I have a question about thyroid blood tests. I am going private for TT4, T3, FT3, FT4 and antibodies as I am experiencing symptoms that are linked to my hypothyroidism (weight gain, fatigue, concentrating difficulties, puffy face, mood swings, hair loss) and feel that the levothyroxine is not working (I am on 125mcg). It has been hopeless so far in trying to get things investigated by the GP when my TSH is normal (2.70).
I feel that by having these additional tests will help to give me a better understanding and reassurance on what is happening with my thyroid health, but I am wondering what could come of the results if they came back abnormal considering the only real treatment is the levothyroxine? Would the likelihood be that my levo dose would be changed?
The blood tests will provide a more comprehensive view of your thyroid function (ie T4-T3 conversion ability) and give scope to reassure that you are adequately replacing.
If you are under-range, you will know to increase dose (or ask GP for a dose raise.)
If you are within range and still symptomatic, then meds aren’t working and you will know further investigation is required. However, many doctors dose by TSH levels and aren't compliant in increasing T4 meds when T4 levels are in-range irrespective of where they lie.
Many members have found optimising iron and nutrient levels have helped thyroid hormone replacement to start working efficiently. Others have needed to reduce or improve cortisol levels and some have found a clean diet beneficial if Hashi is the initial cause of hypothyroidism and thyroid antibodies are raised.
When all preliminary avenues have been explored and still no improvement seen, you will know to start more in-depth investigation such as sex hormones re carrier proteins not being able to transport your thyroid hormone, or cells not being able to use what thyroid hormone you have.
There are many reasons for thyroid hormone replacement not to work efficiently. If you post your results complete with ranges (numbers in brackets), members will comment.
Hi there,
Thank you for your message. How come 2.7 is not normal? I was told the ideal range for a hypothyroid patient is 0.5 to 3.0...
As reallyfedup123 has said a TSH result of 2.7 is definitely not ‘normal’.
I’m guessing this is what your GP has told you?, what they mean is your TSH results are within the lab ranges. However, that doesn’t mean your thyroid is normal.
You have mentioned your having antibodies tested.
If positive results it means you have an autoimmune disease (Hashimoto’s). I have this and by going gluten free can help lower your results.
Hashimoto’s is where your immune system attacks your thyroid, and can cause you all sorts of issues. My symptoms were brain fog and terrible digestive issues.
Your having your T3 and T4 tested as well, what your GP will not tell you is that T3 is very important. It controls our metabolism and even more.
Make sure any thyroid blood tests are carried out first thing in the morning before 9am and don’t take your Levothyroxine before the blood test. No eating and only drink water.
It’s important that when having thyroid blood test TSH, T3 & T4 are tested at the same time.
For us to feel well our TSH should be 1 or below and our T3 & T4 should be in the higher figures of the lab ranges.
A lot of thyroid patients end up on a roller coaster with their Levothyroxine, why? Well some GP’s don’t like a suppressed TSH, so they decrease their Levothyroxine dosage, this then sends the TSH results back up again and the patient feels unwell again, then the Levothyroxine is increased and the pattern is repeated.
Not everyone does well on Levothyroxine, I’m one of them, but you need to get your TSH down to below 1 before you look at other options.
The options are self medicating on NDT or T3, but your not at that stage yet.
I must say I am really intrigued by the comments that my TSH reading is abnormal despite being told by GP and an Endocrine Registrar that this within range. I was told the normal range should be between 0.5 to 3.0 milli-international units per liter.
Lots of people are in the same situation as you, told your TSH results are normal because they are within the lab ranges.
You may find that until your TSH reaches 10 or above your GP may not step in with giving you Levothyroxine, by this time you will be barely functioning, you will be like a walking zombie.
Why, well they are still going by out of date NHS guidelines, just seeing an Endocrinologist doesn’t mean your going to get a positive outcome.
As others have said " normal" is the range for healthy folk ,we all have a different set point where we feel best but this should be about 1 or below when being treated.
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
tukadmin@thyroiduk.org
All thyroid blood tests should ideally be done as early as possible in morning and fasting. Do not take Levothyroxine dose in the 24 hours prior to test, delay and take immediately after blood draw. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)
Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels. Low vitamin levels affect Thyroid hormone working
Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten.
According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps, sometimes 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
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