Bit Puzzled By Latest Blood Test Results

[Hyburn]

Just received my latest MediChecks results - previous ones in brackets at the end of each line. Most were Sept 17. rT3 was July 17 as was B12 of 194.8. My lowest Vit D was in April 2016.

I am now on 100 mcg Thyroxine (reduced from 200 after previous results in Sept) and 40 mcg Liothyronine (increased from 20 after previous results). Taking Vit D, K2, using Epsom salts and magnesium spray.

I note my rT3 has come down as have my TP antibodies. My TSH is up a little but still flagged as out of range. Vitamin D has improved. Am having less illness and respiratory problems. Have so far escaped colds and flu this winter which is unusual for me.

My free and total thyroxine have both dropped significantly while my T3 is now near the top of the range.

My B12 is puzzling - was taking Visionace supplements for my eyesight but stopped them after the July result - so why is it going up when I have symptoms of a deficiency? Folate has gone up a little but not supplementing yet till I work out what is happening with my B12. Ferritin is down a bit.

Have endo appt with Dr Toft later this month and not sure where I go from here. Thinking should ask to increase my thyroxine to 150mcg now that rT3 has cleared and maybe reduce T3 to 30mcg.

Am concerned that inflammatory markers have gone up though last appt Dr T didn't set much store by them.

Do not feel I have hyper symptoms and still feel hypo. Head is a bit clearer than before and my immune system is better but still tired and can't lose weight etc. Basal body temp still low at 36.1 or 36.2 degrees C.

TSH*0.012 miu/L 0.27 - 4.20 (*0.007)

Free Thyroxine *8.48 pmol/L 12.00 - 22.00 (14.6)

Total Thyroxine(T4) *50.0 nmol/L 59.00 - 154.00 (89.8)

Free T3 6.35 pmol/L 3.10 - 6.80 (4.91)

Reverse T3 14 ng/Dl 10.00 - 24.00 (*33)

Reverse T3 Ratio 29.53 15.01 - 75.00

Thyroglobulin Antibody <10 Iu/Ml 0.00 - 115.00 (19.3)

TPA 26.3 Iu/Ml 0.00 - 34.00 (33.4)

Active B12 *165.6 pmol/L 25.10 - 165.00 (159) (*194.8)

Folate (Serum) 5.9 ug/L 2.91 - 50.00 (5.1)

25 OH Vitamin D91.2 nmol/L 50.00 - 200.00 (58) (26)

CRP - High Sensitivity *7.6 mg/L 0.00 - 5.00 (*6.6)

Ferritin 75.3 ug/L 13.00 - 150.00 (86.5)

Selenium (not done) umol/L 1.00-1.90 (1.10)

Magnesium 0.95 mmol/L 0.60 - 1.00 (*1.08)

Advice appreciated.

[SlowDragon Administrator]

You do need more Levo. Both your FT4 and TT4 are too low. But increase slowly. It's fine adjustment. You could try 100/125 alternate days, or possibly 125mcg daily. Retesting after 6-8 weeks.

Are you on gluten free diet?

Your folate is a bit low, do you supplement a good vitamin B complex?

If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 3-5 days before any blood tests, as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

[Hyburn in reply to SlowDragon]

I was previously on 200mcg of thyroxine and Dr Toft halved this at my appointment with him in September and doubled my T3 to 40mcg. I am gluten free and have been for a long time. Am waiting for an endoscopy for coeliac which runs in my family.

[SlowDragon Administrator in reply to Hyburn]

There's little point in endoscopy if you are gluten free, unless you are going to do gluten challenge and eat high level gluten for 6 weeks first.

With Hashimoto's most of us are gluten intolerant not coeliac.

My endo only cut my Levo by 25mcg and introduced 10mcg T3 (in divided dose)

After DIO2 results and blood tests T3 increased to 20mcg but NO further dose reduction in Levo

I have since INCREASED levo back to where it was before T3 started.

