Hello,
My dad has just had his results back after being told to lower his thyroxine and this is the new result. He has many symptoms especially tiredness, perhaps due to the testosterone? Can anyone comment on the thyroid results please? Is he converting ok? His current medication is 200mg daily levo.
I have attached one photo as it wouldn’t let me attach both sheets?
T3 result was 4.6 (3.5-6.5)
FSH 17.7 (1.4-18.1)
LH 5.1 (1.5-9.3)
Thanks so much x
Pinky3
Are these the results before reducing dose ?
I’ve just sent the question to him and he said yes he was on 200 for a long while.
Pinky3
TSH: <0.05 (0.55-4.78)
FT4: 15.6 (9-22.7) = 48.18% through range
FT3: 4.6 (3.5-6.5) = 36.67% through range
It's clear that his GP is altering dose purely on TSH which is wrong. TSH is a pituitary hormone not a thyroid hormone, the thyroid hormones are FT4 and FT3 and as you can see these are low in range.
The aim of a treated hypo patient generally is for TSH to be 1 or below or wherever it needs to be for FT4 and FT3 to be in the upper part of their reference ranges, if that is where you feel well.
Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine (the magazine for doctors):
"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).*"
*He recently confirmed, during a public meeting, that this applies to Free T3 as well as Total T3. You can obtain a copy of the article by emailing Dionne at
tukadmin@thyroiduk.org
print it and highlight question 6 to show his doctor.
Did his GP say why the dose reduction? If because of the low TSH, what was his TSH in previous tests?
Thank you for these calculations 
He has told me the Endo said he is taking the highest dose and wants to lower it on that basis. Even with his results showing as low in range! His last tsh reading was 0.31, this was over a year ago though.
If the endocrinologist believes he is in too much thyroxine, even with these results, would it warrant to ask for liothyronine?
He is not on the highest dose. One of my old neighbours (female) was on 300mcg Levo. I don't think his results warrant asking for liothyronine, he needs to get his FT4 further up the range first. Good conversion needs optimal nutrient levels so Vit D, B12, folate and ferritin need testing, as SlowDragon has mentioned. Optimal levels are
Vit D - 100-150nmol/L according to the Vit D Council/Vit D Society.
B12 - serum minimum 550 to top of range, Active minimum 70 (below 70 suggests testing for B12 deficiency) preferably over 100.
Folate - at least half way through range.
Ferritin - half way through range.
I did think that his medication wasn’t that high. These are all very good points, I will forward everything to him, thank you.
I have read the article you mentioned and question 6 has the following “While taking both hormones it is important serum TSH is normal and not suppressed.” I am taking both and my tsh is suppressed. Should I be worried?
I am taking both and my tsh is suppressed. Should I be worried?
I'm taking both and my TSH is suppressed. My TSH was always below range or suppressed on Levo only. I'm not worried.
For full Thyroid evaluation he needs TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also extremely important to test vitamin D, folate, ferritin and B12
His FT4 is now on low side and FT3 is too
Presumably you have Hashimoto's?
Likely he does too
Low vitamin levels are extremely common, especially if Thyroid antibodies are raised
Low vitamin D and low testosterone may be linked
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 he did 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
Yes we both have the same condition, he started in his 30’s he’s now 65 and alway suffered never thought he could be any different. His previous B12 was low and I believe he’s having that treated. I also think the test was early and I said not to take meds before the test.
What would you advise him? Is there a reason the levels are low? Do you think he needs t3?
Low vitamin levels are extremely common if under treated or poor converter
Ask GP to test vitamin D, folate and ferritin
Are you on strictly gluten free diet?
Is your Dad on strictly gluten free diet?
If not on strictly gluten free diet request Coeliac blood test
ncbi.nlm.nih.gov/pubmed/286...
Vitamin D deficiency is frequent in Hashimoto's thyroiditis and treatment of patients with this condition with Vitamin D may slow down the course of development of hypothyroidism and also decrease cardiovascular risks in these patients. Vitamin D measurement and replacement may be critical in these patients.
endocrine-abstracts.org/ea/...
