Thyroid UK
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The blood test have arrived, no mention of T3 or T4

I have been treated for Hypothyroid for 18 years and was prescribed 75 mcg levothyroxine. I have had blood tests, but had never seen the tests and only a few tests over the years. The dose has not changed and the doctor says that the tests are normal and the dose is correct. I collected the results today and the list of values tested is long. But I see nothing with T3 or T4 written down. The tests appear to not to be for a person with hypothyroid but I could be wrong. On the morning of the test and the day before I took the levothyroxine as usual as I have never to refrain from taking it prior to the blood test.

As advised on the forum asked for my results and was given tests going back to September 2016.

The tests include:

Blood Pressure 143/79

Urine Creatine 11.9

Urine Albumin 2

Then lots of Cholesterol Readings.

One blood test is listed and that has:

Serum TSH level of 2.07

Serum Folate 8.4

Serum Ferritin 233

Serum Vit B12 361

Bilarubin level 6

Full Blood count listed But I see no T3 or T4 mentioned am I missing something?

What should I look for please.

6 Replies
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PizzlieBear

It should say

FT4 or maybe Free Thyroxine

FT3 but it's very very unlikely this will have been done in primary care unless there is something wrong with TSH, usually only done when suppressed.

Your TSH of 2.07 is too high for a treated hypo patient, it should ideally be 1 or below if that is where you feel well.

If you want your tests interpreted then you need to put the reference ranges as well, eg

TSH: 2.07 (0.2-4.2)

Folate could be low, B12 is lower than recommended and Ferritin looks high.

Reply

TSH - 2.07 0.27 - 4.20

Folate - 8.4 - 2.50 - 19.50

Ferritin - 233 - 30.00 - 470.00

B12 - 361 - 180.00 - 900.00

Cholesterol - 5.1 HDL Cholesterol 1.5 (Ratio 3.5) LDL 2.5 Se non HDL level 3.6

Tryglicerides 2.3 - 0.50 - 1.70

Alkaline Phosphates 58

Calcium adjusted 2.4

Calcium 2.29

Sodium 140 133 - 146

Potassium 4.8 - 3.5 - 5.3

Plasma viscosity 1.71 - 1.5 - 1.72

No FT3 or FT4 or Free Thyroxine?

Need to sleep 2 hours or more in the afternoon as cannot stay awake, no energy.

I took extra 25 micro grams yesterday and today and felt better.

Reply

The NHS believes TSH is good enough ,but it is not.Which is why many of us use private testing. See Thyroid UK web site.

Reply

Thank you I will order blood tests via the site.

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You also need vitamin D tested. Can order via vitamindtest.org.uk £29

Essential to test TPO and TG thyroid antibodies plus TSH, FT3 AND FT4.

If antibodies are high then you have Hashimoto's

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

tukadmin@thyroiduk.org

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...

Reply

PizzleBear

TSH - 2.07 0.27 - 4.20

Ok so we know that is too high and you need an increase in your Levo. Ask your GP and in support of this use the following from thyroiduk.org/tuk/about_the... > Treatment Options

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 at tukadmin@thyroiduk.org print it and highlight question 6 to show your doctor.

**

Folate - 8.4 - 2.50 - 19.50

Not too bad but should be at least half way through it's range (11+ with that range). Leafy greens contain folate, and a good B Complex will help raise it - a good supplement to support thyroid and adrenals.

**

B12 - 361 - 180.00 - 900.00

May not be causing you any problems but check for signs of B12 deficiency anyway b12deficiency.info/signs-an...

I have read (but not researched so don't have links) that BCSH, UKNEQAS and NICE guidelines recommend:

"In the presence of discordance between test results and strong clinical features of deficiency, treatment should not be delayed to avoid neurological impairment."

And an extract from the book, "Could it be B12?" by Sally M. Pacholok:

"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".

"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."

If no signs of deficiency then you could supplement with sublingual methylcobalamin lozenges 1000mcg daily to raise your level.

**

Ferritin - 233 - 30.00 - 470.00

Are you supplementing? This is quite high. Half way through range is recommended, although I have seen it said that for females 100-130 is best.

**

I can't understand your cholesterol results but if it is raised then that is a symptom of hypothyroidism and should correct itself when optimally medicated.

**

I doubt whether the extra 25mcg you took yesterday has had any effect. It takes 6 weeks for a dose increase to be effective, it's not instant.

**

Personally, in your position, I would be getting a full thyroid panel with Medichecks or Blue Horizon to see where your FT4 and FT3 levels lie. You also should have Vit D tested.

Full Thyroid panel:

medichecks.com/thyroid-func...

bluehorizonmedicals.co.uk/t...

Full Thyroid panel plus all important vitamins and minerals

medichecks.com/thyroid-func...

bluehorizonmedicals.co.uk/t...

Vit D on it's own

vitamindtest.org.uk/

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