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Thyroid UK
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Advice & Guidance please

Dear friends of Thyroid UK,

I would be very grateful once again for some advice and guidance

I went to see my GP who spent 25 minutes with me discussing the results of my blood test very in depth listen to everything I had to say.

I think this was helped by the fact that he had a newly qualified doctor with him so very patient with me as a patient The Dr to prescribe statins I am very much against statins at the moment I don’t feel I am ready just to accept his diagnosis from what I’ve learnt from this forum, my blood pressure is normal, there is no history in the family of heart disease, I am fit & very active until I hit that fog & the wall ( you all know what I am talking about here) I have about 7 pound I could lose I follow a healthy diet I am not coeliac but I have Hashimoto’s. My Cholesterol is elevated at 6 & my liver function is also elevated

The doctor has agreed to send me to see an endocrinologist through the NHS I have the appointment in October. so I would like to go with some more knowledge to discuss then

I am on 75 mcg of Levo. I supplement with 15 Livo.

My recent test results are serum freeT3 came back as normal no action?

4.5pmol (3.6-6.4)

Vitamin D Normal

Serum TSH level 0.11 dropped from previous test by 0.73

Serum free T4 12.2 down from 15.4 in previous testing in February. All testing done fasting with no medication for 24 hours previously

Folate 5.9 ( 3.9–26.8 )

Ferritin 127 (13-150)

B12 296 ( 220 700)

Many thanks in advance

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What was the actual vit D result? Normal in NHS speak simply means you're not about to topple over with rickets.

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76 D2 D3 does this make sense ?

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Are you in the UK and was the unit of measurement nmol/L? If these results were taken a few weeks ago, we're at the end of the summer and your vit D level may well drop over the winter months. Are you supplementing any vitamin D3? As SeasideSusie says, vitamin D is said to be best mid-range or around 100nmol/L Check your lab ranges.

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Harthill42

I am on 75 mcg of Levo. I supplement with 15 Livo.

Is that 75mcg Levo and 15mcg Liothyronine (T3)?

All testing done fasting with no medication for 24 hours previously

If you are taking T3 then the last dose of that should have been 8-12 hours before blood draw, 24 hours is for Levo only. So if you are taking T3 then you have a false low FT3.

Serum TSH level 0.11 dropped from previous test by 0.73

Serum free T4 12.2 down from 15.4 in previous testing in February.

serum freeT3 - 4.5pmol (3.6-6.4)

I imagine TSH is below range and doctor may not like that.

Where in range is FT4? As ranges vary, if that was my GP's lab where the range is 7-17, it would be in a better place than a lab whose range is 12-22.

But if doctor does want to lower your dose due to the low TSH, you can say that your actual thyroid hormones - FT4 and FT3 - are in range so what's the problem. TSH is not a thyroid hormone, it's a signal from the pituitary for the thyroid to make hormone if it detects there is too little. Taking T3 generally lowers or suppresses TSH and one would hope that any doctor precribing T3 knows this.

Vitamin D Normal

What is the result? Normal has no meaning because there are categories for Vit D - deficient, insufficient, sufficient. The Vit D Council, the Vit D Society and Grassroots Health all recommend a level of 100-150nmol/L

although I wouldn't expect any doctor to know this, they're not taught nutrition so any result that is not deficient or below range is OK by them.

B12 296 ( 220 700)

That seems a bit low. Do you have any signs or symptoms of B12 deficiency - you can check that here b12deficiency.info/signs-an...

If the unit of measurement is pg/ml or ng/L (they are the same) then the following is an extract from the book, "Could it be B12?" by Sally M. Pacholok:

"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".

"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."

Folate 5.9 ( 3.9–26.8 )

Again this is low and is recommended to be at least half way through range (again your doctor wont know this). Folate and B12 work together. Probably not low enough for doctor to prescribe but you can do something about it yourself but not until after you know whether your B12 needs investigating further. Taking folic acid (or folate) masks signs of B12 deficiency.

Ferritin is fine.

Are you addressing the Hashi's with a gluten free diet and supplementing with selenium l-selenomethionine 200mcg daily to help reduce the antibodies (keeping TSH suppressed can also help reduce antibodies).

