Further Advice Please before GP Appointment

[potter5]

Hello, I contacted the group 3 months ago for advice on bloods before GP app, thanks for all those who gave me all the information I needed before app. Could you please give me your thoughts on the thyroid results I got a couple of days ago. I had levothyroxine increased 3 months ago from 50mcg daily to 62 1/2 (50mcg one day then 50 plus 25mcg every other day. Sounds confusing, The thyroid results look well improved to me but I have not much experience and need to be prepared.

October 2018 January 2019

Free T4 17.9 pmol/L (10.6 - 23.2) Free T4 21.6 pmol/L (10.6 - 23.2)

TSH 1.79 mU/L (0.3 - 4.2 ) TSH 0.98 mU/L (0.3 -4.2)

Free T3 3.7 pmol/L (3.1 - 6.8) Free T3 4.3 pmol/L (3.1 - 6.8)

Folate 17.2 ug/l (3.9 - 26.8)

Ferritin 67.0 ug/l (13 - 300)

Serum Iron level 13.7 umol/L (10 - 30)

Should I be asking for a further small increase say up to 75mcg daily or should I keep levothyroxine at same level for now. Thank you o much again. Kind regards Potter 5

[SeasideSusie Remembering]

How do you feel Potter5?

If you feel well, leave well alone.

If you feel symptomatic it's because your FT3 is quite low in range at 32% and your FT4 is 87% through range. They are unbalanced and generally should be in balance with both in the upper part of their ranges when on Levo only.

Serum iron is a bit low, optimal level is 55%-70% through range (higher end for men) and yours is 18.5% although your have a reasonable amount in your iron store (Ferritin). Ferritin is recommended to be half way through range but for a female I've seen that 100 is fine, a bit higher for males.

[potter5 in reply to SeasideSusie]

Hello SeasideSusie, thank you for replying. I do feel less tired being on levothyroxine but never feel really well but I think that's because every day neuropathy symptoms are different. If I increased the levothyroxine to 75mcg daily would that lower the TSH too much or raise the T3. I don't want increasing if it could swing things but trying to get levels right. I think GP would say keep the levothyroxine at same level so need to be prepared. Thanks again for help SeasideSusy. Kind regards Potter

[SeasideSusie Remembering in reply to potter5]

If you increase the dose of Levo then it's likely the TSH will lower, the FT4 will increase and the FT3 may increase slightly as well, but your FT4/FT3 will still be unbalanced.

You have a conversion problem, there is not enough T3 being made from your T4.

Conversion be helped by optimal nutrient levels:

Vit D: 125nmol according to the Vit D Council

B12: top of range for serum B12, over 70 for Active B12 (below 70 suggests testing for B12 deficiency)

Folate: at least half way through range

Ferritin: minimum of 70 for conversion

Selenium and zinc levels should be adequate for conversion.

[potter5 in reply to SeasideSusie]

Thanks again SeasideSusy, I think then, I may be better to leave things as they are for another few months. My vitamin D is 66mol/L so I really need to get this up, and ferritin up as well. B12 over 2000 as I have weekly injections. I will look into selenium and zinc and try and increase T3 this way. Best wishes Potter

[greygoose]

If you increase your levo, it could make your conversion worse, because more T4 would convert to rT3 and less to T3. So, your FT3, instead of rising, would drop a little.

[potter5 in reply to greygoose]

Thank you Greygoose, probably better to hold off and just increase Vitamin d and Iron supplement and retest in maybe another 3 months. Thanks again Greygoose. Best wishes Potter

[greygoose in reply to potter5]

You're welcome.

[potter5]

Thank you reallyfedup, my vitamin d is 66 and ferritin 67 so yes I do need these levels up and hopefully this will help lift t3. My folate is 17.2 so that's probably ok and b12 always over 2000 as I have weekly b12 injections. I hadn't realised that vitamin d and ferritin levels effected t3 so I will wait for a few months and have bloods done again. Thank you so much for your help. Kind regards Potter.

[potter5]

Thank you reallyfedup I am at surgery with plenty of good advice 😊 kind regards Potter