So confused

[suziste]

Can’t seem to get my head round T4 T3 what’s free what’s not....all of it just completely baffles my brain. Had my thyroid removed September2016 after I was found to have multi modular thyroid with thy3a. Now on 150mg thyroxine a day recently increased from 125mg bloods are due again but feel pretty rubbish and have done since my op. I did need Calcium for a short time but that’s ok now and did have a booster course of vit D a while ago. I’ve pretty much have no sex drive, look dreadful, gained weight, have a puffy face and dark circles under my eyes also I can’t sleep but feel drained all the time. I’m nearly 40 but wow it’s not funny how I’ve aged since my op !! Any help and advice is much appreciated x

Just phoned Drs for my blood results that were taken before my last increase

TSH 10.39 (increased Levo to 150mg)

FT4 12

B12 385 (satisfactory no further action)

Vit D 50 (satisfactory but was given a booster course of Vit D for 7 weeks)

[Kell-E]

I had exactly the same thing and my thyroid was removed in 2011. I did not ever feel well on levo only, but some people do. To best give advice people will want to see your thyroid labs with the ranges (stuff in parentheses). You will learn a lot here and you will eventually feel better than you do now!

[suziste in reply to Kell-E]

Thankyou

[SlowDragon Administrator]

You will need bloods retested in 6-8 weeks after your dose increase

For full Thyroid evaluation TSH, FT4, TT4, FT3 plus TPO and TG thyroid antibodies. Plus vitamin D, folate, ferritin and B12.

Essential to test FT3 and vitamins

Private tests are available

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

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 ideally be done as early as possible in morning and fasting and don't take Levo in the 24 hours prior to test. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, GP will be unaware)

If you have your test results and ranges from on 125mcg you could add them to this post

This would give indication of how under treated you were

[suziste in reply to SlowDragon]

Wow thanks I’ll have a look

[SlowDragon Administrator]

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 at

[e-mail]

Professor Toft recent article saying, T3 may be necessary for many, otherwise we need high FT4 and suppressed TSH in order to get high enough FT3. Note especially his comments on current inadequate treatment following RAI or thyroidectomy

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

Official NHS guidelines saying TSH should be between 0.2 and 2.0 when on Levothyroxine

With no functioning thyroid nearer 0.2 likely needed

See box

Thyroxine replacement in primary hypothyroidism

pathology.leedsth.nhs.uk/pa...