More info on my profile especially about coeliac, endoscopy and gluten intolerance

[Hyburn in reply to SlowDragon]

I have IBS and sibling and cousins with coeliac so want to know if I have it too. I know about doing a gluten challenge. They made my sister do one even though she had not been gluten free beforehand. Damage to her villi was very extensive when checked yet prior to diagnosis she did not react to gluten - now she collapses with sickness and diarrohea just from cross contamination. NHS endo agrees I may have absorption issues so referred me for this to check.

[Hyburn in reply to SlowDragon]

I looked at your profile and was struck by the similarities with me. I too am on named brand Eltroxin now Mercury Pharma and wonder if, like you, I would be better on Morningside? I asked for Morningside T3 from Lloyds Pharmacy last week and got it. Could ask endo to specify Morningside T4 too - will try anything that might help.

I just want to rule coeliac in or out but will resume my gluten free diet as it does not agree with me and makes my IBS much worse.

[SlowDragon Administrator in reply to Hyburn]

Yes well coeliac endoscopy cost me £2k and only told me what I knew already, that I needed to be strictly gluten free diet.

The fact they had to do DNA testing after endoscopy to help decide if it was or wasn't coeliac shows it's not always clear cut.

I still only got answer "probably not coeliac, probably severely gluten intolerant "

But I think it helped me secure T3 prescriptions, so it was worth it (assuming I get to keep them!)

[greygoose]

I'm afraid I disagree. With the dose of T3 you are taking, why would yo want more T4? And why reduce your T3 if you aren't feeling hyper on this dose? Your FT3 isn't over-range. I don't see why you want to meddle with your dose.

[Hyburn in reply to greygoose]

So where do I go from here greygoose as I am still feeling hypo in terms of physical symptoms? My head is deffo much clearer.

[greygoose in reply to Hyburn]

That test was done only recently. And symptoms often lag behind results. So, if I were you, I would wait a while and see if things improve with time.

If you have the DIO2 gene abnormality, there's not much point in increasing your T4. It won't do anything for you.

Have your adrenals been investigated?

[Hyburn in reply to greygoose]

Had cortisol tests done by Medichecks last time. Results were not ideal. Neither GP nor endo has offered anything in that regard. I was thinking of trying T3 only see how that goes. I am heterozygous for DIO2. What do you suggest?

[greygoose in reply to Hyburn]

Not ideal in what way? Too high, too low? Doctors know little to nothing about cortisol, they probably didn't understand the results!

I think that T3 only is a good thing to try. It won't do you any harm, and might do you some good. But, come off the T4 slowly - 25 mcg every six weeks, and keep an eye on FT3 results, in case your T3 dose needs increasing.

[Hyburn in reply to greygoose]

Medichecks cortisol results from August 2017

Waking 8.130 nmol/L (6-21.00)

Noon 4.190 nmol/L (1.50-&7.60)

4pm 2.050 nmol/L (0.00-5.49)

Bedtime <1.5 nmol/L (0.00-1.99)

My sleep patterns are erratic - am extreme night owl.

[greygoose in reply to Hyburn]

And, yet, your bedtime cortisol is reasonable.

Think you made a mistake with the range for the noon result.

Your waking result is very low. Adrenals obviously need a bit of support. They need lots of vit C, B vits and salt, and a high protein breakfast as soon as you get up. So, I would suggest taking your hormone at bedtime - if you don't already.

[Hyburn in reply to greygoose]

Fixed the noon result tx. Omitted a 7 before the .60. Ooops

[SlowDragon Administrator in reply to greygoose]

But Greygoose you are on T3 only

I personally definitely need FT4 and FT3 at least over half way, and preferably at higher end of range

I had terrible symptoms when FT4 and TT4 were low

We are only taking small dose T3

DIO2 only marginally affects conversion

I have that too

[greygoose in reply to SlowDragon]

But the OP is taking 40 mcg T3. I don't call that a small dose. And who's to say that she doesn't also need to be on T3 only? She hasn't tried that, yet. Maybe the DIO2 only marginally affects conversion, but she could have other reasons for poor conversion, on top of that. Difficult to say without seeing results when she was on T4 only.

