Advice please

[Ling477]

Hi I wondered what people’s thoughts were, I’m 38 been on thyroxine for around ten years currently on 200mg per day, always been able to manage my weight, always wanted to be a stone lighter but doesn’t everyone! It hasn’t really bothered me that much however I’ve put a stone on since Xmas and am really struggling, also feel so tired and fainted last week for the first time. Had bloods done and these are results, T4 17.4 Range is 10-18.7, T3 3.2, Range is 3.5-6.5, iron is 58, Range is 22-322, B12 is353 Range is 211-911. Receptionist stated they are all normal repeat in 2 months! I said hang on I want an appointment which I now have for next Friday, my thoughts are that I’m not converting properly and that my iron is on the low side but I would appreciate any views thank you

[SeasideSusie Remembering]

my thoughts are that I’m not converting properly and that my iron is on the low side

And I agree with you

iron is 58, Range is 22-322

Is this Ferritin? If so it's recommended to be half way through range with a minimum of 70 for any thyroid hormone to work (our own or replacement). You can help raise your level by eating liver regularly, maximum 200g per week due to it's high Vit A content, also liver pate, black pudding, and including lots of iron rich foods in your diet

apjcn.nhri.org.tw/server/in...

B12 is353 Range is 211-911

Is this pmol/L or ng/L or pg/ml?

According to an extract from the book, "Could it be B12?" by Sally M. Pacholok:

"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".

"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."

Any signs of B12 deficiency? Check that here b12deficiency.info/signs-an...

FT4: 17.4 Range is 10-18.7,

FT3 3.2, Range is 3.5-6.5

Receptionist stated they are all normal repeat in 2 months!

Please ask your doctor, on which planet is a below range result - as is your FT3 - considered normal? And should a receptionist be giving out opinions on test results?

Your FT4 is 85% through range, your FT3 is 10% BELOW range. This should be pointed out to your GP and the fact that you aren't converting T4 to the active hormone T3, that every cell in our body needs, discussed. [Your low FT3 is the reason you're not able to lose weight.] Maybe ask for a referral to an endo with providing a prescription for T3 in mind. It's an endo's decision to start T3, although it is increasingly difficult to get it prescribed on the NHS now due to cost. A private prescription can be offered if the doctor thinks the need is there.

Optimising your ferrtin may help conversion, but your FT3 is so poor that it's unlikely optimising ferritin will make that much difference.

Just remembered - Dr Toft, leading endocrinologist and past president of the British Thyroid Association, has recently written a new article which says that T3 may be helpful for many patients

rcpe.ac.uk/sites/default/fi...

[Ling477 in reply to SeasideSusie]

Thank you so much for this! So informative I’m going to my appointment armed with all your information although my thoughts are that he will not prescribe T3, I’m going to ask for a private prescription however not sure if GPS can do this and also for my ferritin to be treated, I’m not sure on the B12 but will find out, I really appreciate you taking the time to answer thank you

[SeasideSusie Remembering in reply to Ling477]

Your GP probably wont give you anything for your ferritin level, it's not really low enough - as far as they're concerned it's within range, that's all they care about. But it's too low for us Hypos and this is where we have to help ourselves.

GPs can issue private prescriptions but whether yours will or not is another thing. If not, then ask for a referral to an endo. Chances are you GP wont know anything about T3, most of them don't unfortunately. But use the Dr Toft article to "educate" your doctor

[SlowDragon Administrator]

Recommended on here that 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)

Is this how you do your tests?

You also need vitamin D and folate tested

Both likely low

What was your TSH?

Guidelines on getting referral for possible T3 trial

british-thyroid-association...

New NHS England Liothyronine guidelines November 2018 clearly state on pages 8 & 12 that TSH should be between 0.4-1.5 when treated with just Levothyroxine

Note that it says test should be in morning BEFORE taking Levothyroxine

sps.nhs.uk/wp-content/uploa...