Thyroid UK
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Blood test results help

Hi all, I wrote a couple of weeks ago regarding my hoarse voice etc...I have had an underactive thyroid for years.

I got my results back today if anyone can help:

T4 - 22.6 & TSH - 0.07

Doc says to reduce my Levothyroxin to 125mg a day. I told him I'm not happy with speech & Language as it doesn't help my voice. Has anybody else suffered with this?

Any advice very much welcomed.

Thanks :)

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Aguero

Have you got the reference ranges for your results?

We can see your TSH is low, but we have no idea of your FT4 is within range or over range. Ranges vary from lab to lab so we need your lab's range to interpret your results.

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It states

0.07 mu/l (0.35-5.5) "Low"

Thanks.

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It's FT4 range we need, we know your TSH is low.

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Sorry blonde moment!

22.6 pmol/L (10.0 - 20.0) "High"

Thanks.

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OK, so your FT4 is over range. What you need now is FT3 tested (at the same time as FT4) and that will tell you 2 things -

1) If FT3 is within range then you're not overmedicated according to Dr Toft's article in Pulse magazine which says

"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 and highlight question 6 to show your GP.

2) If you are converting T4 to T3 well enough (T4 is a storage hormone, some of which is converted to T3 which is the active hormone that every cell in our body needs). If your FT3 is low in range then conversion is poor and you would benefit from the addition of T3 to a slightly lower dose of Levo.

You could tell your GP that you have taken advice from NHS Choices recommended source of information about thyroid disorders (which is ThyroidUK). Don't mention the Internet or forums as they don't like that.

If your GP won't or can't get FT3 tested with FT4 (and they must both be done at the same time) then you could do a private test with one of our recommended labs.

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Thank you so much for your help. Very much appreciated x

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You're welcome. Come back and tell us what your FT3 level is and what your doctor says.

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Essential to also test vitamin D, folate, ferritin and B12

Do you have Hashimoto's? Also called autoimmune thyroid disease diagnosed by high thyroid antibodies

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. Thousands on here forced to do this as 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.

If on Levothyroxine, don't take in the 24 hours prior to test, and if on T3 don't take in 12 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. Low vitamins are especially common with Hashimoto's. Food intolerances too, especially gluten. So it's important to get tested.

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Thanks SlowDragon. I have asked for them to check more bloods yesterday and they said they can only test my TSH. I have mentioned Hashimoto but the Doctor wouldn't listen really. I requested lots of bloods etc...from advise off here, he said they weren't needed. Eventually I said I wasn't happy and asked to be seen again by the Endocrinologist and ENT.

I will look through all the info given by yourself and SeasideSusie and go from there.

Very disappointing that our NHS won't offer these tests!

Thanks for your help.

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Sadly it's very common. I was terribly ill 22 years, believing that my tests were "normal ", though my endo was puzzled at continuing extremely high antibodies

Was only coming here, realising the importance of good vitamin levels, how gut is implicated and just how common and widespread gluten intolerance is.

Following advice from here I got full private testing. Was the turning point. More on my profile. Never got an apology from any medic though!

Ignore the GP, get tested and take control

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Thanks for your reply. This forum has been so helpful and you guys are ace for replying. So thank you.

I have ordered a full testing kit online today as recommended ;)

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Hi Aguero,

Have you had a thyroid ultrasound yet? Your hoarse voice is concerning and might be caused by an enlarged thyroid and/or thyroid nodules. It is very common to get a swelling in your neck (not always detectable on the outside, unless palpated) when you have thyroid disease. A thyroid ultrasound is needed to access the condition of your thyroid. You having thyroid disease and having a hoarse voice are two solid reasons to get an ultrasound. If your Gp has not suggested this yet, please push for getting one. You need to analyze the condition of your thyroid and make sure you do not have thyroid cancer. (not super common, but it does happen, and is treatable).

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Aguero, besides a hoarse voice, what other symptoms do you have?

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I had a scan long before my hoarse/Low pitched voice (2.5yrs ago I've put up with it!!). I've asked for another and they said there is no need!

I'm having palpatations, tingling/numb fingers/toes, weight gain, upper body shakes (not all the time but often enough), constantly tired and dry skin.

I took a list with me to explain my symptoms and the doctor wasn't interested and wouldn't let me tell him everything. He just said about my medicine. This is the worst I have felt since being diagnosed around 10 years ago.

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Forgot to mention, my neck does swell.

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