I'm looking for advice please. Because I was feeling very tired and weak etc I had a private thyroid blood test. Results are :
TSH value 1.65 uIU/mL Range 0.35 - 4.94
Free T4 11.30 pmol/L Range 9.01 - 19.051
Free T3 4.08 pmol/L Range 1.88 - 3.18
The freeT3 is raised but only slightly and as the TSH and Free T4 fall within the normal range and so I am advised that it is 'unlikely' that I am hyperthyroid. However I have about 80% of the symptoms attributed to being hyperthyroid . Any advice please?
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Aspiegirl
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This is a bit confusing. Can you list all your symptoms and take your pulse and temperature as it is difficault to comment on just blood tests alone. Are you taking any medication? Has your ferritin, b12 vitamin D or folate been taken by GP 0r privately. Sorry for so many questions but it will help give us a picture picture to respond from.
t4 is very low, I would feel like death warmed up on that score - tell your consultant that you want to try t4 - if you have any chronic illnesses such as eds you will require more, do your research before you discuss this with them. Not sure why your t3 is elevated but you do seem to be converting appropriately but others may advise differently, I'm not really up on that.
T4 is our storage hormone and our bodies convert it to T3, the active hormone. The levels of hormone that are available for the body's use are the FreeT4 and FreeT3, respectively.
Sometimes, when the body doesn't have adequate stores of T4 it will "overconvert" as much T4 as possible into T3
Although your TSH is pretty good.
Have you checked B12 and Vitamin D levels, folate and ferritin?
Get Drs advice, preferably an endo as a lot of GP’s don’t have a clue.
The blog owner cut back on NDT + T3 to take mainly T4 and a little T3. She argues that T4 has a role in the body, too, and is not just a storage hormone. That's quite different from what you read on the STTM and other sites advocating the use of T3 and/or NDT where it's often said that T4 is completely inactive.
The author of Tired Thyroid is *Spot On* . I experienced many of her experiences with thyroid meds . In my experience a high dose T3 gave me many symptoms . A low dose T3 with a higher dose T4 works best for me . Dr Blanchard's approach to thyroid dosing was the same in his book "Functional Approach " . Higher dose T4 to a small dose T3 .
I am beginning to suspect that is true for me as well...that I should lower NDT and add some T4. A while ago, I read about adding T3 to a reduced dose of NDT, to clear rT3 (just what the blog author describes), and I felt terrible...racing heart, sweating profusely, itching all over my body. I felt better as soon as I went off synthetic T3. The blog "Tired thyroid" mentions some being on as little as 1/2-1 grain of NDT daily, along with T4, so I have no way of knowing where I'll end up...however, I am beginning to suspect the T3:T4 ratio in NDT may not be optimal for me, at least no longer, so maybe my hormonal needs have changed.
This blog also contains some interesting information:
I had the same symptoms as yourself too from high dose NDT for my T3 mix . Sweating , aches and pain , insomnia , fatigue , irritable , palpitations . Raising my T4 dose with low dose NDT made a huge difference for me . There are those as myself that are sensitive to high dose T3 . I'm sure that there are thyroid patients that are sensitive to T4 dose and need higher dose T3 with lower dose T4 . Our needs are individual and ought to be respected and *custom tailored to our needs* to feel our *Optimal* .
You too I find this article (from the same blog) very interesting as well...I especially like what the author says about "more (T3) is not always better"...!
Yes me too . And the author is So So Right . I bought into high dose T3/NDT at first only to feel even worse than ever. I realized that this was not working for me . I was doing pretty well on T4 only dose with a few exceptions . Adding nutrients made a huge improvements as did adding a low dose NDT for my T3mix .
I had TT many years ago . Not having my own thyroid I now need to manually add T4 and T3 what my thyroids once made . My thyroids now come from a bottle . I'm also not a good converter T4 to T3 . So adding a small dose NDT for my T3 helps with the conversions .
PS. Can I ask how much of each hormone (T3 + T4) you are currently taking; just to get an idea...? I know we are all different, but it can always be useful to know how much others are taking.
My Dr once told me that he wanted me to be eventually on 150mcg T4 . I was at the time on a higher dose for suppression purposes . I went down to 150mcg T4 felt well and my labs proved it too . But I was experiencing palpitations and would never know when it would happen . It was very debilitating . I went to an Endo who gave me 5mcg T3 my palpitations stopped but instead I had surges . I switched to a different Endo who over dosed me with NDT and as a result I had many symptoms . While I'm very grateful for my Endo giving me NDT. But too much is just as bad as not having enough . I had to do it on my own . Journaling each time my symptoms . I became my own lab rat . What I worked off of was 150mcg T4 that worked well for me . I lowered my 150mcg to 137mcg T4 + 3/8 grain NDT . Which gives me 150mcg T4 + T3 a bit over 3mcg . I split my T4 2x/daily and my NDT 3x/daily . This is what works for me .
