Results

[dpa87]

Hi could you please advise my TSH has been constant at 0.01-0.2 for last two years on 100 levothyroxine and 20 Liothyronine. This was up till May 2018. My latest results received yesterday show TSH 1.6. Which meds would need increased to bring me back in line with previous results. I have had big weight gain in last six months which prompted doc to investigate

[SeasideSusie Remembering]

dpa87

TSH alone is not enough to answer your question. You need results for FT4 and FT3, and particularly FT3 is very important to test as you are taking T3.

Also, have you had thyroid antibodies tested? Just wondering if you may have Hashi's and this is causing the fluctuation in your results if your dose is the same as before.

Also, did you have your test at the same time of day to compare the result accurately? TSH fluctuates with highest being very early morning and lowest being around 1pm. If you had your tests done at different times this could account for the difference. Also coffee can affect TSH so water only before a test is recommended.

[dpa87 in reply to SeasideSusie]

Hi thanks for reply, been on this journey for 18 years always take Meds in evening with bloods early morning before 11am.

[SeasideSusie Remembering in reply to dpa87]

So if there's no difference in the conditions in which you had your tests, and you drank only water and fasted overnight, there must be another reason for the higher TSH.

So - antibodies?

What about FT4 and FT3, it's not possible to suggest whether you should change your dose of Levo or T3 without seeing those results.

[dpa87 in reply to SeasideSusie]

The FT4 was constant at 10 (9-21) they didn’t do FT3. Think might go back to endocrinologist who advised two years ago to keep TSH low at 0.01-0.1

[SeasideSusie Remembering in reply to dpa87]

It's essential to test FT3 when taking T3. A doctor who prescribes T3 should know this. How on earth can they possibly know if you are taking enough T3 or too much if they don't test FT3!

[dpa87 in reply to SeasideSusie]

True have tel consult next week with GP so will discuss more tests and referral back to endo

[dpa87 in reply to SeasideSusie]

Hi just an update, seeing Dr Anthony Toft on 23/1 so will hopefully get all required checks done then

[SeasideSusie Remembering in reply to dpa87]

I hope your appointment goes well, do let us know

[dpa87 in reply to SeasideSusie]

Just had latest results with FT3 at 6.9 (2.5-4.9) does this indicate too much or too little T3 dosage?

[SeasideSusie Remembering in reply to dpa87]

Reference ranges are there to tell us the range between which our level should fall. We should aim to keep our level within the range and take an appropriate dose which keeps it there. You are way over range so this results suggests that you are taking too much T3.

However, there are things that can give false results so it's important to always test following the advice given here:

When doing thyroid tests, we advise:

* Book the first appointment of the morning, or with private tests at home no later than 9am. This is because TSH is highest early morning and lowers throughout the day. If we are looking for a diagnosis of hypothyroidism, or looking for an increase in dose or to avoid a reduction then we need TSH to be as high as possible.

* Fast overnight - have your evening meal/supper as normal the night before but delay breakfast on the day of the test and drink water only until after the blood draw. Eating may lower TSH, coffee affects TSH so it's possible that other caffeine containing drinks may also affect TSH.

* If taking thyroid hormone replacement, last dose of Levo should be 24 hours before blood draw, if taking NDT or T3 then last dose should be 8-12 hours before blood draw. Adjust timing the day before if necessary. This avoids measuring hormone levels at their peak after ingestion of hormone replacement. Take your thyroid meds after the blood draw. Taking your dose too close to the blood draw will give false high results, leaving any longer gap will give false low results.

* If you take Biotin or a B Complex containing Biotin (B7), leave this off for 7 days before any blood test. This is because if Biotin is used in the testing procedure it can give false results (most labs use Biotin in the assay).

These are patient to patient tips which we don't discuss with doctors or phlebotomists.

So two important questions to ask about your test conditions before we can be sure that you are taking too much T3:

1) When did you take your last dose of T3 before the test?

2) Did you take B Complex or Biotin in the 7 days before the test?

And you never did answer the question previously asked about whether or not you have had thyroid antibodies tested. Knowing whether or not you have autoimmune thyroid disease (Hashimoto's) is another part of the puzzle.

[dpa87 in reply to SeasideSusie]

Yes realise I hadn’t replied to question, have been referred back to endocrinologist as go thought I needed to up my T3 which concerned me, will see endo asap as will do privately and ask to get everything checked. Dr Toft has retired but left me the name of his replacement who he highly recommended

[dpa87 in reply to dpa87]

I was just confused as the more T4 you take the lower the Tsh result so was just checking

[SeasideSusie Remembering in reply to dpa87]

Taking any thyroid hormone will lower TSH, as you become optimally medicated your pituitary gland is satisfied that you have enough thyroid hormone so it doesn't send the signal (TSH) to the thyroid to make any, hence TSH will be low.

Taking T3 seems to have more effect as it often suppresses TSH.

[dpa87 in reply to SeasideSusie]

Thank you, I realise it makes sense to you and I had my thyroid removed in 2000 but still get confused

[SlowDragon Administrator]

You need vitamin D,folate, ferritin and B12 tested too