Blood Test Results - Guidance

[gary7878]

Hello,

I would really appericate some help, I have given up on my GP

I was diagnosed with Histmotos roughtly 2yrs ago (confirmed by antibody test) this caused Hypothyrodism.

I went for a blood test last week and came back with the following results

18-Jan-2019 ! Serum TSH level - (CTU) - 6.01 mIU/L 0.27 - 4.20mIU/L

18-Jan-2019 Serum free T4 level 16.5 pmol/L 10.00 - 23.00pmol/L

They were supposed to test for free T3, but did not or have not sent me the results

I am currently taking 20mg T3 and 100mg levothyroxine. I have been taking this does for 9mths

Should I be worried about my TSH level given I am taking T3? Historically I have been advised this should be below 1. If this should be below 1 should I increase T3 or levothyroxine? I should also add I had a genetic test and have trouble breaking down T4 (sorry can not remember the technical term)

Should free T4 be at the top end of the range for optimal health?

I am chasing them for my free T3 results, however suspect I will need to take another test?

Thanks

Gary

[SeasideSusie Remembering]

gary7878

Is this an NHS or private test?

When taking liothyronine it is essential to test FT3. Your doctor should write on the lab request form something along the lines of "patient taking T3, please test FT3". If the lab doesn't do it he should take it up with them. And all tests should be done from the same blood draw. There is no way of knowing if you are on the right dose of T3 unless FT3 is tested and whoever prescribed this for you should know this and ensure it's done.

Your current TSH shows that you are undermedicated. When taking T3 it tends to lower FT4 and lowers, even suppresses TSH. There is no way of knowing if you need T3 increased without seeing your FT3 result.

Historically I have been advised this should be below 1.

You will often see mentioned here that 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. It doesn't apply when taking T3, but as I said taking T3 should give a low or suppressed TSH anyway.

Should free T4 be at the top end of the range for optimal health?

We are all individual in where our levels need to be when on combination Levo/T3. It's something we find out from tweaking doses and it takes time. I have found that both my FT4 and FT3 need to be about 75% through range on combination Levo/T3. Other members on combination therapy do quite well with a lower FT4 as long as FT3 is optimal for them.

As you have Hashi's, are you addressing this with a gluten free diet and supplementing with selenium l-selenomethionine 200mcg daily to try and reduce the antibodies?

[gary7878 in reply to SeasideSusie]

Thank you for the response, it was NHS. The Blood form did have "patient taking T3, please test free T3" I have a call with the Doctor this afternoon. I will update once I have spoken to him. I can not understand why they would test free T4 and not free T3, I guess free T4 must be part of the normal thyroid panel.

[SeasideSusie Remembering in reply to gary7878]

If your GP requested it and said you were on T3 then the lab should have done it. I believe they may keep the blood sample for a few days so perhaps your GP can ring them and insist they do the test from the saved sample. It beggars believe that the labs can override a GPs request, especially when it's so important to test what you are actually prescribed.

When on Levo only, some labs only test TSH as standard and nothing else if that is within range. Some test TSH and FT4 as standard. My NHS lab seems to test FT3 automatically if TSH is suppressed - at least my last 2 tests have had FT3 included, but I do avoid NHS testing as much as possible as I self treat with T3 and get my own tests done. I managed to dodge GP testing from March 2014 to November 2017.