What this means? Serum free T4level 20.2.The GP reduce my Levothyroxine from 125mg to 100mg , but I’m discovering that I start having problem with my digestion, pain on my tummy like a burn, could be from Levothyroxine or I needed to check again my TSH? Any ideas? Thanks!
The result are like this:
Serum free T4level -20.2pmol/L range of -(9.00-19.00pmol/L)
Serum TSH level 0.22mu/L range of ( 0.35-4.94mu/L)
Your doctor is panicking because your FT4 reading is above the range and he thinks your TSH is too low so he thinks you are over medicated and has reacted by lowering your dose.
He may be correct but I suspect, if you aren't feeling good that you have a conversion issue. You are taking T4 which is an inactive hormone but our body should convert this into T3 which is the active hormone that makes us feel well.
So if you still have issues then he should be checking your FT3 at the same time as the others. By lowering your T4 then your T3 will get lower so I've I am correct then you will start feeling worse instead of better. So you need to tell him that you are worried this is what will happen and why. If he is unable to check this, sometimes it's the lab that refuses then you need to get private testing. Many of us have to do that and in the U.K. we recommend either Blue Horizon or Medichecks. Both can have special offers. Medichecks have them on Thursdays so you need to order the test you need of the Thursday the offer is made. But you need to use the test within 6 months but check on that as I've always had mine tested at the hospital so haven't used them.
You may have this problem because you are low in other things. Ask your doctor to test Vit D, B12, folatate and ferritin and if these are optimal, not just in range, then your thyroid will work better. Please post any results and ranges and we can advise what to do next. adding more Levo(T4) will mean that it will keep getting higher if it's not converting well and the T3 will remain very low but addressing this then more of the T4 will convert to T3 so the T4 level will fall and the T3 level will rise and you will feel the benefits.
I have the same problem. Over the last 15 years I've been told my t4 is too high at 125mcg because of my very low TSH level and reducing it to 100mcg, so that I become a cretin: slow of body & mind, fearful & tearful & fat. Nowadays it only takes six weeks for this to happen. Then someone puts me back on 125mcg and I get better. One doctor did mention t3 but didn't prescribe, so I'm now self-medicating. I've had no thyroid or parathyroid glands at all for decades, so I don't convert t4 to t3 any more. But hardly any doctors seem to know anything about this, and they also don't know what tests to do. I'm having tests done privately through Medichecks.
A small amount of T3 is produced in the thyroid gland, but conversion of T4 to T3 takes place in the peripheral tissues such as the liver, kidneys and many others. Not having a thyroid will not impact on that. The parathyroids are not involved at all, their name simply signifies their location relative to the thyroid, para meaning near or by; but other than that, their function relates to calcium levels not thyroid hormone levels.
If you think about it, if it were the case that conversion happened in the thyroid, and for years you'd had no thyroid and only exogenous T4, without T3, the active hormone, you'd have likely been in a myxoedema coma, or worse, long before now. 🙂
Dear Maisie,
When I say Cretin I mean myxodoemic.
Hi Lopears Yes, cretinism is a congenital condition. It was feared that my first son would be born a cretin, but thankfully he wasn't (although is very severely affected by Crohns, so who knows what impact my own under treated hypothyroidism may have had on the developing foetus.) I was responding though, to "I've had no thyroid or parathyroid glands at all for decades, so I don't convert t4 to t3 any more" to clarify that conversion happens independent of the thyroid.
The word cretin was invented by a French doctor in the nineteenth century to describe anyone with very low thyroid activity, so it isn't congenital, though it may also describe people born with the condition. I'm glad your son wasn't affected.
I don’t have thyroid for one year, so do you think I should be worry, I might be in the lower dose? Thank you for reply! x
Thank you very much for your reply, I forgot to mention I had radio iodine treatment, I don’t have thyroid now! Do I need to test T3 ?
Yes, you should get free T3 tested at the same time as free t4 and TSH
Thank you for reply! x
lucs Yes, we should all, and always, be tested for the trio of TSH/FT4/FT3, irrespective of having a gland, a partial gland, or no gland at all.
Thanks darling! x
Do you at all have any scientific papers on this? I am doing a little personal research project and making v slow process with this area!
Yes the essentials are still happening and we need to know they are correct.
As I understand it, you have had RAI so your thyroid has been disabled.
Do you have a diagnosis of Graves Disease and confirmed TSI / TRAB antibodies ?
Graves is an autoimmune disease and as such it is for life.
It may not now be life threatening but if not managed correctly it is QOL limiting.
Your thyroid was the victim of an autoimmune attack and not the cause -
You can't be managed on TSH blood tests, your feedback loop is broken, your doctor needs to test T3 and T4 and dose to these readings
It's essential you read up and become your own advocate as this disease seems poorly understood within the medical profession.
Graves Disease - A Practical Guide by Elaine Moore - this has the disease and gone through RAI - there is also a very comprehensive website - USA protocol -
Barbara S Lougheed - from Hyper to Hypo to Healing - another American lady with the same condition, debunking the TSH test in Graves patients -
Last but by no means least is Your Thyroid and How to Keep it Healthy - by a doctor who is hypothyroid - an excellent go to thyroid health bible -
You may not now have a thyroid but you need to understand what it does and how to help yourself compensate for it having been destroyed - you've lost a major gland - it's a massive learning curve.
We are all on our own journeys back to better health , learning from this fantastic site.
When you have the relevant blood test results as detailed throughout this website, thyroid plus vitamins and minerals, repost the results and you will be guided through the next steps you may need to take.
Help understanding bloods please. TSH jumped from 10.75 to 4.00 in 8 days. How???
New Blood Results 27/2/23
TSH level Can someone interpret please. 
TSH and T4 levels
TSH fluctuating 
