Advice on latest blood results please

[SunsetLady]

Morning everyone

I've just got my latest results and would like advise, am I now needing to look for T3 medication to add to my levo? -

TSH 0.81 ( 0.27-4.2)

T4 15.2 (10-21)

T3 4.7 (3.5-6.5)

I feel better than I did before this increase but still lack energy to do much, am gaining weight and resting pulse is 53.

I take 100mcg levothyroxine daily, B complex, vitamin D+K, magnesium spray, vitamin C 1000.

Thanks for any advise.

[Judithdalston]

I'd up my levothyroxin first by 25 mcg , you still have a lot of room in FT4 range, and that extra 25 mcg ( or even another after that) should send your FT3 over midrange, 5. You are converting T4 to T3 well (ratio should be between 3:1 and 4:1, which yours is). You obviously take some supplements, but are your VitD, B12, folate and ferritin optimal ie been checked this year or so?

[SunsetLady in reply to Judithdalston]

Thank you so much for that advise- l will increase the levo by 25. I’m relieved to hear that might do the trick. I did a medicheck two months ago- active B12 >300 (25.1-165)

Folate serum 17.16 (2.91-50)

Vitamin D 77.4 (50-200)

Ferritin 98.1 (13-150)

and have started folate 400mcg since then in addition to the b complex. I also increased vitamin D3 to 4000 daily, and eat liver weekly.

Thanks again for your reply x

[Judithdalston in reply to SunsetLady]

Ok, Vit D could be upped to 100-150, folate should be halfway thru range; ferritin not bad but 100-130 recommended for menstruating women; B12 should be near top of range- Medichecks tend to stop at 300, then recommend cease supplementing. See SeasideSusie has responded - she provides excellent advice re doses, brands etc of supplements if you find your vits/ mins are not increasing as you'd like at next test.

[SeasideSusie Remembering]

SunsetLady

No, your results don't show the need for T3, they show good conversion.

Good conversion takes place when the FT4:FT3 ratio is between 3:1 and 4:1 and yours is 15.2 : 4.7 = 3.23 : 1

Your FT4 is 47% through it's range, FT3 is 40% through range, so reasonably well balanced. Both are low. With your good conversion an increase in Levo is your next step to get both FT4 and FT3 up into the upper part of their ranges.

See article by Dr Toft, past president of the British Thyroid Association and leading endocrinologist, which he wrote in Pulse magazine (the online magazine for doctors) 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)."

If you would like a copy of the article, which you may need if your GP is reluctant to increase your dose of Levo and concerned about your TSH going lower, you can email Dionne at ThyroidUK, then print it and highlight Question 6

[e-mail]

Are you vitamin and mineral levels optimal? Have you tested recently and supplementing at the right dose? Optimal levels are:

Vit D - 100-150nmol/L

B12 - top of range

Folate - at least half way through range

Ferritin - half way through range

[SunsetLady in reply to SeasideSusie]

Thank you so much SeasideSusie, l had vitamins checked two months ago with medicheck and you’re right some aren’t optimal yet. I’m taking extra folate 400 in addition to b complex as folate was 17.16 (2.91-50) and my vitamin D was 77.4 (50-200) am taking 4000 D3+K2.

Active B12 was >300 (25.1-165)

Ferritin was 98.1 (13-150)

Thanks

[shaws Administrator]

GP should increase dose by 25mcg every six weeks until you have relief of clinical symptoms. The TSH should be around 1 or lower when we start taking thyroid hormone replacements.

[SunsetLady in reply to shaws]

Many thanks Shaws, l have some spare so will increase and am seeing Gp Friday, thanks again.

[Judithdalston in reply to SunsetLady]

When I had a rather reluctant Gp and wanted to up my dose I told him i'started 25 mcg dose two weeks before and would test again in 4 weeks- only TSH, but still came back within his acceptable range.

[SunsetLady in reply to Judithdalston]

I might try that, it’s rediculous how we have to battle to get the dose we need isn’t it! Thanks

[shaws Administrator in reply to SunsetLady]

Dr Skinner and Dr Peatfield (old school doctors) took note of clinical symptoms and also the patient. They didn't need blood tests to give a trial of NDT or levo and if patient felt the benefit they contnued with increases. i.e common symptoms were low pulse and temps plus symptoms ie fatigue etc.

[SunsetLady in reply to shaws]

It’s such a shame most doctors are no longer like that, l went to my Gp a few months ago when my resting pulse was 46- which alarmed me- and Gp said why are you taking your pulse? So l explained, and she then said - check it after you’ve been walking around instead.

I won’t be going back to her!!

[shaws Administrator in reply to SunsetLady]

It is absolutely apalling that they don't even know the very basic of symptoms.

It might be different if you were a top of the tree athlete whose pulse is often very low but they wont be at the doctor to complain about feeling ill.