Blood test what to request

[rubyred]

Hi all,

I’m due to have my annual blood tests to take along to my endocrine.

My thyroid was destroyed with RAI for Graves’ disease.

What should I be requesting

I have on my list so far

Thyroid function

Ferritin

What is the thyroid antibodies one.

Thank you for your help

[SlowDragon Administrator]

For full evaluation you ideally need TSH, FT4, FT3, TT4, TPO and TG antibodies, plus vitamin D, folate, ferritin and B12 tested

See if you can get full thyroid and vitamin testing from GP. Unlikely to get FT3

Private tests are available

thyroiduk.org.uk/tuk/testin...

Vitamindtest.org.uk - £28 postal kit

Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have money off offers.

All thyroid tests should be done as early as possible in morning and fasting and don't take Levo in the 24 hours prior to test, delay and take straight after. This gives highest TSH, lowest FT4 and most consistent results

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 email print it and highlight question 6 to show your doctor

please email Dionne:
[e-mail]

Prof Toft - article just published now saying T3 is likely essential for many. Note how he says he is reluctant to knock out patients Thyroid now due to inadequate thyroid medication replacement

rcpe.ac.uk/sites/default/fi...

[rubyred in reply to SlowDragon]

Hi SlowDragon,

Thank you for your reply.

My surgery are quite good they do the FT3. I am on T3

Please can us ask TG and TPO antibodies. I know I should know but what are they.

Sorry feeling very dense today I had a rotten sleep last night. X

[SlowDragon Administrator in reply to rubyred]

Just FT3, FT4, TSH, plus vitamin D, folate, ferritin and B12 then

If you get NHS T3 you might be interested in trying different brand if you feel Mercury Pharma is not working well

Two new ones available

Morningside Healthcare

Teva (lactose free)

[rubyred in reply to SlowDragon]

Hi SlowDragon my last two batches have been morningside.

I hadn’t realised that the mercury Pharos was getting short on dates until another member said.

That had then made sense why some of my tabs had come in plain brown bottle with no label peeled off original bottle.

I had been quite fatigued back in October November and had restless leg which usually occurred when something upset the balance.

X

[greygoose]

'Thyroid function' is a bit of a sticky one. Obviously, you don't have any actual thyroid function because your thyroid has been destroyed. Doctors interpret 'thyroid function' test as TSH only, but that doesn't tell you much at all!

What you really need is 'thyroid status', which is TSH, FT4, FT3. But, very doubtful you'll get the FT3, I'm afraid. Although, in reality, the FT3 is the most important number, because T3 is the active hormone, and, if you are on T4 only, your only source of T3 is from conversion, and we're not all very good at that!

The antibodies for Grave's are TSI or TRAB. Did you have those tested before your diagnosis? Or did you just have a low TSH and they 'guessed' it was Grave's? If you had high Grave's antibodies, then they will still be there - not sure if there is much point in testing for them. It seems to be hard to get doctors to test Grave's antibodies, anyway! But, if your low TSH was due to Hashi's antibodies - TPO and Tg - there will not longer be any. They disappear when the thyroid dies or is removed.

[rubyred in reply to greygoose]

Hi Greygoose, I think the antibodies where done at the time of diagnosis. It was graves not hashi.

I am also on T3 as wasn’t very well on thyroxine. Didn’t do anything for me

X

[greygoose in reply to rubyred]

It was only Grave's if the Grave's antibodies were positive. If you don't even know if they were tested, it's possible they weren't. Still, too late now.

So, how much are you taking of each, levo and T3? Levo will only do anything for you if you take the right amount. And, the problem often is that doctors will not prescribe as much as you need - often for fear of suppressing the TSH! But, of course, the problem could have been that you weren't converting it. How do you feel now on T3?

[rubyred in reply to greygoose]

Hi Greygoose,

The antibodies where tested but the initial diagnosis by GP was just thyroid test. The hospital then did the antibodies tests along with lots of others.

I don’t take thyroxine I was not absorbing and endo felt may be D102.

I am on 40 NHS plus 50 Mexican T3.

Once I stopped the thyroxine. I still felt unwell. It took about 3 months to leave my system.

The day the thyroxine left me I knew instantly I felt nice. Difficult to explain but I felt clean.

I am very well on T3

[greygoose in reply to rubyred]

DIO2 (three letters and one number) has nothing to do with absorption, it's a conversion problem.

OK, so you're on T3 only, and it would have been very helpful if you'd given all those details in your original post. Because that means that you only test that is going to be of any use to you is the FT3.

Your TSH will obviously be low as you're taking so much T3, and doesn't mean anything.

Your FT4 will be zero because you're not taking any and don't have a thyroid to make any.

If you had Grave's antibodies you will still have them because they don't go away. No point in testing.

Even if you had Hashi's antibodies they will have gone now, so no point in testing.

So, all that's left is the FT3 (essential) and nutrients (recommended).