Latest blood results for advice please

[SunsetLady]

I have been taking levothyroxine 100mcg on 3 mornings / 75mcg on 4 mornings a week. A month ago I noticed my resting pulse was slower - 46/49/52 and I have felt lower in energy and unmotivated.

Had an ECG at Gps- back tomorrow for result. Latest blood test results from medicheck are :

TSH 2.53 (0.27-4.2)

Free Thyroxine 18.1 (12-22)

Free T3 4.64 (3.1-6.8)

Thyroglobulin antibody 17.7 (0-115)

Thyroid Peroxidase antibody less than 9 (0-34)

Active B12 more than 300 (25-165)

Folate 17.16 (2.91-50)

Vitamin D 77.4 (50-200)

CRP high sensitivity 3.71 (0-5)

Ferritin 98.1 (13-150)

I had an ultra sound scan in January which showed 'resolving thyroiditis' but I see these antibodies are in range, does that mean I do or don't have Hashimotos? I have been gluten free anyway since last September. I also take B12 1000, B complex, Vit D3+K2 2,000 iu, magnesium spray, vitamin c , omega 3.

Thank you for any advice

[SlowDragon Administrator]

Your TSH is too high and likely under medicated

FT3 is too low

You either need dose increase in Levothyroxine or the addition of small dose of T3

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]

Professor Toft recent article saying, T3 may be necessary for many otherwise we need high FT4 and suppressed TSH in order to have high enough FT3

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

[SunsetLady in reply to SlowDragon]

Thank you SlowDragon, would increasing to 100/125 levo alternate days be right? (I was taking 75/100 .

[SlowDragon Administrator in reply to SunsetLady]

Far too big an increase.

Your FT4 is already near top of range

Maximum increase should only ever be 25mcg.

Suggest you increase to 100mcg every day (12.5mcg increase)

Retest after 8 weeks

If FT4 goes higher and especially if above range, but FT3 doesn't improve, then need to look at adding T3

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, delay and take straight after. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, GP will be unaware)

[SunsetLady in reply to SlowDragon]

Thank you, I will do that. Many thanks SlowDragon.