Odd Blood Test Results ( and more help please :)

[cal1971]

Here we go again. I have just had bloods back . For reference , in September 17 on 75mcg Levo and 20mcg T3they were :

TSH : 1 (0.2-5.5)

FT4 : 6.9 ( 10-24.5)

FT3 : 3.8 ( 3.1-6.8)

I wasn't happy and wanted to up the T3 but the Dr wasn't willing to do much, so I started taking adding some extra T3 as Tiromel in October, and now have 25mcg of Tiromel , 20 mcg LioThy and 75 mcg Levo.. My last results were :

TSH : 0.06 ( 0.2-5.5)

FT4 : <5 ( 10-24.5)

FT3 : 3.4 ( 3.1-6.8)

How can this be? I have never had an FT4 below range before. And the T3 has gone DOWN despite me upping my T3?

The (latest) Dr is hopeless, is ordering all sorts of other blood tests to find out why I I am sleeping constantly (and still tired )and putting on weight at a ridiculous rate. The last few 'full' blood counts came back fine.

She now says to take LESS levo ( 50mcg) probably because she saw the low TSH and panicked. She doesn't know about the extra T3 - after her lecture about over medicating ( I did point out that if I was on too much T3 I would be bouncing off the walls and about 3 stone by now ) I was too scared to tell her- and next time I will go to my other Dr.

Any suggestions? Should I ask them to check antibodies on my next test? Change to Cytomel? Up my Levo? I really am confused by these results and don't seem to be getting anywhere but worse. Sick and tired. Thanks in advance.

[greygoose]

Have your antibodies been tested?

Do you take both levo and T3 on an empty stomach, leaving at least an hour before eating or drinking anything other than water? Looks like an absorption problem.

[cal1971 in reply to greygoose]

Yes , I always take last thing...

[cal1971 in reply to cal1971]

My antibodies were last tested in 2015 and showed 91 ( range of 0-50)

[greygoose in reply to cal1971]

So, you have Hashi's. Do you know how that works?

[cal1971 in reply to greygoose]

Yes, I think you said that last time - I have read up on it but I'm assuming that if I ask for the TPaOB test next time it will be higher again, and then I can go armed to the Drs ....am I on the wrong regime for Hashtis? I will go and read up now, thank you,

[cal1971 in reply to cal1971]

Oh and I am on the Hashis regime and have been for about 3 years now - no refined sugar, low / no gluten , i'm already vegetarian ; supplements are lots of probiotics, selenium supps, B vits .

[greygoose in reply to cal1971]

Being vegetarian isn't necessarily a good thing.

[greygoose in reply to cal1971]

They won't necessarily be higher, because antibodies fluctuate all the time.

[cal1971 in reply to greygoose]

Ah yes, i just realized that after re reading some things! However, I am penning a letter to my GP about Hashi's and will request a TpO test on my next results. Should I also be looking for RT3 or is that a false marker?

[greygoose in reply to cal1971]

I don't think you need another TPO test. If they've been high once, then you have Hashi's. Retesting them won't give you any further information.

Nor do I recommend an rT3 test. It will just tell you if there is a problem, but won't tell you where it is. High FT4 and low FT3, for example. But, that won't be your case because your FT4 is low. RT3 can also be high if you have an illness/bug of some sort, or low nutrients, But it won't tell you which one it is, so best to get your nutrients tested, rather than pay through the nose for an rT3 test.

[jimh111]

Your fT4 is lower because your TSH is now lower and so not stimulating your thyroid to produce T4 (and T3). Your fT3 is lower probably because you may be leaving a long time between taking your L-T3 and having the blood taken, thus producing false results that are of no use.

[cal1971 in reply to jimh111]

How long before blood test do you think I should take to produce a 'true' result do you think?

[Clutter]

Cal1971,

How long did you leave between last T3 dose and blood draw?

FT4 is lower because TSH is lower and not stimulating the gland and because you are taking proportionally far more T3 than Levothyroxine.

[cal1971 in reply to Clutter]

Didnt take a dose the night before so would have been over 24hrs- I never do and have never had these results before?

I had a test a week earlier on which I HAD taken a dose the night before ( forgot about the blood test) and they were wildly out the other way- these were:

Serum TSH level < 0.05 miu/L [0.2 - 5.5]

Serum free T4 level 6.1 pmol/L [10.0 - 24.5]

Serum free triiodothyronine level 14.2 pmol/L [3.1 - 6.8]

Above high reference limit

[Clutter in reply to cal1971]

Cal1971,

24 hours after last T3 dose FT3 can be extrapolated +20% to estimate normal circulating FT3 at 3.74 but I still think that's low considering you are taking a combined dose of 75mcg T4 and 45mcg T3.

I would ignore the TSH and increase T3 dose by 12.5mcg.

[cal1971 in reply to Clutter]

Ok , thank you .I thought so too, but was concerned about the T4- however, as you say, I don't need the T4 if i am getting the T3 I need. Should I keep to the 50 Levo?

I'm not bothered about the TSH . ( it's been that low before) but not sure how to explain all this to the Doc. However, I am SO annoyed with them now that I will be ready to tell them I will be self medicating

[Clutter in reply to cal1971]

Cal1971,

I wouldn't have reduced Levothyroxine from 75mcg. I would keep the 50mcg Levothyroxine. There are T4 receptors in the body so it does something!

Why are you annoyed that your GP is concerned? My endo is not happy that my TSH is suppressed <0.01 and would be happier with it 0.05. She thinks I'm increasing my risks of developing atrial fibrillation and/or osteoporosis by keeping it so suppressed. I don't agree and have said I prefer to feel well today on current dose and accept that it may mean adverse health outcomes in the future.

Surely you are already selfmedicating by adding 25mcg T3?

[cal1971 in reply to Clutter]

Sorry, I think that came out wrong- I'm annoyed ( more frustrated I guess) that after 5 years they are still not listening and as soon as they see suppressed TSH that they fly in to a panic, despite me giving them a number of papers on the subject. She also dismissed my request to up the T3 and said 'it isn't working so it's obviously not your thyroid'. Hence wanting more blood tests ( even though every time I have had a full blood test nothing else has been abnormal- no low iron, vit B etc). My usual doctor ( who at least listens to my reasons) is so difficult to get an appointment with that I ended up going to this one, but I will wait to go back to my original one next time.

[jimh111 in reply to Clutter]

(Would extrapolate by +40%. Assuming once daily dosing and 24 hour half life fT3 would be 70% at 12 hours and 50% at 24 hours. Thus, upscale by 70 / 50 = 40%. It would be a bit more than this as it was over 24 hours.) Even so an fT3 of 3.4 after e.g. 30 hours seems a bit low for someone on 45 mcg. Individual T3 half lives have been measured between 8 hours and 48 hours so it gets very difficult to extrapolate.

Cal1971, I would split your L-T3 doses taking 20 mcg at breakfast and 25 mcg at bedtime (I find the bedtime dose improves sleep quality and subsequent alertness the next day). You could then have the blood taken sometime later in the day, allow four hours plus. This will record your TSH a little lower but it's a small effect when your TSH is already low.

It may be that you clear out T3 quicker than average and this affects your results. This would be another reason to split your L-T3 doses.

[cal1971 in reply to jimh111]

I had been splitting them into am and pm already then went back to just pm. I will go back to splitting them again- thanks.