Help with test results please - historical and recent

[Fran6500]

Sorry in advance for the lengthy post and numerous results. Amazing how long it takes to see what is under your nose but that is how I feel now!

Had blood tests done in august 2016 which showed thyroid issues for the first time although I didnt understand the significance of the results! But have been monitoring things since. Medication wasn't started till January 2018 for some reason though now I know more I obviously missed the opportunity to remedy the issue earlier but cannot go back.

Some results shown below before thyroid medication:

(august 2016)

T3 free 3.07 pg/ml (2.70 to 5.30)

T4 free .84 ng/dl (.80 to 2.20)

TSH 5.82 mUI/L (0.47 to 4.68)

B12 591 pg/ml (239 to 931)

D3 32 ng/ml (sufficient 31-100)

Iron 58 ug/dl (50 - 170)

Ferritin 48 ug/dl (10-120)

17 April 2017 - still with no medication :

T4 free 0.76 ng/dl (.80 to 2.20)

TSH 2.14 mUI/L (0.47 to 4.68)

D3 19 ng/ml (insufficient 10-30)

B12 534 pg/ml (289-931)

AC Anti-peroxidase - more than 1300 Ul/ml - should be less than 60

AC Anti-tiroglobulina - 150 Ul/ml - should be less than 60

I had read enough at this time to ask about the anti-bodies and include them in the blood tests.

November 2017 - still with no medication though D3 and B12 injections were prescribed and taken.

T3 free 2.70 pg/ml (2.70 to 5.30)

T4 free .85 ng/dl (.80 to 2.20)

TSH 6.08 mUI/L (0.47 to 4.68)

B12 469 pg/ml (239 to 931)

D3 27 ng/ml (insufficient 10-30)

AC Anti-peroxidase - more than 1300 Ul/ml - should be less than 60

AC Anti-tiroglobulina - 134 Ul/ml - should be less than 60

December 2017 - was prescribed thyroxine 25 mcg. Started gluten free, dairy free eating from January 2018 until mid March when we were travelling and found it difficult to stick to.

27 February 2018 test results : Thyroxine medication increased to 50mcg

T3 free 2.98 pg/ml (2.70 to 5.30)

T4 free 1.05 ng/dl (.80 to 2.20)

Reverse T3 0.18 ng/ml (0.09 to 0.35)

TSH 4.69 mUI/L (0.47 to 4.68)

D3 44 ng/ml (sufficient 31-100)

AC Anti-peroxidase - more than 1300 Ul/ml - should be less than 60

AC Anti-tiroglobulina - 116.5 Ul/ml - should be less than 60

20 April 2018 test results - Thyroxine medication increased to 75mcg

TSH 3.21 mUI/L (0.47 to 4.68)

MOST RECENT RESULTS: 19 May 2018

T3 free 2.92 pg/ml (2.70 to 5.30)

T4 free 1.21 ng/dl (.80 to 2.20)

Reverse T3 0.15 ng/ml (0.09 to 0.35)

TSH 0.64 mUI/L (0.47 to 4.68)

D3 44 ng/ml (sufficient 31-100)

Following this consultation the doctor wishes me to reduce my dose of thyroxine to 75 mcg 3 days a week, and 50 mcg 4 days a week. I live in Portugal and she says she cannot prescribe T3 but if I can source it elsewhere is happy to monitor and advise me on the use of it. Do I need that? Should I reduce my dosage of T4?

I can see my TSH has improved significantly but having difficulty keeping my D3 levels up and nowhere near optimum.

Feeling a lot better but often exhausted and cannot find words to finish a sentence and am hoarse when I feel really tired.

Can I have your thoughts please? I would appreciate it very much.

thanks

[SeasideSusie Remembering]

Fran6500

What is your doctor's reason for wanting you to reduce your dose of Levo? TSH, FT4 and FT3 are all in range, in fact FT4 and FT3 are low in range and should be nearer the upper end, and it's low FT3 that's making you symptomatic. Personally, I would refuse to reduce, it will make you feel even worse.

[Fran6500 in reply to SeasideSusie]

thank you. I suspect she thinks my TSH is low enough so don't need to stay on the 75 mcg. I haven't reduced yet and don't think I will do.

I dont understand the concept of conversion of T3 to T4. Is my reverse T3 showing that I am converting ok? Or do I need T3 to bring T4 and T3 up in range?

Will the Levo bring them up if I continue on the same dose?

Many thanks for your help

[SeasideSusie Remembering in reply to Fran6500]

Fran

Your ranges are different from what we normally see in the UK. Your reverse T3 isn't a problem, it's low in range. An over range FT4 with low FT3 can indicate that you are making rT3 rather than FT3 and your rT3 would be high. So we don't need to worry about your rT3 result.

It's T4 that is the storage/pro hormone and it converts to the active hormone T3 which every cell in our bodies need.

From what I can work out your FT4 is about 30% through range, and your FT3 is about 0.08% through range. So you can see your FT3 is almost non-existent and your FT4 is very low in range, so your conversion is poor. Both should be nearer the upper end of their ranges, in balance, generally around the 75% mark when on Levo. But, of course, we're all different so some people may need their levels higher, some lower.

TSH is not important when on thyroid replacement, it's not a thyroid hormone, the thyroid hormones are T4 and T3. 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.

Why doctors don't understand this is beyond me.

So we look at the thyroid hormones when on Levo, and yours are very low. If anything, you need an increase in dose of Levo and you would benefit from the addition of T3 because your conversion is poor.

[Fran6500 in reply to SeasideSusie]

Thanks for that. I will increase my Levo to 100mcg over the next 10 days and see how I feel.

I already have the prescription for blood tests in 7 weeks but she has only put TSH, D, Magnesium and calcium (I am having an annual infusion for osteoporosis next week) so has ignored the T3 and T4 tests. I can get those from another clinic relatively cheaply without prescription so will do that myself but the reverse T3 is quite expensive so will leave that until I see the doctor again and ask her to include that one the time after.

She has prescribed magnesium and Selenium since January 2018 and because I take D3 supplements daily, I add K2 to the mix. Disappointed my D is not improving but hoping the summer will help with that.

She is also testing my Parathyroids Hormone PTH. Another area to learn about? It can be so confusing.

I will need to message again to ask for help through a personal message with finding T3 without prescription.

thanks again for your help. Much appreciated.