Hello again,
I'm back with a new name and new test results (please see photo).
Out of range:
FT3 ... 2.83 pmol/L (ref range 3.10 - 6.80)
Active B12 ... 295 pmol/L (ref range 25.10 - 165)
Ferritin ... 220 ug/L (ref range 13 - 150)
Low end of range:
Vit D ... 60.4 nmol/L (ref range 50 - 200)
Any input hugely appreciated!
For further details (eg brief medical history, other test results, diet, etc) please see my profile.
X
Welcome back, Venus77.
TSH is low-normal and FT4 is less than halfway through range but FT3 is very low and that will be making you feel dreadful. Have any of your doctors done a pituitary function blood test?
You aren't taking Levothyroxine so high rT3 and low FT3 doesn't indicate conversion issues.
There are two schools of thought re adrenal function and replacement thyroid hormone. One is that adrenal support should be taken for a couple of weeks prior to starting thyroid hormone and the other is that improving thyroid levels will improve adrenal function. As you've been supporting adrenals for over a year you could try supplementing Levothyroxine to raise FT4 and FT3 or Liothyronine only to raise FT3. Most people try Levothyroxine first. You could start with 25mcg and increase to 50mcg after 4 weeks. Hold at 50mcg for 6-8 weeks and order a private TSH, FT4 and FT3 via thyroiduk.org.uk/tuk/testin... before increasing further.
Thyroid antibodies are negative for autoimmune thyroiditis (Hashimoto's).
Active B12 is high. This is fine if you are supplementing or having B12 injections but needs investigation if not as it may indicate underlying disease. If you are supplementing you can stop for a while or considerably reduce dose.
Folate is good.
Ferritin is over range too. If you are supplementing iron you should stop. If not, high ferritin indicates inflammation in the body. A cold or virus at the time of testing can elevate ferritin but it's worth retesting in 4-6 months.
VitD 60.4 is insufficient. VitD is replete >75 and optimal 100-150. I would supplement 5,000iu D3 daily for 6 weeks then reduce to 5,000iu alternate days and retest in late April.
Thank you absolutely loads for your brilliant reply! 
PITUITARY: I've never had a pituitary function test. However, I see that MediCheck's Pituitary Function Profile includes FSH and LH. The NHS checked my FSH and LH in Aug 2016 and they were approx middle of ref range. Should I re-test?
CONVERSION: My previous two thyroid tests (2015 and 2017) included RT3 which was elevated by exactly the same amount as my FT3 was low. The MediChecks report (with latest test results) said, "there may be issues with converting thyroxine to T3 within the target tissues" ?
ADRENAL FATIGUE WITH HYPOTHYROID: Thanks so much for clarifying that there are different approaches to treating this combination of disorders. Very glad!
MEDICATION: Because my previous two thyroid tests had shown good levels of FT4 with high RT3 and below range FT3, I had thought that T3-only med was my only option but now that my FT4 is also quite low I'm wondering if NDT may work for me?
B12: My B12 is always extremely high, even when I do not take any B vit supplements. Currently, I'm taking a B complex but no separate B12 and I did suspend taking the B complex 5 days prior to my thyroid test.
FERRITIN: I've never taken an iron supplement. I didn't have a cold or any noticeable virus at time of testing. I suppose my elevated ferritin must be due to inflammation, which worries me as I don't know what's causing the inflammation?
VIT D: For many years I've been taking vit D3 2000 IU daily. When tested in 2016 my serum level was 99. Strange that the same dose of D3 is no longer sufficient but I will double my dose and hope that improves my level?
Thanks again for all of your help!
Venus77,
I was wondering whether the low-normal TSH and low FT4 and FT3 might indicate secondary hypothyroidism due to pituitary dysfunction or tertiary hypothyroidism due to hypothalmic dysfunction (central hypothyroidism). I don't think FSH and LH is a complete pituitary test. Ideally an endocrinologist would do a TRH test to rule out TSH deficiency. google.co.uk/search?q=trh+s...
Good luck with getting a UK endo to understand rT3. It isn't tested on NHS so I doubt they're even taught about it in med school.
High rT3 in 2015 and 2017 doesn't mean it is still high. I would retest rather than base medication on historic rT3 results.
B Complex has B12 in it. To get a baseline B12 result you would have to stop supplementing for 4 months as that's how long it takes for red blood cells to die off and renew.
If ferritin hasn't dropped in 4-6 months ask your GP to do a full blood count.
Most of us need a higher winter dose of D3 to maintain levels.
I've heard about the TRH stimulation test (through Dr. Raphael Kellman). I can't find anywhere in the UK that does it though?