[SlowDragon Administrator in reply to greygoose]

But it would be worth trying slightly higher dose FT4 first

Obviously need to keep an eye on RT3

It was huge reduction from 200mcg to 100mcg

[greygoose in reply to SlowDragon]

It was a huge reduction, but at the same time, he doubled her T3 to 40 mcg. If she's a poor converter, then that was the right thing to do. No point in taking masses of T4 if you can't convert it. That's the way you get rT3. And, if she's not a poor converter, that increase in T4 could easily push her FT3 well over-range. And all that, probably, without making her feel any better.

[Hyburn in reply to SlowDragon]

Endo worked out equivalent dose of T3 to make up for the reduction in T4. Also titrated it to my weight which is now double what it was before I became hypo.

[Hyburn in reply to greygoose]

I think that is a largish dose of T3.

Was on 20 mcg T3 for about 10 years and was put on to it by Dr Toft at Edinburgh Royal Infirmary because I was not doing well on Eltroxin.

I have my results going way back in a folder which I have just found. In 2001 on T4 only (haven't noted dose but from Feb 2002 was on 175mcg so probably the same or 150mcg) my TSH was <0.05 (0.15-4) FT4 10.5 (9-24) FT3 4.40 (3.4-6.4). Lab notes 'suggests at least adequate replacement'!!!!! I sought access to my medical records so will have results prior to this but have no idea where they are at the mo. They will turn up when I tidy.

In February 2002 I added 2x12.5mcg Cytomel which I bought myself and in June 2002 my TSH was the same, FT4 was 7.7 and FT3 was 20.9 probably because I took it on the morning of the test. I survived.

In August 2002 my TSH was the same, FT4 was 11.9 and FT3 9.8.

In Sept 2002 my TSH was 0.08, FT4 11.7 and FT3 3.4.

During this period my highest FT4 was 19.1 and corresponding FT3 on that result sheet was 5.7 in April 2003. Lab reported 'may be overreplaced with thyroxine' even though the range was still 9-24 and for T3 3.4-6.4.

Have noted referred to Dr Toft in November 2005 but was probably a year or more before he put me on NHS T3.

From then till now my TSH has always been suppressed and often flagged up as 'overreplaced' by the lab.

When I get a chance I am going to look at all my results and marry them up with a record I kept of basal body temp, pulse and dosages of various combos of thyroid meds to see if I can discern a pattern and find out what worked for me.

Apologies if this is TMI.

[greygoose in reply to Hyburn]

TSH was <0.05 (0.15-4) FT4 10.5 (9-24) FT3 4.40 (3.4-6.4)

Those results do not indicate a conversion problem. But, you didn't have enough T4 to convert! It looks as if you didn't absorb your hormone very well.

[Hyburn in reply to greygoose]

Perhaps my DIO2 gene abnormality had not kicked in at that time or my recollection of what meds I was on is faulty as it is a long time ago. I did not start keeping a log until Feb 2001.

This was all a bit out there back then and my GP was very ill at ease with what I was doing. I was unsure myself but desperate to feel better so willing to try anything. Was trying to hold on to a demanding career.

The log has info on meds, temp, pulse and how I felt. In February 2001 I was on 10mg of hydrocortone tabs divided dose and 3.5 grains of Armour. I either got this from Dr Skinner or Dr Peatfield.

In April the hydrocortone was increased to 20mg and 10mcg of T3 was added. This was subsequently increased to 20mcg T3, Armour down to 3 grains and hydrocortone increased to 30mg divided dose.

In June GP told me to cut down hydrocortone gradually to come off it which I did. I thought she knew what she was doing and she scared me off it. Now, of course I know she didn't. Increased Armour to 4 grains, then went back down to 3.

I adjusted my meds up and down, ending up on 1 grain of Armour & 40mcg T3 in May 2002 and in June my BBT was 'normalish' for the first time in years. Things went a bit crazy after that as I increased the Armour to 1.5 grains and added 25mcg Cynomel to my 20mcg of T3. I have no idea what I was thinking but that is how I ended up with a FT3 of 20.9 on 26 June 2002 yet my FT4 was just 7.7 (range 9-24) which is strange. I must have taken the T3 on the morning of the test as well. After this result, I dropped the 20mcg T3 (Tertroxin) and was persuaded to drop the Armour too I presume because of more scare stories from GP and endo about it being unstable and dosage issues etc but don't remember.

