I’ve just had my 3rd blood test since being diagnosed with hypothyroidism in January this year. My first 2 tests only looked at TSH and T4, but this time I asked for the full range of tests including T3.
I’ve just had the results back (below) but for some reason the T3 result wasn’t returned. When I asked my Dr about this he said that the lab often won’t bother to test T3 if they don’t believe it’s necessary, despite the request.
My Levothyroxine dose has just been increased to 100g as my TSH is not yet in range. I’m certainly feeling nowhere near well, but is there any point in my asking again for my T3 to be tested if my TSH is not yet optimal?
These are my results:
Thyroid antibodies - 386 iu/ml
FT4 - 16.6 pmol/L
TSH - 4.38 mu/L
Vit D - 101.1 nmol/L
Ferritin - 69 ug/L
B12 - 379 ng/L
Folate - 8.8 ug/L
Thank you in advance,
Jo
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It's normal for labs not to test FT3, they may do it if TSH is suppressed.
Can you please add the reference ranges for all your tests, they vary from lab to lab so we can't interpret your results without them.
Your TSH is far too high, 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. So you still have a long way to go, you need an increase of 25mcg Levo now, retest in 6-8 weeks, keep repeating until levels are where they need to be for you to feel well.
I imagine your thyroid antibodies are well over range (is this Thyroid Peroxidase?) and this confirms autoimmune thyroid disease (known to patients as Hashimoto's) which is where the thyroid is attacked and gradually destroyed. Fluctuations in symptoms and test results are common with Hashi's.
Some members have found that adopting a strict gluten free diet can help, although there is no guarantee.
Gluten contains gliadin (a protein) which is thought to trigger autoimmune attacks so eliminating gluten can help reduce these attacks.
You don't need to be gluten sensitive or have Coeliac disease for a gluten free diet to help.
It’s strangely reassuring to hear I have a long way to go before I feel better. My Dr led me to believe I’d be feeling better almost immediately after starting Levo, and said the same after my TSH result went from 23 to 7 suggesting I’d very soon be on the mend. In reality I continue to feel like a walking corpse.
Many thanks for the links. I have had gut problems for years, and was diagnosed with IBS a few years ago. This has significantly improved since I started Levo so they may well be linked.
I agree with SeasideSusie, it takes a long time to get hormone optimal. Doctors will always under play things and say it will be a piece of cake. I've started saying to people it takes at least 6 months to get to an optimal dose, but for many of us that's a big under estimation!
The out of range Thyroid peroxidase result proves you have Hashinotos.
Looking at the TSH and freeT4 you have quite a way to go to get these in good shape. For TSH most of us feel better with it very low in the range, right at the bottom or even below. For freeT4 most people feel well with it right at the top. Your freeT4 is just under halfway, so there's a lot of room for increases.
With the freeT3 test we often hear the story that labs refuse to test it when it is requested Whether you need it or not is a judgement call. It's very obvious from the TSH and freeT4 you need an increase, probably a few increases in a row. In that sense freeT3 doesn't add additional information, so it's not critical.
On the other hand, in the future if you get to they point where freeT3 is more obviously useful, it can be very nice to compare that result with where your freeT3 was at this point. Unfortunately the NHS is really bad about this and probably won't do freeT3 in the future, either
If you'd like to have the test for your own records, you could go to Medichecks or Bluehorizon and get a finger prick mail-order test. I think it's about £40 to get the full thyroid panel, and a bit less for only the freeT3 (its best to get the 3 together). If you can easily afford it you could get one on this dose, but it will be more valuable to see the freeT3 later, once your other numbers look good.
Thank you for very much for your reply. You’ve answered my question about whether I can test privately for T3.
I have to say I was expecting my TSH to be in range this time round. Not because I’m feeling well, but because it dropped a lot initially. In your opinion do you think my Levo dose may even go up again? I’m only asking because I feel so awful every time I have an increase.
In my experience when numbers look very bad, they improve quickly, but it takes a bigger increase to improve the closer we get to optimal.
Yes, looking at your blood tests I'd guess you will need several increases in Levothyroxine to get your freeT4 to the top which will hopefully resolve symptoms and have you feeling well. Everyone is different, though, so it's hard to predict. I'm not surprised you still feel terrible with it this low.
It's interesting you feel bad in having an increase. I've always tended to feel an improvement after a few weeks. You feel worse at first and then it settles down after a while? Is it a speeded up feeling, like heart racing, feeling restless, hot and bothered?
If it's like I describe, it can be due to adrenal issues. These benefit from vitamins improving and from thyroid hormones getting into your body, so it may eventually sort itself out.
It's common to feel worse overall when starting thyroid hormones. This is because your body will have been working overtime and ramping up efficiency to keep everything going while your hormone has been low. Then you add some extra hormone into the mix, and that disrupts everything, but isn't a high enough dose to actually improve things. It could also be that you're still at that point, despite having a few increases, because your numbers are still quite low.
Hopefully whatever is making you feel worse is a consequence of being low on hormone, which would mean it should reduce as you get closer to being well.
