Endo letter regarding t3 assessment

[Mickeydooley]

I just received a letter from the endocrinologist I saw over two weeks ago. He stated that having spoken to me he felt that some of the remaining symptoms I’m experiencing may be alleviated by by combination T4/T3 therapy.

Apparently I have no palpable goitre and am clinically euthyroid. My results (bloods taken that day after my 3pm appointment without fasting and having taken levo and metavive that morning) were as follows:

FT4 21.8

TSH 0.31

Free T3 4.9

Anti TPO. 13

Random serum cortisol 620

(Nb no ranges have been supplied so I assume standard NHS ones apply?)

The endo says these results are satisfactory and there is no associated autoimmune adrenal disease.

At the appointment I told him that my TG antibodies were outside the normal range but I don’t think these were tested?

I shouldn’t complain but I’m confused! Why give me the treatment if I’m fine? Is it because I’m ‘well informed of my thyroid condition’’?

[SeasideSusie Remembering]

Mickeydooley

(Nb no ranges have been supplied so I assume standard NHS ones apply?)

There are no standard NHS ranges. The NHS hospital that does my surgery's tests have a FT4 range of 7-17 but we also see 9-19, 11-23 and others.

I shouldn’t complain but I’m confused! Why give me the treatment if I’m fine? Is it because I’m ‘well informed of my thyroid condition’’?

It's not unknown for doctors to mix up patients and write the wrong comments on a patient's letter. However, assuming that he hasn't mixed you up with someone else, has your endo initiated T4/T3 combination treatment?

[Mickeydooley in reply to SeasideSusie]

Thank you. The letter I received is a copy of the one sent to the gp and describes our conversation so he didn’t confuse me with someone else. He listened to my symptoms and checked my medichecks results and basal temp charts I brought with me. He has advised my gp to prescribe a reduced dose of T4 and 10mcg T4 which may be increased if tolerated. He’s going to monitor me and I have an appointment in 4/5 weeks

[Mickeydooley in reply to Mickeydooley]

Sorry! 10mcgs T3

[greygoose]

If the ranges are like the ones we normally see, you would appear to have a conversion problem - this is just guess-work with ranges, but still… If your endo has the knowledge and intelligence to understand that, then that would be why he suggested T3 would help. And, if he's told your GP do prescribe it, I would say 'don't look a gift horse in the mouth.'

[Mickeydooley in reply to greygoose]

Thanks GG. Yes I think I may have got a good one! Although I’m still a bit annoyed that he didn’t check my TG antibodies as I told him they were raised but he told me at the time that they weren’t important. Still! Like you say I’m not going to turn down the opportunity to try the T3 - if the gp agrees to prescribe it!!!

[greygoose in reply to Mickeydooley]

Well, it might be unimportant. But it might indicate Hashi's. Depends how high they were. But, in any case, little point in retesting them. What about your TPO antibodies?

[Mickeydooley in reply to greygoose]

They’ve never been above range. (22, 11 and 13 in last tests/range <34). TG was 302 and 390 (range <115) on last medichecks tests.

[greygoose in reply to Mickeydooley]

OK, so with Tg antibodies at that level, I think it's pretty certain that you have Hashi's. And, it's important for you to know that, even if your endo doesn't understand the implications. If your FT4/3 suddenly shoot up very high, that's the Hashi's, and not over-medication!

[Mickeydooley in reply to greygoose]

Thank you for that info. Don’t know how I’ll convince him of that though. He was adamant that they weren’t important. And I don’t want to argue with him. Just yet!

[Mickeydooley in reply to greygoose]

Can you comment on the cortisol level? I know nothing about it but always suspected I had adrenal issues. Stress wipes me out or lots of activity. I’m just curious as to why he said I had no adrenal issues. My basal temp chart is very erratic

[greygoose in reply to Mickeydooley]

Not without a range, no. But, it doesn't look low. You really need to do a 24 hour saliva cortisol test, to have more detail.

[Mickeydooley in reply to greygoose]

I thought that would be your answer. I’ll ask him next time I’m there. Thanks again. Always most helpful.

[greygoose in reply to Mickeydooley]

You're welcome.