This might not work for many because many need more T3 . But for me it works and my palpitations calmed down .
Interesting! It seems many patients feel well on 150 mcg daily. I remember feeling pretty well on 175 mcg daily eight years ago, before switching to NDT...anyway, it seems many patients need more than the 100 mcg that our thyroid glands are said to produce daily when healthy...! Wishing you well as well
Are you in any thyroid hormone replacement, or been diagnosed with any thyroid condition? Have you ever had a test for Hashimoto's antibodies, that is Thyroid Peroxidase Antibody, and Thyroglobulin Antibody?
These are unusual results, and interpreting them it makes a big difference whether you're taking thyroid hormone or not.
Thank you for responding. No I am not taking any thyroid hormones. I have not yet seen my GP about thyroid issues and I did the test because I thought I might have an underactive thyroid - in common with my mother, grandfather and aunt.
Okay, I'll tell you what I think about each number.
TSH of 1.65 (0.35-4.84) is an ideal number that we'd expect to see in a healthy person. This skews towards the bottom of the range, and people with a healthy thyroid would have values between about 0.8 and 1.88.
The TSH is Thyroid Stimulating Hormone, and is a responses to how much thyroid hormone you've got made by the pituitary gland. When overall hormone is low, it makes higher TSH to call out to the thyroid to make more. This can become suppressed below the range when your hormone is high and the body isn't asking for any new hormone to be made.
Because this is a response, it can sometimes be a bit sluggish and slower to act than the other numbers in the thyroid panel.
Both your free values are quite unusual. For these the range in healthy people is a normal curve, so the largest number of people with a healthy thyroid will be close to the middle of the range. Usually if we see the results of a person with a healthy thyroid both numbers are close to the centre.
In your case, freeT4 is pretty low in the range, and freeT3 is very high, all the way over the range. Free T4 11.30 (9.01 - 19.051), Free T3 4.08 (1.88 - 3.18).
However, this panel as a whole is quite puzzling. Usually if your thyroid had become overactive and was producing loads of hormone, you'd see freeT3 sky rocket high, and the TSH would have responded to that by becoming very very low. But your freeT3 isn't in that hugely increased range.m
I don't know as much about overactive thyroid or Grave's disease as I do about underactive. So it is possible that this could be an early stage or something I don't know about. It looks to me like it probably isn't Grave's, but I don't know enough about it to tell you that categorically.
Something I suspect is that this could be a Hashimoto's flare up. This would mean you have the autoimmune disease that causes underactive thyroid, which would mean your thyroid will slowly deteriorate, but yours is overall still quite good. But one symptom of Hashimoto's is that as it damages the thyroid, sometimes extra hormone gets dumped in the bloodstream. This means temporarily there is a big spike in thyroid hormone, and makes you feel bad. But hopefully it passes in a short time. This would explain why your TSH hasn't reacted yet, that this is more of a short term situation and it hasn't had time to get in gear yet.
I think you were very right to get your thyroid tested. These things run in families, and with all that family history it was always likely you will have thyroid problems. Both overactive and underactive can appear in the same family.
My suggestion would be to go back and have a retest of the thyroid panel in about 2 months. I think with what you've got here it's clear something is going on, but its so unusual I've never seen this pattern before. Seeing a change over time will help make it clear. If you're able to get Hashimoto's antibodies tested at the same time, do, these are Thyroglobulin antibody and Thyroid Peroxidase antibody.
I don't know where you had them done, but both Medichecks and Bluehorizon are easy places to get a finger prick, mail order blood test that might work out cheaper if you've done something else.
If you get new blood tests post them as as brand new post so more people will see them.
Another thing is to be quite cautious of anyone gives you any firm suggested diagnosis from these results, as doctors can often jump to conclusions. Especially if it's Grave's, as the treatment for that is quite destructive to the thyroid. Its possible you may end up with that diagnosis in the end, but I think you don't have enough evidence for it today.
I'm sorry these are not more conclusive comments. Unfortunately everything with thyroid is slow!
Thank you again. I have read your message to me. You really seem to have been through the mill but looks like better things are on the horizon.
I am still very new to all things thyroid but nonetheless have read about failing thyroid glands flaring up and then diminishing again. I think that you might be right that to leave things for several months and retesting might shine more light on what is happening.
I think you're ahead of the game because you're getting your own tests and learning about the illness. People who don't do their own research can get left hanging around for years by doctors!
Good luck, I hope you see something clearer when you get retested!
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I find this article (from the same blog) very interesting as well...I especially like what the author says about "more (T3) is not always better"...!
T3 very high
Can Free T4 chop and change and cause change in symptoms?
High T4, T3 and Anti-Thyroglobulin. Graves Disease? 
Hypothyroid Symptoms/Hyperthyroid Bloods 
