Hi, attached is my basic record of my blood tests and I have a couple of questions which I hope someone can help with. After my test on 24/01 (and after seeing my Endo) my gp increase my Levo to 75mcg....Endo states that he wanted my TSH down to lower end of range and FT4 in the upper end of range. My test on 18/03 shows that my TSH is heading in the right direction but the FT4 is above range.
Now my gp has refused to increase my Levo to 100mcg as planned because of the FT4 being slightly over...gp is writing to Endo to ask for advice as they’re still convinced that I’ll go from HYPO to HYPER with an additional 25mcg.
So the obvious questions are:
1) is the high FT4 going to cause any problems?
2) is the high FT4 indicative of a poor conversion of Levo?
3) what can I do next?
My gp is also going to ask Endo about doing a test for FT3...and I’m due to get bloods done again in 6 weeks.
Any help / suggestions would be appreciated.
Thanks
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markwsteele
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It's unusual to have an over range FT4 when TSH is close to top of range. One would expect to see your TSH nearer 1, maybe lower, with such a high FT4.
What time of day was this test done?
When did you take your last dose of Levo before the blood draw for this test?
1) is the high FT4 going to cause any problems?
Possibly. High FT4 can cause reverse T3, but few doctors know much about this. But we need to know when you took your last dose of Levo to know if this is a false high result or your normal circulating level of FT4.
2) is the high FT4 indicative of a poor conversion of Levo?
It can be indicative of poor conversion of T4 to T3. To be sure of this, TSH needs to be down to around 1 and you would have to have TSH, FT4 and FT3 all tested at the same time, having taken Levo 24 hours before the blood draw. There's no other way of knowing.
3) what can I do next?
See what your endo says. But tell us when you took your last dose of Levo before this test.
My test was done at 0830 on the 18th...last levo was at 0800 on the 17th. As each increase has helped me feel better the last thing I really want is to start to decline again, as I really want to go back to work.
So your timing was perfect and you don't have a false high FT4. Your endo should see that there is an anomaly here with such a high TSH and high FT4. Whether or not he has enough knowledge of treating hypothyroidism to know what to do though is another thing.
What are your current vitamin/mineral levels? Vit D, B12, Folate, Ferritin.
Are you supplementing anything?
Do you take any supplements/medication anywhere near your Levo - gap must be at least 2 hours, some require longer.
Did you take a B Complex or Biotin (B7) in the week before this test?
Did you drink anything other than water before this test? Caffeine containing drinks (tea, coffee, cola, etc) before this test?
I don’t take any kind of supplements...it’s never been mentioned at all. My other levels are:
Serum Folate 4.5 (3.9-26.8)
Serum Ferritin 98 (30-400)
B12 840 (197-771)
Vit D 59 (50-100)
I have been on 12 weekly b12 injections for nearly 2 years now.
I didn’t drink anything other than water before my blood test and the only other medication I take in the morning is Propranolol 40mg...and that’s always 2 hours later.
That's low. It's recommended that folate is at least half way through range. When taking B12 in any form, we need a good B Complex to balance all the B vitamins. So as you have B12 injections you should consider taking a B Complex - one that contains methylfolate rather than folic acid (I like Thorne Basic B, others use Igennus Super B).
Serum Ferritin 98 (30-400)
Ferritin is recommended to be half way through range. I'd increase your intake of iron rich foods, particularly liver (max 200g per week), liver pate or black pudding is good for raising ferritin. Other iron rich foods here
I imagine the unit of measurement is nmol/L (and not ng/ml), in which case this is low. The Vit D Council recommends a level of 125nmol/L (50ng/ml) and the Vit D Society recommends a level of 100-150nmol/L (40-60ng/ml).
The Vit D Council recommends, for your current level - if it is 59nmol/L - supplementing with 3,700iu D3 daily (nearest is 4,000iu).
Retest in 3 months.
Once you've reached the recommended level then you'll need a maintenance dose to keep it there, which may be 2000iu daily, maybe more or less, maybe less in summer than winter, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. You can do this with a private fingerprick blood spot test with an NHS lab which offers this test to the general public:
D3 aids absorption of calcium from food and K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems such as hardening of the arteries, kidney stones, etc.
D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds if taking tablets/capsules/softgels, no necessity if using an oral spray
Magnesium helps D3 to work. We need Magnesium so that the body utilises D3, it's required to convert Vit D into it's active form. So it's important we ensure we take magnesium when supplementing with D3.
Magnesium comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds if taking tablets/capsules, no necessity if using topical forms of magnesium.
Propranolol is likely causing problems. It can significantly affect Levothyroxine uptake/conversion
However it MUST NOT be stopped suddenly
Why are you on propranolol?
It has to be weened off incredibly slowly, dose reduced extremely slowly
Is the propranolol you are taking a single slow release capsule?
You might need to swop to 4 x 10mg tablets spread through the day. That enables you to slowly cut the tablets down.
Discuss with GP
Personally I found the maximum I could tolerate was 5mg reduction. Wait 10-14 days to get use to. Then reduce by further 5mg. Repeat until only on 5mg. The last 5mg is the hardest. Stoping just one day a week, then two days a week etc
You might find my profile interesting....I was stuck on propranolol for almost 20 years as Levothyroxine caused terrible "anxiety " due to low vitamins and hidden gluten intolerance
Getting vitamins optimal essential
Propranolol may lower magnesium
Looking at DIO2 gene test at some point in future too may be helpful if you are eventually considering adding T3
Of the beta-blockers, propranolol and nadolol have an additional benefit by blocking peripheral conversion of T4 to T3, although any beta-blocker can be used
Hi Markwsteele, I clicked through from your recent post to have a look at your results. Just wanted to mention to you that a good friend of mine had very similar results, and since then I've noticed it popping up on the forum now and again, so it's not unusual.
He also had an over range freeT4, and high TSH. The highest I saw was a TSH of 9 while the freeT4 was over range! He had a problem similar to you that doctors had no idea what was going on, because it's not what you'd expect as the most standard pattern. He had some doctors looking at TSH only and increasing his dose, then later doctors seeing freeT4 as well and reducing him
Once we saw a freeT3 of course it was low! The TSH is responding to the level of circulating T3 and whether the body has what it needs to function!
In my friend's case he ended up buying his own T3, that is an idea you should keep on the back burner in case you get no joy from doctors. My advice would still be to try the hoop jumping, and if they don't budge on the T3 at your next test in 6 weeks think about sourcing your own.
Edit: As you've got some very low vitamin results, addressing those may also improve conversion on its own. A lot needs to be in place for the body to be able to process and convert the hormone effectively.
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