucose levels over 3 months.

So conversely if my T4 or T3 were over on a test, it wouldn't necessarily mean I'm overmedicated?

[greygoose in reply to ShinyB]

Well, that's a difficult one to answer. All I can say is : it would depend. But, I wouldn't panic if my FT3 was slightly over on one test, I would need to see what happened on the next test - especially if I didn't feel over-medicated.

[ShinyB in reply to greygoose]

Thanks greygoose

[greygoose in reply to ShinyB]

You're welcome.