Can someone please advise on my recent Medicheck results. I have showN these to my GP but she cannot even tell me if I have Hasimotos and says all my thyroid readings are in range so everything ok. I am having CRP rechecked in a couple of weeks.
I am currently taking 50mg Levo and was wondering if I would benefit from T3 as I never feel right and I am going to Cyprus soon so could possibly get some there. I have read in one post on here that my FT4: FT3 ratio should be 4:1 and mine doesn't appear to be this ratio.
Before we can work out if we need T3, we need a few other things in place first and a bit more information.
When were you diagnosed Hypothyroid?
How long have you been on Levo?
Have you always been on 50mcg or have you been on different doses, had them changed, if so why the changes?
The FT4:FT3 ratio to see if you need T3 because of poor conversion of T4 to T3 is only really relevant if TSH is 1 or below, so we can't really tell at the moment. Another way of telling if you have poor conversion is if your FT4 is high in range (or over range) with a low in range FT3. That doesn't apply with your results.
TSH 2.86 (0.27 - 4.20)
FREE THYROXINE 15.3 (12.00 - 22.00)
TOTAL THYROXINE (T4) 100.0 (59.00 - 154.00)
FREE T3 4.79 (3.10-6.80)
Your TSH is too high. Your FT4 is less than half way through it's range. Your Total T4 is pretty decent. Your FT3 shows that conversion isn't that bad with this particular set of results.
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 need an increase in Levo and you should ask your GP for 25mcg now, retest in 6 weeks' time and another 25mcg increase, repeat until levels are where they need to be for you to feel well. In support of your request you can use the following information from thyroiduk.org/tuk/about_the...
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.
Your raised antibodies confirm that you have autoimmune thyroid disease aka Hashimoto's as confirmed by your high antibodies? This is where antibodies attack the thyroid and gradually destroy it. The antibody attacks cause fluctuations in symptoms and test results.
Most doctors dismiss antibodies as being of no importance and know little or nothing about Hashi's and how it affects the patient, test results and symptoms. You need to read, learn, understand and help yourself where Hashi's is concerned.
You can help reduce the antibodies by adopting a strict gluten free diet which has helped many members here. Gluten contains gliadin (a protein) which is thought to trigger autoimmune attacks so eliminating gluten can help reduce these attacks. You don't need to be gluten sensitive or have Coeliac disease for a gluten free diet to help.
Supplementing with selenium l-selenomethionine 200mcg daily can also help reduce the antibodies, as can keeping TSH suppressed.
This is too low. Folate is recommended to be at least half way through it's range, so 26.5+ with that range. A good B Complex containing 400mcg methylfolate should raise your level, eg Thorne Basic B.
**
CRP HIGH SENSITIVITY *8.96 (0.00 - 5.00)
This is an inflammation marker and could be high due to an infection or inflammation somewhere.
**
FERRTIN *167 (13.00- 150.00)
Do you take iron supplements? Ferritin can be raised due to infection, and as your CRP is raised as well that could be the cause. It would be worth checking both again at some point and if they stay raised your GP should investigate.
Thank you for your comprehensive reply, Ive got a lot to read here.
I was diagnosed in Jan 2017 and took 50mcg levo retested 03/03/2017 T4 14.5 (10-25) TSH 9.030 (0.4-4) and levo increased to 75mcg. Re tested again 01/06/2017 T4 15.2 (10-25) TSH 3.9 (04-4) then advised that because I was in range to come back in a year. I was tested begining Oct for Rheumatoid Athritis and T4 and TSH were tested. The T4 was 14.3 and TSH 5.690. Because T4 was in range I wasn't told to take any extra Levo.
By end of October I was feeling really ill and having palputations so I decided to stop Levo myself and felt better for a few weeks. I had to start again with levo before Christmas as I was getting muscle and joint pain again. I had my yearly 'MOT' Jan this year and T4 15.7 and TSH 7.030 advised by my GP to continue with 50 mcg Levo and retest in June this year. This is why I had the private bloods done no one is consistant at my doctors surgery with some quoting T4 and others preferring to quote TSH figures.
Sorry this is a bit long winded, but you give a lot of good advise that I am unable to get from my GP. When I next see her I am going to insist my dose is increased.
What we advise here, and a good idea to follow, is when booking thyroid tests, always book the very first appointment of the morning, fast overnight (water allowed) and leave off Levo for 24 hours. This gives the highest possible TSH which is needed when looking for an increase in dose or to avoid a reduction. TSH is highest early morning and lowers throughout the day. It also lowers after eating. It also means that you can compare test results accurately if conditions are the same every time.This is a patient to patient tip which we don't discuss with doctors or phlebotomists.
Dr Toft's article should hopefully be enough to persuade your GP that you need the appropriate dose of Levo to get your levels where they need to be for you to feel well, even if it does mean a very low TSH. Once on thyroid replacement, TSH is not relevant. TSH is a pituitary hormone, the pituitary checks to see if there is enough thyroid hormone, if not it sends a message to the thyroid to produce some. That message is TSH (Thyroid Stimulating Hormone). In this case TSH will be high. If there is enough hormone - and this happens if you take any replacement hormone - then there's no need for the pituitary to send the message to the thyroid so TSH remains low.
The tests that are important are - FT4 to see if you are getting enough thyroid replacement, and FT3 to see if your are converting T4 to T3 well enough, T3 being the active hormone that every cell in our bodies need (T4 is a storage hormone, some of which converts to T3).
Having Hashi's complicates things because even if you follow the advice about having all blood tests done early, etc, the antibody attacks mean that your results (and symptoms) can fluctuate. Sometimes it can be necessary to adjust dose of Levo when the antibodies attack, and readjust when things settle down again.
I would say from the results you have given, even 75mcg isn't enough, you will more likely end up on about 125mcg or even 150mcg, not set in stone of course, we're all different and need the dose which suits us best.
Sorry for the information overload. Keep re-reading and it will sink in eventually
You are undermedicated if on levo (if not it could be that your thyroid is starting to struggle but it not yet bad enough for NHS to treat . It is obvious from your bloods that you have Hashimotos (autoimmune thyroid disease) as both TG and TPO antibodies are over the range. Any GP who can't see that needs a basic maths lesson. Folate is poor.
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