Help with test results

[Auntbessy]

Hi everyone,

I had a dose change several weeks back and am now on 150 mg every day. I am still getting numb tingling hands, constipation and tiredness though.

Here are the results:

Tsh 1.57 range 0.27-4.20

Free thyroxine 19.100 range 12-22

FT3 5.44 range 2.10-6.80

I cannot seem to get my tsh below 1 with my dosages lately and keep upping them with little success.

I was unable to test iron, B12 and vit due to financial constraints. These results all sit at the lower range though. I’m taking supplements for these deficiencies.

Are these results normal?

Thanks

[SlowDragon Administrator]

As you are gluten and dairy intolerant you are likely to need addition of small dose of T3

Have you got the recommended list of thyroid specialists from Thyroid UK?

If not, email Dionne on Jan 3rd


 please email Dionne at

[e-mail]

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]

New NHS England Liothyronine guidelines November 2018 clearly state on pages 8 & 12 that TSH should be under 1.5 when on just Levothyroxine to be adequately treated

sps.nhs.uk/wp-content/uploa...

Dossier presented to Lord O'Shaughnessy November 26th

drive.google.com/file/d/1c2...

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...

[Auntbessy in reply to SlowDragon]

Thank you! As always you have been immense help. I feel like I can go to my endocrinologist appointment in January asking for the right thing. If I don’t get anywhere with them, then I will try finding out about those specialists as recommended by thyroid uk!

[SlowDragon Administrator in reply to Auntbessy]

Your GP can and should test vitamin D, folate, ferritin and B12

[RockyPath]

Technically you may have ok numbers on the tests, but this begs the question about your list of persistent and obvious hypothyroid symptoms. The tests should include an rT3 measurement. I had nice looking labs and was so hypothyroid (due to rT3) that I could barely string together a coherent thought. Watching and waiting is fine for the doctor whose body it is not, but watching and waiting in your case is just writing yourself a sentence for an even worse chronic disease as you age -- atherosclerosis, heart failure, orthopedic problems from hyper mobile joints, for example -- all provoked by untreated hypothyroidism.

My endocrinologist could see I was hypothyroid, though the lab numbers looked ok. He kept increasing the levothyroxine, to no avail. To a doctor who is capable of overlooking hypothyroid symptoms, this would be justification for thinking the symptoms weren't hypothyroidism at all. Instead, my endocrinologist persisted and I am now on liothyronine and all those hypo symptoms are a thing of the past.

You must argue persistently for your own care, and follow the good advice above on the T3 resources. I suggest the thyroid uk .org .uk web site and, under "related conditions" is a page with Dr. John C Lowe's observations on hypometabolism symptoms (primary outcome of hypothyroidism) and how he treated it with T3.

Good luck!

[Auntbessy in reply to RockyPath]

Thanks. You have hit the nail on the head there about GPS overlooking things. My GP said I was hung up on numbers when I wanted to try and aim for a suppressed TSH. She started telling me that I needed to do meditation. I saw another GP later on and he started to go down the path of me being depressed and needing to do meditation. The daft thing is my life apart from health problems is good and that is how I know I am not 100% anyway moan over. I will take this information you have shared to my endocrinologist appointment in January. Thanks you have been so helpful.

[Marz]

Your GP should be able to test B12 - Folate - Ferritin and VitD. Tingling symptoms could be LOW B12