Help with test results: Hi folks So glad I was... - Thyroid UK

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Help with test results

Angie_Phalange profile image

Hi folks

So glad I was recommended to check out this forum. Lots of support and advice for those in need. I had no idea so many people are suffering 🙁

I’d be grateful for some collective thoughts on recent blood tests. In a nutshell, I have Hashimotos (no antibodies in testing) struggling big time on Levothyroxine (50mcg), it’s poisoning me. Realise I’m likely to be undermedicated at the moment but cannot tolerate any more Levothyroxine - I’ve tried. Not having good experience with endocrinologist either. NDT is the next step so will be looking for some advice on how to “phase in” with that 🙂

TSH 1.49 (range 0.27-4.20)

Free T4 14.47 (range 12-22)

Free T3 4.2 (range 3.1-6.8)

Total T3 1.8 (range 1.3-3.1)

Iron 9.5 (range 5.83-34.5)

Ferritin 100.4 (range 13-150)

B12 1209 - 3mthly injections (range 197-771)

Serum Folate 5.45 (range 3.89-26.80)

Vitamin D 123.4 (range 30-250)

Coeliac - negative

7 Replies
SlowDragon profile image

As you have B12 injections its recommended on here to also supplement a good quality daily vitamin B complex, one with folate in not folic acid eg Igennus Super B or Jarrow B-right

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

Presumably you supplement vitamin D?

Are you also taking magnesium and vitamin K2 Mk7?

Are you on strictly gluten free diet? If not it's likely to help

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

Your results suggest you are under medicated. FT4 should be near top of range (around 20) and FT3 at least half way in range. You most likely need 25mcg dose increase in Levothyroxine

All thyroid tests should be done as early as possible in morning and fasting and don't take Levo 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)

Is this how you did the test?

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

If FT3 remains low when FT4 finally gets high enough after dose increase(s) then next step is to ask Endocrinologist for trial of T3

DIO2 gene test might help in this

Currently you are still under medicated

Thanks. Yes, delayed taking Levo prior to these blood tests. Levo making me feel worse.

SlowDragon profile image
SlowDragonAdministrator in reply to Angie_Phalange

Extremely common.

Gluten free diet can be very beneficial

Do you have Pernicious Anaemia or just low B12?

Any gut symptoms or acid reflux suggesting low stomach acid?

Just low B12. Gut stuff all ok. Have lost loads of weight on thyroxine. Not good as only 54kg to begin with! Fading away 🙁

SlowDragon profile image
SlowDragonAdministrator in reply to Angie_Phalange

Another classic sign of poor gut don't have to have any gut symptoms to still benefit from strictly gluten free diet

Trying to eat little and often can help weight, especially if your appetite is affected

Low B12 without Pernicious Anaemia is likely low stomach acid, then struggle to absorb nutrients

Have you had coeliac blood test?

Ask Dionne at Thyroid Uk for list of recommended thyroid specialists

Many Endo's only think you're hypo if your over weight

Do you think it’s sensible to ask for a trial of T3 now?

SlowDragon profile image
SlowDragonAdministrator in reply to Angie_Phalange

Thyroid Uk has list of recommended thyroid specialists, some are T3 friendly.

If your current endo is not keen

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