Evidence of a link between increased level of antithyroid antibodies in hypothyroid patients with HT and 25OHD3 deficiency may suggest that this group is particularly prone to the vitamin D deficiency and can benefit from its alignment.
Same applies to low B12 - extremely common in hypothyroid patients
All patients who are hypothyroid should have B12 tested
ncbi.nlm.nih.gov/pubmed/186...
There is a high (approx 40%) prevalence of B12 deficiency in hypothyroid patients. Traditional symptoms are not a good guide to determining presence of B12 deficiency. Screening for vitamin B12 levels should be undertaken in all hypothyroid patients, irrespective of their thyroid antibody status. Replacement of B12 leads to improvement in symptoms,
Folate supplements can help lower homocysteine
ncbi.nlm.nih.gov/pmc/articl...
Levothyroxine can decrease serum homocysteine level partly; still its combination with folic acid empowers the effect. Combination therapy declines serum homocysteine level more successfully.
Low ferritin frequent in hypothyroidism
endocrineweb.com/profession...
Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies
While still eating high gluten diet ask GP for coeliac blood test first or buy test online for under £20, just to rule it out first
Assuming test is negative you can immediately go on strictly gluten free diet
(If test is positive you will need to remain on high gluten diet until endoscopy, maximum 6 weeks wait officially)
Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse
chriskresser.com/the-gluten...
amymyersmd.com/2018/04/3-re...
thyroidpharmacist.com/artic...
scdlifestyle.com/2014/08/th...
drknews.com/changing-your-d...
restartmed.com/hashimotos-g...
healthcentral.com/article/t...
Other gut issues due to being hypothyroid
healthunlocked.com/thyroidu...
That’s great, thank you for the advice
I will get him to order the test. I have had the test and mine was negative so I’m not coeliac, does this mean I don’t need to be gluten free?
Also to test for the others, especially vit D.
My result was 60 for vitamin d, would you say this is ok, my gp said it’s fine?
If you have Hashimoto's you very likely do need to be absolutely strictly gluten free
You don't need any gut symptoms to still benefit
The only way to know is to try it
Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse
ncbi.nlm.nih.gov/pubmed/300...
The obtained results suggest that the gluten-free diet may bring clinical benefits to women with autoimmune thyroid disease
nuclmed.gr/wp/wp-content/up...
In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned
restartmed.com/hashimotos-g...
Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.
88% benefit from strictly gluten free diet
thyroidpharmacist.com/artic...
Going gluten free is a strategy that everyone with Hashimoto’s should try. In some cases, we see a complete remission of the condition; in other cases (88% of the time), the person feels significantly better in terms of bloating, diarrhea, energy, weight, constipation, stomach pain, reflux, hair regrowth, and anxiety.
Vitamin D is too low. GP will only prescribe to bring vitamin D up to 50nmol. Aiming to improve vitamin D by self supplementing to at least 80nmol and around 100nmol may be better .
Once you Improve level, very likely you will need on going maintenance dose to keep it there.
Retesting twice yearly via vitamindtest.org.uk
Vitamin D mouth spray by Better You is good as avoids poor gut function.
It's trial and error what dose each person needs. Frequently with Hashimoto's we need higher dose than average
Essential to test B12, folate and ferritin too
B12 and folate frequently low
Thank you, I don’t believe I’m hashimoto as precious antibodies you testing was on the low side. However my dads was very high if I remember rightly. I will make sure he’s taking higher doses of vit d and get him to test the remaining vitamins.
Thank you for all the information
3 years ago I suggested you check antibodies
healthunlocked.com/thyroidu...
Did you ever do that ?
If your Dad has Hashimoto's, it's likely you do too
Yes I did have them checked and my levels were low, my dad checked his and his were very high. I generally eat gluten free but it may be a rough ride convincing my dad to :/
I developed hypothyroidism after my second child and since then have always had it, that or it’s hereditary?
It's likely a mix of the two, Hashimoto's often has genetic link....but often starts after hormonal changes.....after pregnancy, or run up to menopause most common
Husband's test results- advice appreciated please! trying to get a diagnosis.
I do not understand the results given for my Thyroid test-please help.
Is my Dad hypothyroid?
Please, - help needed with my son's results and symptons
£5 for printout of blood results??
