Very odd results...

[KT304]

Hi All,

Posted last week about my consultant wanting to reduce my thyroid medication as my TSH is suppressed, and had lots of fantastic responses which I have for my GP appointment this coming Friday.

I logged in today to pick up the last blood test results, and these are the results on current dose 100mcg T4 and 25mcg T3 with 24 hours since last dose:

Serum free triiodothyronine level 3.21 pmol/L [3.1 - 6.8]

No clinical or medication details. Unusual TFTs. Any thyroid-related

medications?

Serum free T4 level 5.8 pmol/L [11.0 - 23.0] Outside reference range

Serum TSH level < 0.01 mU/L [0.27 - 4.5]

Outside reference range

Symptoms are awful. I feel like I did back in early 2015 which was just before I started to self medicate. I have had this flu bug thing twice since Christmas and I haven't felt 100% since October 2017 when I picked up a flu-type viral infection.

Should I be demanding an increase? Or just go with the flow, ignore the pro's and self medicate again. Waiting on extra T3, I could order some T4 perhaps and try dose increase to 150mcg & 25mcg or just 50mcg of T3?

Also to add - the T3 has been changed to another brand....morningside, not the sigma pharm from my previous GP in London. I still have some of this left in 5mcg size tabs.

I have an operation next week, full GA, day case but will be out of action for weeks, will having TFT's like this affect my recovery?

Previous results:

Bloods Oct 17:

(6 weeks after dose reduction to 100mcg T4 and 25mcg T3)

TSH 0.01 (0.27 - 4.5)

FT4 11.7 (11-23)

FT3 4.8 (3.1-6.8)

Bloods Aug 17:

(Dose then was 125mcg T4 and 25 mcg T3)

TSH 0.01

(0.27 - 4.5)

FT4 14.3 (11 - 23)

FT3 4.5 ( 3.1 - 6.8)

Any advice gratefully received....thank you in advance. KTx

[Nanaedake]

Sounds like the change in T3 formulation could be the cause.

[SeasideSusie Remembering]

Just taking your current results

Serum free triiodothyronine level 3.21 pmol/L [3.1 - 6.8]

Serum free T4 level 5.8 pmol/L [11.0 - 23.0]

Serum TSH level < 0.01 mU/L [0.27 - 4.5]

Because you left 24 hours since your last dose of T3 you have a false low result. It should be 24 hours for Levo and 12 hours for T3. You should retest before increasing T3.

I take a combo of Levo and T3 and I certainly couldn't function with FT4 that low. I need mine over half way through range (but we are all different).

Is there any of your previous results where you actually felt well? Look at the free T levels at that time and maybe that is what you should aim for.

Your change of brand may have made a difference.

Having all those viruses the last few months may also have made a difference. My problems started 20 years ago after having 3 serious viruses in quick succession. I didn't realise at the time and it's taken me all this time to realise how important vitamins and minerals are plus adrenals. I reckon mine got completely knocked at at the time and I didn't know, nor did the doctors.

Maybe you need to check vitamins and minerals, maybe even adrenals.

Be aware that a general anaesthetic will affect B12, certainly check that after your operation.

[KT304 in reply to SeasideSusie]

Paris 2016 - April - felt pretty good. All vits were in a good place too. Best results on 125/25 t4/t3 combo.

Rather annoyed because I've always left 24 hours between last dose and blood draw, has it changed recently? All my other results and all bloods done via Blue Horizon have always been 24 hours after last dose. I actually feel sick. What a complete waste of all these years' worth of private blood tests...

[Clutter in reply to KT304]

KT304,

It's not a waste of the private blood tests. 24 hours after last dose there will be very little T3 in the blood. Add 20% to the FT3 results to get an estimation of normal circulating T3. Even adding 20% to FT3 3.2 only gives 3.84 which is considerably lower than your previous results.

[SeasideSusie Remembering in reply to KT304]

I've always left 24 hours between last dose and blood draw, has it changed recently?

I have been a member of this forum for almost 5 years and I've always read 24 hours for Levo and 12 for T3.

You may have a false low FT3 with those results but do as Clutter says to get an estimation of what it would normally be.

You certainly need a dose increase, but whether that should be Levo first and then T3 is down to how you feel best with FT4 level. Like I said, I couldn't function with that level.

When you felt best in April 2016 that was the same dose of Levo/T3 as you are on now so other things might be at play here. I haven't read your other posts but antibodies, vitamins and minerals, adrenals all worth considering.

[KT304 in reply to SeasideSusie]

Thanks Susie, the most prevalent difference is diverticulitis. My vit-minerals are falling, mainly due to lack of absorption as my gut is quite poorly, it bleeds constantly.

I’ve checked the web, searched for last dose before blood draw and results vary in responses. Glad to know what I should do in the future.

[SeasideSusie Remembering in reply to KT304]

Have you seen any of SlowDragon 's posts about gut/absorption issues and how to address them?

Check out this one, near the end of the thread, lots of links and information that may help

healthunlocked.com/thyroidu...

[Clutter]

KT304,

FT4 dropped alarmingly and FT3 has dropped considerably too. Could your results have been mixed up with someone elses?

Despite the incredibly low FT4 and FT3 TSH hasn't risen. Endo should certainly not reduce dose.

[KT304 in reply to Clutter]

The results would explain my feeling unwell Clutter (coupled with my gut issues) but they are shocking.

I’ll speak with my GP on Friday and if they still want to reduce I’m refusing and will increase to 125/25 myself with a BH test around Easter time. Is it increase/6 week’s/test/analyse/increase (if required) /6 weeks/test...

[Clutter in reply to KT304]

KT304,

Yes, retest 6-8 weeks after any dose adjustment.

I'd want endo to investigate why FT4 and FT3 have plummeted but TSH not budged.