Old results to interpret please

[Dee8686]

Just got off the phone to my gp and requested results from when I initially became unwell in autumn 2015

Results were

tsh 2.7

T3 5.2 ( 3.1-6.8)

T4 16 (9-19)

9am cortisol 203

My tsh is now 4.1 (Jan 2018)

T4 17

Cortisol 246

(No t3)

Does this simply show that I have been left undermedifated and so health has declined as a result? Apologies for all the posts but trying to piece together all the info I have.

Awaiting in depth tests Monday to post Tuesday.

Thank you. Dee x

[SlowDragon Administrator]

Presumably you were on 25mcg Levothyroxine when these results were done?

TSH was too high, likely had low vitamin levels. Don't suppose any were tested ?

[Dee8686 in reply to SlowDragon]

Yes was on 25mg. This was about A year after having my daughter too. (Was on 76 levo then).

No vitamin results...

Do t4 and t3 look good?

[SlowDragon Administrator in reply to Dee8686]

They don't look terrible

But if vitamins are low, FT3 and FT4 can appear fine, because we can't use them well

See Box 1. Towards end of article

Some possible causes of persistent symptoms in euthyroid patients on L-T4

You will see low vitamin D, folate, ferritin and B12 listed

onlinelibrary.wiley.com/doi...

[Dee8686 in reply to SlowDragon]

Thank you. So much to get my head round!

[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 have high enough FT3

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

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

(Many of us need TSH nearer 0.2 than 2.0 to feel well)

See box

Thyroxine replacement in primary hypothyroidism

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

Nice guidelines saying how to initiate and increase. Note that most patients eventually need somewhere between 100mcg and 200mcg Levothyroxine

cks.nice.org.uk/hypothyroid...