Results help please

[Salphy]

Hi could someone please advise on my results. I still don't feel great at all. But my antibodies have come right down from 303 and my t4 is raised.

I really don't want to reduce my dose but feel like they will make me I'm on 100mcg Levo daily. Gluten free, b12 injections, take vitamin d and folic acid.

Thank you

[SeasideSusie Remembering]

Salphy

Your conversion is poor. Your FT4:FT3 ratio is 25.6 : 5.31 = 4.82 : 1 whereas good conversion takes place when the ratio is between 3:1 and 4:1

You could do with a little less Levo to bring your FT4 down into range, and some T3 added. Dr Toft suggests in his latest article that some patients will benefit from a combination of Levo and T3

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

A few bits stand out (I haven't studied it all in great detail yet) so you might find other parts that would be appropriate to discuss with your GP

The facts of the matter are that the current guidelines for

LT4 replacement therapy in primary hypothyroidism are not

fit for purpose and the continued reluctance to approve

additional treatment with liothyronine denies the patient the

precision medicine which we are encouraged to adopt, and

which many patients crave.

At the end of the article:

As I see it, we have three choices for those patients convinced

that their present LT4 treatment is inadequate.

1. We can carry on with the current advice and be plagued

by patients who do not achieve their anticipated quality

of life as a result, surely a non-starter.

2. We can prescribe doses of LT4 which do result in TSH

suppression, but are associated with unequivocally

normal serum T3 concentrations as I am unaware that

this combination of results has ever been proved a

risk factor for atrial fi brillation or reduced bone mineral

density, and why should it if the level of the active

hormone is normal?

3. We can prescribe a combination of LT4 and liothyronine,

ensuring that serum TSH is normal.

If the last is the preferred choice..........

However, I'm not sure how the TSH can be normal as when taking T3 this tends to lower or suppress TSH.

[Salphy in reply to SeasideSusie]

Thank you. I'm worried he's going to tell me my t3 is OK to reduce t4 x

[Salphy in reply to Salphy]

The thing is I'd only increased 12.5mcg.

My t3 was 3.8. Tsh 2.52 and t4 14.7

[SlowDragon Administrator]

Your folate level is still very low

You might be better taking a good vitamin B complex that has folate in either instead of folic acid or as well as folic acid

Not everyone can utilise folic acid.

chriskresser.com/folate-vs-...

If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 3-5 days before any blood tests, as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

Presumably you had had B12 injection not long before test

Your FT3 looks reasonably high. But You might benefit from reducing Levo slightly and adding small dose of T3 instead, but probably need to improve folate first

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]

Also can request list of recommended thyroid specialists, some are T3 friendly

Professor Toft recent article saying, T3 may be necessary for many otherwise we need high FT4 and low TSH to get high enough FT3

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

[Salphy in reply to SlowDragon]

My b12 injection was 4 weeks ago. To be honest I'm really rubbish at remembering to take the folic acid. I think its because I don't notice a difference when it's higher or low. I'm religious with the others because I know they're working.

Thanks I still can't get through a day without a nap. I'm just really fed up because I feel like this is probably the end of the line with consultants/gp's help.

I do see one of the recommended endo's. He wanted my tsh around 0.4 which we have now got. I feel like he's going to tell me my t3 is OK and need to reduce t4

[Salphy]

SeasideSusie SlowDragon

[Salphy in reply to Salphy]

It's just dawned on me that I took my medication the night before which I never do!

Feel silly but is it a good thing that i've found my t4 too high? Should I share these results with my endo or redo them? X