I didn't do the rT3 test last week (along with the other tests) because it wld have delayed receiving my test results by 2 weeks and, being incredibly ill and desperate to start thyroid med, I didn't want to delay things any longer. Maybe this was a major mistake, as now I don't know which thyroid med wld wk best for me. However, I did have elevated rT3 as recently as 5 months ago (and, also, 2 and a half yrs ago) and my FT3 has not altered much during these yrs so perhaps logical to trial T3-only med?
As my B complex contains B12, should I stop taking it?
My vit D was last tested in Feb 2016 and I get almost no sun exposure, even in summers, so I do find it odd that my serum vit D has dropped so much (despite taking the same dose) but I have now doubled my dose.
Thank you massively for all of your help!
Venus77,
TRH is usually ordered by an endocrinologist and done in an outpatient hospital setting. If you intend to pursue it do so before you self-medicate. Once you are self-medicating you may be asked to come of meds if investigation is needed.
If you intend self medicating taking T4 or NDT will raise rT3 so it may be better to trial Liothyronine.
No need to stop taking the B Complex. Excess B12 will be excreted in urine.
The NHS won't acknowledge that I have any thyroid-related problem. I gave up going to GPs ages ago because they were all clueless. I don't think it would be possible for me to persuade a GP to refer me to an endo to do the TRH test. Maybe I will have to pay for a private endo? If a test did reveal a pituitary or hypothalamic problem, could anything actually be done about it? I'm mostly housebound by crushing fatigue so, at present, I don't feel up to tackling any of that.
Yes, it sounds like I should try Lio.
Thanks again for your messages! I deeply appreciate your wise advice and support
Venus77,
If the TRH showed you had central hypothyroidism you would be prescribed Levothyroxine thyroid replacement because that's what NHS prescribes for primary and central hypothyroidism. Endocrinologist would probably also investigate to see whether there were sex and growth hormone deficiencies.
Okay, thanks for the info! I already know I have sex hormone deficiencies (extremely low testosterone and estrogen and bottom of range progesterone). I don't know about growth hormone though.
Venus77,
It does appear that you may have some pituitary or hypothyalmic dysfunction but it is a nightmare to get NHS to investigate appropriately because they obsess about TSH and if it is in normal range dismiss primary hypothyroidism and don't give sufficient consideration to central hypothyroidism.
Yes, I'm sure I do have severe HPA axis dysfunction which is causing "stage 3 adrenal fatigue" (with consequently horribly low hormone levels) and that this, in turn, is causing thyroid dysfunction (HPA-T axis dysfunction). I realise that, sadly, such problems are beyond the scope of the NHS. The only treatments they have offered me (in 18 years of severe ill-health) are antidepressants, sleeping pills and pain-killers.
You need to get your vitamin D much higher at least to around 100nmol
Do you supplement at all at moment?
If so increase the dose, plus magnesium and vitamin K2 Mk7 are important too
Importance of magnesium
hypothyroidmom.com/two-vita...
magnesiumeducation.com/how-...
naturopathconnect.com/artic...
articles.mercola.com/vitami...
Have you tried Levothyroxine first? It's easier to manage. Suggest you try that first.
Your FT3 is obviously terrible
If Levothyroxine doesn't work then you are going to need to start T3. You can introduce incredibly slowly. Eg 1/8th tablet per day, then 2 x 1/8th tablet etc
Vitamin C and plenty of salt for adrenals
Have you done saliva adrenal test?
So you are gluten free. Are you dairy free too?
EBV - you have probably seen these already, but here's a few links
thyroidpharmacist.com/artic...
drhedberg.com/epstein-barr-...
hypothyroidmom.com/hashimot...
drchristianson.com/epstein-...
Thanks massively for your great reply!
VIT D: For many years I've been taking vit D3 2000 IU daily. When tested in 2016 my serum level was 99. Strange that the same dose of D3 is no longer sufficient but I will double my dose and hope that improves my level?
MAGNESIUM & VIT K2 MK7: I take loads of both daily.
MEDICATION: Because my previous two thyroid tests had shown good levels of FT4 with high RT3 and below range FT3, I had thought that T3-only med was my only option but, now that my FT4 is also quite low, I'm wondering if NDT may work for me? I really don't want to take Levo.
VITAMIN C & SALT: I take loads of vit C with every meal and also add sea salt to each meal.
ADRENAL TEST: I've done the D.U.T.C.H. test twice which showed my cortisol and DHEA are extremely low, indicating "stage 3 adrenal fatigue" (severe HPA axis dysregulation). I have not done saliva adrenal test.
DAIRY: Yes, I've been dairy-free for years. I'm on the autoimmune paleo diet which strictly prohibits all dairy.
EBV: Thanks loads for those links! I will read them ASAP.
Thanks again for being so helpful!
Thank you so much for the suggestions!
Blood test results 
Test results - please advise
New blood test results
Medichecks results, please advise
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