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Thank you for your in-depth reply. Yes 75 mcg of Levo & 15 mcg of Liothyronine. When my Serum free T3 test was taken I was taking not taking T3, this test was done in February the Dr was surprised that the lab had tested it as he said the lab often refuses. The Serum free T4 range is (10-22). The Dr has not prescribed T3 I am self medicated slowly over 4 months starting on 5mcg now up to 15mcg. I feel much better but still I think there is room for improvement. I would rather ask for an increase in Levo to 100 than go on statins. My liver function & cholesterol are 7 for cholesterol & slightly above the normal range!! My Vit D is 76 I don’t know what this means D2 & D3 identified as normal. I take selenium 1 pharma nord a day. I shall look in to link on B12 thanks, I don’t take any other supplements.

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Harthill42

So we can't actually take those results and make much use of them in respect of your current meds then.

So, am I correct in thinking that in February on 75mcg Levo

TSH was 0.73 (or as you said dropped by 0.73 was it 0.84 in February?)

FT4 was 15.4 (10-22)

FT3 was 4.5pmol (3.6-6.4)

and now on 75mcg Levo + 15mcg T3 you have

TSH: 0.11

FT4: 12.2 (10-22)

First thoughts are that your February results did not show a need for adding T3, it showed a need for increasing Levo. The reason for this is that FT4 was only 45% through range and FT3 was 32% through range. The aim of a treated hypo patient generally is for TSH to be 1 or below or wherever it needs to be for FT4 and FT3 to be in the upper part of their respective reference ranges when on Levo if that is where you feel well.

Your conversion ratio of T4:T3 is 15.4 / 4.5 = 3.4 : 1 and good conversion takes place when the ratio is between 3:1 and 4:1

What made you start taking T3 after your February results?

When taking T3 it is essential to test FT3, you need to know that you are still within range and not overmedicating with T3. This was explained in my reply to your previous post here healthunlocked.com/thyroidu... and I suggested that you do a private TSH/FT4/FT3 test if your GP can't get FT3 done.

Taking T3 has done exactly what we expect, lowered TSH and lowered FT4.

Does your doctor know that you are taking T3? If not are you going to tell the endo you are taking it?

Don't forget that having Hashi's complicates things as antibodies fluctuate and can cause fluctuations in your symptoms and test results/hormone levels.

My Vit D is 76 I don’t know what this means D2 & D3 identified as normal

When testing Vit D, both D2 and D3 are tested. D2 will always show a very low number, D3 a higher number, they are added together to give a total D3 and yours is presumably 76nmol/L. That will be in the sufficient category but as I said the recommende level is 100-150nmol/L.

When one has Hashi's it's essential that vitamins and minerals are optimal and optimal levels are

Vit D - 100-150nmol/L

B12 - top of range

Folate - at least half way through range

Ferritin - half way through range

You do not have to take statins if you don't want to, your GP can't make you. If you don't want to take them then refuse.

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Thanks I am going to revisit all of my results & time lines. I know I have complicated things with my little knowledge. Yes I shall tell the endocrinologist I am taking T3 & have felt much better since, however still not feeling 100%. My TSH in February was12.2 pmol. Dropped from 15.4. I shall take a photo of my results so not to confuse myself

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Harthill

My TSH in February was12.2 pmol. Dropped from 15.4

I think you've got that mixed up somewhere as before you said

Serum free T4 12.2 down from 15.4 in previous testing in February.

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You are simply not on enough meds

If you were correctly treated for hypothyroid your cholesterol would lower and there should be no talk whatever of statins

Your T4 should be more like 19 if the range is 10 to 22

Your T3 should be more like 5 or 5.5

I believe you need a dose increase

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Thank you, I am slowly learning bits of information from this fabulous forum & putting together what I have read here. it should be exactly as you say.

Retest after an increase in the dosage, then look at the need for statins. Is there a monetary incentive for prescribing statins just as I have read about when asked if I had suicidal tendencies when I discussed how low I was & it was living in a mist.

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No need to take statins - they do not prevent heart disease. Cholesterol is naturally produced in the body - and for a good reason. The brain is over 25% cholesterol - so why block it ? Statins also block other important things needed by the body. Cholesterol is needed for the production of all hormones. 😊

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I have two friends who have been taking statins for over 15 years these people are not overweight either, and both eat a healthy diet. One has a family history of heart disease but both parents were very heavy smokers. I have no thyroid at 72 years of age and am well, these two are very unwell with no others health problems. I would never take these the brain requires cholesterol too.

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Yes GPs are paid to prescribe statins but they are not correctly trained to treat hypothyroid ...sadly neither are majority of Endos ...we know far far more than 95% of medics by look of things

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