What this is telling me now is that I have always had difficulty finding the correct combination and dose of meds to manage my condition.

On 1 August 2002, I switched to 100mcg Eltroxin and increased Cynomel to 37.5mcg divided dose. After five days I increased the Cynomel to 50mcg divided dose and in Sept had a TSH of 0.08, FT4 11.9 & FT3 3.4 (same ranges as before) so not great results. That said I quite often forgot to take the second dose of T3.

Seems to me looking back that I did better when I was on Armour, hydrocortone and some supplementary T3.

Not sure about Armour now as it is a different formulation to when I was on it and I have heard it is very expensive but my conclusion is that it is all pointing me towards NDT and adrenal support.

[greygoose in reply to Hyburn]

Seems to me there's been far too much chopping and changing, and increasing too much and too fast, and never giving yourself time to settle on anything.

Perhaps NDT is the way to go. But, if you do that, don't increase too fast. It well, of course, mean you have a massive reduction in T3, unless you start on 4 grains, which will give you 152 mcg T4 and 36 mcg T3. Which is not at all the same ratio as you are taking at the moment.

As for adrenal support, what did you have in mind? I don't think that, with your results, HC is suitable. But, if you did go back on that, just a small dose in the morning, first thing, with your high protein breakfast, and nothing for the rest of the day.

But, you would need to stay on these doses for a good few months, to give your body time to adapt and heal. No jumping around with your dose. That's the way I see it, anyway.

[Hyburn in reply to SlowDragon]

Not sure if I need T4 but it was giving me high rT3 which has now gone down to within normal range. I was on 200 mcg Eltroxin and my FT4 was 14.6pmol/L (range 12-22).

[greygoose in reply to Hyburn]

If you weren't converting it, then it would cause high rT3. But, that's not something to really worry about. Just a waste of good T4! lol

[SlowDragon Administrator in reply to Hyburn]

Well if you had high RT3 on that low FT4, you better not increase T4

See what Prof Toft says

[Hyburn in reply to SlowDragon]

He said last time that rT3 is inert and was a bit concerned about the suppressed TSH. I can tell him it has been suppressed since 2001 without ill effect.

[Hyburn in reply to SlowDragon]

My high rT3 was when I was still on 200mcg of Eltroxin & 20mcg of T3 and NHS endo wanted to up this to 225mcg and I said no - I felt what was the point if I have the DIO2 gene abnormality and conversion issue which the high rT3 would indicate.

[Angel_of_the_North]

It's usual to have low free T4 when taking a decent amount of T3, although it's often just in range when taking T4 as well, so you could try increaing levo (but that might send your rT3 up again). Folate could do with being higher and vit D is better a bit higher. The CRP result indicates inflammation, so might be worth looking up things that reduce inflammation like golden paste (mmm, curry!!)

[Hyburn in reply to Angel_of_the_North]

Thanks angelofthenorth . Have been taking turmeric capsules on and off so need to be more diligent with them. Reducing T4 has brought rT3 within range and thyroid antibodies are down and TSH is up a little. Just wondering now what I can do to improve as seeing Dr Toft again on 24 January. I doubt he will increase my T3 with those results. Thought perhaps a little more T4 might be worth trying but I don't want high rT3 again and I have heterozygous DIO2 gene abnormality so don't convert well.

[Angel_of_the_North in reply to Hyburn]

If they are curcumin capsules they don't contain all the nutrients in actual turmeric - you are better off making golden paste (or buying from golden paste company) - cheaper too.

[Hyburn in reply to Angel_of_the_North]

They are turmeric capsules and I use it in cooking too.

[Angel_of_the_North in reply to Hyburn]

Cheaper to use turmeric powder from a shop - remember it needs fat for absorption and black pepper (or chilli).

[Hyburn in reply to Angel_of_the_North]

I use turmeric powder in cooking and baking and put fresh black pepper on everything bec I love it. Been trying to get Vit D up since deficiency was identified in 2016 by DEXA scan nurse practitioner. Didn't realise stuff Dr gave me (Fultium D) was rubbish and far too little. Am now on proper stuff and co-factors. Seems you can't trust them to get anything right!!!