Hi all,
Just returned from my second appointment with a private endrocronologist who stated my TSH is perfect; TSH 0.54 and Free T4 12.2. He is happy that my current dose of 75mcg levothyroxine is working well. However, he suggested that my symptoms specifically my weight gain, fatigue, dry skin could be down to my liver function. Please see results attached and let me know your thoughts. Thanks.
Looking st previous posts, 5 months ago you were taking 125mcg/150mcg Levothyroxine alternate days
So now you are on significantly lower dose
Why?
What's the range on the FT4 result?
FT4 of 12 sounds low
Most patients on Levothyroxine need low TSH, frequently under 1 and FT4 towards top of range and FT3 at least half way in range
Was FT3 tested? It's the most important result
When were vitamins last tested?
Do you have Hashimoto's diagnosed by high thyroid antibodies
For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also extremely important to test vitamin D, folate, ferritin and B12
Low vitamin levels are extremely common, especially if Thyroid antibodies are raised or if on too small a dose
Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and fasting. Last Levothyroxine dose should be 24 hours prior to test, (taking delayed dose 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?
Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies or all vitamins
thyroiduk.org.uk/tuk/testin...
Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have special offers, Medichecks usually have offers on Thursdays, Blue Horizon its more random
Was this endocrinologist from the list of recommended thyroid specialists from Thyroid UK?
Email Dionne for the list if you don't have it
tukadmin@thyroiduk.org
Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,
"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.
In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l.
Most patients will feel well in that circumstance. But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.
This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."
You can obtain a copy of the articles from Thyroid UK email print it and highlight question 6 to show your doctor please email Dionne
Hi SlowDragon
Yes you are right, 5 months ago you I was taking 125mcg/150mcg Levothyroxine alternate days but after meeting Dr Peatfield he suggested I gradually decrease my dose.
The range on the FT4 result is (7.9 -16) and I'm currently 12.2
FT3 was not tested this time. In November, the range was (3.8 - 6.0) and I was 5.0 pmol/L.
My vitamins were last tested in November and my Vitamin D levels were borderline insufficient but I have been taking supplements since then.
I have not had Hashimoto's diagnosed but did mention it to my Endro and he does not think I have it.
I previously had a full thyroid evaluation which included everything you mentioned and in addition paid for a Medichecks test.
I do my blood tests as suggested.
The endocrinologist was from the list of recommended thyroid specialists from Thyroid UK.
Thanks
Seesee18
Your liver test results are all in range except for raised ALT levels. You can check what this means here, click on "What does the test result mean"
labtestsonline.org.uk/tests...
he suggested that my symptoms specifically my weight gain, fatigue, dry skin could be down to my liver function
I don't agree. Those are all symptoms of hypothyroidism. When I was undermedicated my skin was so dry on my legs that when I took off my trousers there would be a shower of dry skin.
private endrocronologist who stated my TSH is perfect; TSH 0.54 and Free T4 12.2. He is happy that my current dose of 75mcg
Your TSH may be perfect, but what's the range for the Free T4? We see on here the following ranges:
1) 7-17
2) 9-19
3) 12-22
So if it's anything like any of those you are
1) 52% through range
2) 32% through range
3) 2% through range
and none of those are ideal.
When on Levo only, the aim of a treated hypo patient generally is for TSH to be 1 or lower with FT4 and FT3 in the upper part of their ranges if that is where you feel well.
75mcg is a low dose.
You may have poor conversion of T4 to T3. The way to find out is to test FT3 at the same time as FT4 and TSH.
For good conversion to take place we need optimal nutrient levels, so you need to test Vit D, B12, Folate and Ferritin.
If GP can't or wont do all the tests - and with FT3 it's the lab that makes the decision, then if you would like to do the full thyroid (including antibodies/vitamin panel then we have recommended labs that do home fingerprick tests, or venous blood draw if preferred at extra cost.
Medichecks Thyroid Check ULTRAVIT medichecks.com/thyroid-func... (this is on special offer at the time of writing this reply and is a good buy)
or
Blue Horizon Thyroid Check PLUS ELEVEN bluehorizonmedicals.co.uk/t...
Both tests include the full thyroid and vitamin panel. They are basically the same test but with the following small differences:
For the fingerprick test, Blue Horizon requires 1 x microtainer of blood (0.8ml), Medichecks requires 2 x microtainers (total 1.6ml)
Blue Horizon includes Total T4 (can be useful but not essential). Medichecks doesn't include this test.
B12 - Blue Horizon does Serum B12. Medichecks does Active B12.
Serum B12 shows the total B12 in the blood. Active B12 shows what's available to be taken up by the cells. You can have a reasonable level of Serum B12 but a poor level of Active B12. (Personally, I would go for the Active B12 test.)
Hi Seesee, Unless you have hepatitis, it's probably fatty liver which seems to go along with being hypothyroid. I agree with others that you have thyroid symptoms. Are you sure Dr. Peatfield wanted you to reduce to that extent? I think you are undermedicated because we don't really know what's working without knowing your FT3. I would guess it is low. Your symptoms also deem it low.
Your liver is where T4 converts to T3 for the most part and with those symptoms it seems you may not be converting.
Hi, I had a similar issues. The endo i saw said the Alt levels were connected to the weight I had put around my stomach. He suggested a low carb diet (part 2 and 3 of Atkins) which I followed and my levels returned to normal. However I only saw the results once all my levels were optimal (TSH, fFT3 and fFT4). Which I guess you could argue it was down to not being properly treated for hypo. I have an issue converting T4 to T3 btw.
Hi Seesee18 your results do look good your TSH is under 1 which is good and T4 seems good at 12.2 since the range is 7.9-16 
I would trust your Endo on this one he seems to know whats going on not everyone needs to be on a high dose of Levo and if your levels are stable on 75mg then thats perfect. Everyone is different and this dose seems to be good for you at the moment.
I don't think your doctor is a very good diagnostician. If I can find this on the internet, so can he:
"What are the symptoms of fatty liver disease?
A feeling of fullness in the middle or upper right side of the abdomen.
Abdominal pain.
Loss of appetite or weight loss.
Nausea.
Weakness.
Jaundice (yellowing of the skin and the whites of the eyes)
Swelling of the abdomen and legs (edema)
Mental confusion."
my.clevelandclinic.org/heal...
You have weight gain, not loss. Fatigue is not the same thing as weakness. Don't see dry skin in the list of symptoms. Personally, I think he is embarrassed about not treating your thyroid disease well, so he is grasping at straws to explain your symptoms.
A FT4 result of 12 is very likely far too low
FT4 should be in top third of range
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