Thyroid UK

Can someone help with Thyroid results

Hi All

I was disagnosed 2 years ago as having under active thyroid. I take 100mg Levothyroxine a day but i feel absolutely rubbish. I am exhausted, could sleep and sleep and just generally feel rotton which is making me tearful. I recently had a blood test and have the below results from January. I noticed that it states on blood test form that i do not have Thyroid disease but today i went again for another blood test and the technician noticed that again the doctor had put that I do not have thyroid disease but she says as she read my notes she was going to change it and it gives the wrong reading if the blood guys do not know that i am on levotyhrocxine. Below is the January results:

Serum TSH level 3.30mu/L (Range 0.27 to 4.2)

Serum T4 Level 20.3Pmol/L (Range 11.00 - 22.00)

This suggests that my levels are in range but why do i feel so horrible. It is really getting me down.

Thanks in advance

18 Replies
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The aim of a treated hypo patient generally is for TSH to be 1 or below or wherever it needs to be for FT4 and FT3 to be in the upper part of their respective reference ranges when on Levo. You are undermedicated and that is why you feel so unwell.

Your FT4 is quite high im ramge considering your high TSH. You need FT3 testing, I imagine that is quite low and hat will be causing your symptoms.T3 is the active hormone which every cell in our bodies need so we need a decent level.

According to the BMA's booklet, "Understanding Thyroid Disorders", many people do not feel well unless their levels are at the bottom of the TSH range or below and at the top of the FT4 range or a little above.

The booklet is written by Dr Anthony Toft, past president of the British Thyroid Association and leading endocrinologist. It's published by the British Medical Association for patients. Available on Amazon and from pharmacies for £4.95 and might be worth buying to highlight the appropriate part and show your doctor. However, I don't know if this is in the current edition as it has been reprinted a few times.

Also -

Dr Toft 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 article by emailing dionne.fulcher@thyroiduk.org print it and highlight question 6 to show your doctor and request a dose increase. If he is reluctamt then ask for FT3 to be tested.

If GP cant or wont test FT3then I would do a thyroid panel with a home fingerprick test with Medichecks or Blue Horizon. If TSH, FT4 and FT3 are all done at the same time then you will see if you are converting T4 to T3 well enough, my guess is that you aren't and will be shown by a low FT3.

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Many thanks for the reply. Do I need more Levothyroxine or T3 Medication? I have never been tested for FT3 but have just ordered an online one prior to seeing your response so hope to have the results in a few days. I am so desperate i am tempted to self medicate if i need T3 as i know my doctor will not prescribe it.

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Do I need more Levothyroxine or T3 Medication?

You need to see your results for FT4 and FT3 tested at the same time before that question can be answered I'm afraid. You need to know that you need T3 before taking it. If your FT3 is actually high in range (which I doubt, but you don't know) then taking T3 will raise your FT3 over range which isn't good, FT3 should stay in range.

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I have just looked at my previous blood results since i was diagnoased and wondered if this might help..

April 16 TSH 7.67, T4 13.9 gave 25mg Levo

Aug 16 TSH 5.04, T4 16.4 Gave 75mg Levo

Oct 16 TSH 6.12, T4 13.8 Gave 100mg Levo

Jan 17 TSH 0.46, T4 20.8 Still on 100mg Levo

Jan 18 TSH 3.3. T4 20.3 Still on 100mg Levo

I should say that even in Jan 17 when my levels were as they should be, I still felt rubbish 😢

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Results can only be accurately compared if conditions are the same each time, and always recommended is blood draw at the earliest appointment of the day and fast overnight. This is because TSH is highest early morning and lowers throughout the day, and it so lowers after eating. If thyroid meds are taken then you leave off Levo for 24 hours and NDT/T3 for 12 hours.

Have you had thyroid antibodies tested?

The fact that your TSH rose after an increase in dose - Aug/Oct 2016 - 75mcg, and then when on 100mcg Jan 17/Jan 18 you have a big difference in TSH - 0.46/3.3 makes me think that either the tests weren't done under the same conditions or you may have raised antibodies which would confirm autoimmune thyroid disease aka Hashimoto's.

There are two types of antibodies - TPO and TG. Usually it's only TPO that are tested, but you can be negative for TPO but positive for TG and that's rarely tested.

I would actually put money on low FT3 and poor conversion but you need that confirmed with testing. You can actually get the full thyroid panel, including both types of antibodies, from Medichecks or Blue Horizon if necessary.

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No i have not had the antibodies tested before. All the blood tests were taken at the same time in the morning but not one of them was fasting though as was never told it needed to be and neither was this mornings!

Also I stopped taking Levo 24 hours before each test.

Thanks for taking the time to respond.

Kind regards

kerry

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OK, so conditions were the same - don't worry about the fasting, we now know that the blood draw was the same time and after food so they can be compared.

I think you should should have antibodies tested because if you do have Hashi's then there are things you can do to help.

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Ok lovely, thanks for all your help. I will raise a new post when I get some results x

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By the way, is that a Cockerpoo in your profile pic?!

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No, she's a Bichon Frise :)

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Ok many thanks i will ask to get the full test although i have had bloods at the doctors today for TSH and FT4?

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Low levels of B12 - Folate - Ferritin - Vitamin D - can also make you feel poorly and prevent thyroid hormones working well. Have they been tested ?

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These were also being tested from blood taken at the doctors this morning as I had read on here that it was a good idea to have them checked too. I also requested being tested for Rheumatoid arthritis today as all my joints, elbows, knees, toes all hurt. I can view the results on line from the doctor probably Friday.

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Hope the lab will do them all. Could be low VitD. Start a new post when you have resuts 😆

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Ha I will. Thank you both for responding x

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In range is a load of bull

Your TSH should be 1.0 or below but because your t4 is high in its range it is highly likely your T3 is low because your body cannot convert the T4 in levothyrocine into the T3 that every cell needs to function

It may be because

Ferritin

Folate

B12

Vit d3

Are low or you might have the DIO2 gene and need treatment with T3 not levothyroxine

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Hi thanks for responding. I’m am waiting for some blood results and have paid to have some through online so hope to have all the results next week 😀

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

Essential to test thyroid antibodies, FT3 and FT4 plus vitamins

Private tests are available. NHS often refuses to test FT3 or antibodies

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, delay and take straight after. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, GP will be unaware)

If antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).

About 90% of all hypothyroidism in Uk is due to Hashimoto's

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