Hi, I’ve posted a few months previous and got some excellent support so hoping for some more help please.
My Symptoms are ongoing and driving me insane, I’ve got an Appointment with endocrinologist in two weeks and want to be able to go in informed so I’ve just asked for a copy of my results. These repeat tests were taken at 9.17am before medication.
Can anyone help me understand this?
My Gp took a wide range of other bloods and my Serum LH Level was also high (19 U/L) and Eosinophil (0.48) not sure if this has any relevance.
Thanks in advance
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CMBB27
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When you are healthy the ratio FT4/FT3 is about 3/1 to 4/1. The top acceptable FT4/FT3 ratio for someone on T4 only is about 4.5/1. Your ratio is nearly 7/1. It is obvious you have a conversion problem. Your FT4 is raised above the range even though your FT3 is only modestly above its range's bottom limit. This means that you probably need T3 medication as well as T4. This should lower your FT4 because you will take less T4, and raise your FT3 with the T3 you would take. This in turn will suppress your TSH to more acceptable lower values. I would guess that if reverse T3 was measured it would be elevated because your body will try to remove the excess T4 it can't handle in conversion to T3 by draining it by the rT3 pathway.
Thank you so much. I read something on this and wondered if there was a medication that could be taken. I’m not very knowledgeable on it all. Much appreciated
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
Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and fasting. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)
Last Levothyroxine dose should be 24 hours prior to test, (taking delayed dose immediately after blood draw).
Is this how you do your tests?
Ask GP to test vitamins and antibodies if not been tested
Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies or all vitamins
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
Medichecks currently have an offer on until end of May - 20% off
The aim of Levothyroxine is to increase the dose slowly in 25mcg steps upwards until TSH is under 2 (many need TSH under one) and FT4 in top third of range and FT3 at least half way in range
All four vitamins need to be regularly tested and frequently need supplementing to maintain optimal levels
NHS guidelines on Levothyroxine including that most patients need somewhere between 100mcg and 200mcg Levothyroxine. Also what foods to avoid (note recommended to avoid calcium rich foods at least four hours away from Levo)
For most people: 50–100 micrograms once daily, preferably taken at least 30 minutes before breakfast, caffeine-containing liquids (such as coffee or tea), or other drugs.
This should be adjusted in increments of 25–50 micrograms every 3–4 weeks according to response. The usual maintenance dose is 100–200 micrograms once daily.
Previous post showed low ferritin. Have you been working on improving this?
Did GP do full iron panel to test for Anaemia?
If TPO or TG antibodies are high (Hashimoto's) ask for Coeliac blood test
Always take Levo on empty stomach and then nothing apart from water for at least an hour after.
Many take Levothyroxine early morning, on waking, but it may be more convenient and possibly more effective taken at bedtime.
Other medication at least 2 hours away, some like HRT, iron, calcium, vitamin D or magnesium at least four hours away from Levothyroxine
Many people find Levothyroxine brands are not interchangeable.
Once you find a brand that suits you, best to make sure to only get that one at each prescription. Watch out for brand change when dose is increased or at repeat prescription.
Many patients do NOT get on well with Teva brand of Levothyroxine. Though it is the only one for lactose intolerant patients
Tested positive for thyroid antibodies about 2 year ago when pregnant with my son and seen endocrinologist. My Dosage was increased to 150 in pregnancy and I was fine, reduced to 125 and was ok and then since they’ve reduced to 100 that’s when all symptoms have returned. I’m now permitted to take an extra 25mg every other day but this had shown no improvement.
My vitamin D levels were tested and were also low and told to take over the counter medication. Admittedly I have not been doing this regular although i should be as I breastfeed a toddler too.
I am unsure what to do to improve Ferritin levels, can you help with this?
I have been considering trialling a gluten free diet and also I was dairy and egg free for my sons allergies and I think I may have felt better when doing so.
I have had all symptoms back since around October last year, it’s affecting my whole life and although still attending my slimming class I have gained almost two stone in this same period. I feel like I have no control and this then affects my mood too.
I can’t thank you enough for you advise I will read the links and try to learn more about it to help myself.
I’ve just had them done again this morning but stupidly I didn’t fast and took my meds because GP Said it was irrelevant (I now note your earlier advice). Would you mind if I post them in a couple of days for your advice please? The endocrinologist hasn’t asked for me to get bloods taken but I thought it would be wise to go with a recent update. Should I be taking vitamin supplements for all 4 or just the one that is low?
TSH secretion is pulsatile and has a circadian rhythm: serum TSH levels are 50% higher at night and early in the morning than during the rest of the day. Thus, repeated measurements in the same patient can vary by as much as half of the reference range.
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Under active thyroid
Undiagnosed under active Thyroid
Under active thyroid 
Under active thyroid 
Under active thyroid 