Yes, SilverAvocado, it’s exactly like that, and I feel like i’m coming down with the flu but nothing materialises. So far, i’ve only begun feeling better after about 5/6 weeks, which is obviously just before a retest followed by a dose increase. As a result i’ve only had about 2 weeks since Jan that i’ve had any energy and motivation. I have 6 children so this has been especially hard on my husband!
My Dr said he thought i’d remain at 75mcg when my TSH was 7.3 so I fully expected to be feeling well by now. If it wasn’t for this group and the reassurances that my journey to wellness will take far longer than he suggested, i’d be going insane!
Sorry for late reply, I didn't get notification of your reply because you replied to your own opening post rather than to me - if you are replying to someone you need to click on the blue "Reply" directly beneath their message (between the heart and "More") and then notification is sent to the person you are replying to
OK, so it's your TPO antibodies that are well over range, so the information above may help.
FT4 is only 46% through range so along with your high TSH this shows there's a long way to go to reach your optimal dose and optimal hormone levels.
Ferritin - 69 ug/L (15-300)
It's said that for thyroid hormone to work properly (that's our own as well as replacement hormone) ferritin needs to be at least 70, preferably half way through range.
I've also seen it said that 100-130 is a good level for females. So you don't need an iron supplement but you might want to try and improve your level and the easiest way is 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
I only needed 120-140g liver a week to raise my low level, then just once every 2-3 weeks should maintain a good level.
B12 - 379 ng/L (180-700)
ng/L is the same as pg/ml
This is on the low side. 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."
Folate - 8.8 ug/L (4.6-18.7)
Folate is recommended to be at least half way through range (12+ with that range) so you're a bit low. A good B Complex containing methylfolate (not folic acid) and methylcobalamin (not cyanocobalamin) will help raise both Folate and B12. Consider Thorne Basic B or Igennus Super B, both contain the bioactive forms of ingredients.
Vit D - 101.1 nmol/L
Vit D has categories and each category has a range. I think yours comes into the Sufficient or Adequate category. The Vit D Council recommends a level of 125nmol/L and the Vit D Society recommends a level of 100-150nmol/L so as we are coming up to summer you may make enough Vit D naturally from the sun (uncovered skin with no sunscreen for about half an hour should make sufficient Vit D). You may wish to retest in November as you may need to top up with a maintenance dose during the winter.
Gut and absorption problems are very common when Hashi's is present, and often leads to low nutrient levels and deficiencies. Yours aren't too bad at the moment but worth keeping an eye on. I don't have Hashi's but when testing privately I did discover severe Vit D deficiency, low folate and low ferritin. I've addressed these and now maintain at a good level and do a private test to include full thyroid and vitamin panel once a year, although I do test Vit D twice a year.
Medichecks and Blue Horizon do a wide range of tests, the test bundles tend to be better value, and Medichecks have a 10% discount on tests not on special offer when using code THYROIDUK, have special offer on specific tests every Thursday, and bonus discounts occasionally - currently code TUK20 gives 20% discount until the end of May. Blue Horizon occasionally have discounts and special offers. Feel free to ask for suggestions for tests if you wish to do any private ones.
Thank you so much for your reply, and for giving me so much information!
I can’t say the idea of eating liver is an appealing one but I could probably just about manage some pate on some gluten free bread!
I have just ordered Selenium and Thorne Basic B supplements as per your recommendations. I have been taking a multi-vitamin too but from what I’m reading this probably isn’t necessary. I’ve been supplementing Vit D for several months now, which is likely why my levels are okay.
Thanks for the info re private testing. Does that include T3?
Thanks for the info re private testing. Does that include T3?
Yes, their most basic thyroid panel covers TSH, FT4 and FT3 (never do FT3 on it's own, it needs to be done with the others). Medichecks is Thyroid Monitoring, Blue Horizon is Thyroid Check Plus 3.
There is the basic panel plus antibodies but you don't need that as you already know you have positive thyroid antibodies.
If you want to check your vitamin levels - recommended once a year or to monitor if building levels up - then the cheapest way is with a thyroid/vitamin bundles which covers TSh, FT4, FT3, Thyroid antibodies, Vit D, B12, Folate, Ferritin and CRP. Medichecks is Thyroid Check ULTRAVIT and Blue Horizon is Thyroid Check Plus ELEVEN.
If you make curry, then you could chop/mince some liver and add it to that, the curry sauce will disguise any taste of the liver, it can also be put in spaghetti bolognese, cottage pie, or any meat dish. But liver pate is fine.
Don't start all supplements at the same time. Start with one, leave it 1-2 weeks and if no adverse reaction then add the second one. Continue like this. If you have any reaction then you will know what caused it.
Are you taking the cofactors needed when supplementing with D3 as recommended by the Vit D Council -
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.
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Whether you need it or not is a judgement call. It's very obvious from the TSH and freeT4 you need an increase, probably a few increases in a row. In that sense freeT3 doesn't add additional information, so it's not critical. 
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