Same Dose- different results

[Bramble83]

Would love some thoughts / comments on my latest results please, this is on 100mg of Levo, exactly the same as I was on for my previous results. My TSH seems to have come down quite a bit but my FT4 has also dropped quite a bit

TSH 0.11 (0.27-4.2)

FT4 22 (9-26)

FT3 4.1 (2.8-7.1)

This is no change of dose from the previous results, however on the last lot (below) I made a mistake and took my 100mg of Levo 3 hours before my blood test, although general consensus on here was that it wouldn’t have made a huge difference:

TSH 1.48 (0.27-4.20)

FT4 28.4 (9-26)

FT3 4.36 (2.8-7.1)

Previous results on 75mg were as follows:

TSH 1.61 (0.27-4.20)

FT4 18.2 (9-26)

FT3 2.9 (3.1-6.8)

All my vitamins and minerals are pretty optimal, so I didn’t spend the money to have them done again via Medichecks

All comments very much appreciated 😀

[greygoose]

Actually, it wasn't a general consensus. I was the only one that commented on the possible difference, and concluded that it was 'impossible to tell with any accuracy'. But, looking at your latest results, it's possible that it did make quite a difference. And, not surprising that your FT4 level has dropped when the test was done respecting the 24 hour gap.

But, in a way it doesn't make much difference in the end, because you're still a poor converter, and it's the FT3 that is the most important number. And, that could do with being higher.

[Bramble83 in reply to greygoose]

Oops! Maybe general consensus was not quite accurate 🤣

I was surprised that my TSH has dropped so much in comparison to before.

Got an appointment on Wednesday to review the results- i’m wondering whether because the TSH is low, they will try and reduce the Levo dose- what do you think?

My usual endo was up for trying me on T3 before but i’m 12 weeks pregnant now, so I’m pretty sure that will no longer be an option.

[greygoose in reply to Bramble83]

The TSH rarely, accurately reflects thyroid status - which is one of the reasons it shouldn't be relied on as much as it is. Variations in times of the blood draw will cause variations in TSH levels, but they're pretty random. There's no direct, hard and fast link between TSH level and FT4 level.

[Bramble83 in reply to greygoose]

Just had confirmation from my endo to stay at 100mg Levo 😀

[Bramble83 in reply to greygoose]

I guess I will have to wait until after I have the baby to see if T3 can be added.

[greygoose in reply to Bramble83]

Yes, looks that way. Although, in my opinion, that's pretty stupid. Pregnancy is hard work, and the mother needs to be kept fit and healthy, too. T4 for the baby, yes. But the mother needs T3.

[Bramble83 in reply to greygoose]

I think the reservation is there are no studies on whether it is safe to take T3 in pregnancy?

[greygoose in reply to Bramble83]

Normal, healthy mothers have T3 made by their thyroids, and by conversion in their cells. Why would it suddenly become unsafe because you're hypo?

[Bramble83 in reply to greygoose]

I’ve got no idea, they just mentioned that T3 isn’t approved in pregnancy and when I asked why, that was the line they gave me!

I don’t feel terrible, just tired (which could always be my Addisons anyway) so will probably just wait. The only thing that really convinces me I could do with my T3 being higher- which is my resting heart rate which is still super low at around 40-45bpm

[greygoose in reply to Bramble83]

Most of them will say anything to get out of prescribing T3, they just don't want to do it. The don't understand what it is or what it does.

[Bramble83 in reply to greygoose]

Out of interest, considering my current results, if I wasn’t pregnant and able to start T3, what dose do you think would be sensible, based on the results I posted.

Keen to know what to push for later on (presuming my numbers don’t change, which they could of course)

[greygoose in reply to Bramble83]

Same dose one always starts on: 1/4 pill, be it 20 mcg or 25 mcg. It has nothing to do with your results, it's just following the rules of taking hormones: start low and increase slowly. With T3, that means 5 mcg or 6.25 mcg - the difference is negligible.

[Bramble83 in reply to greygoose]

Thank you, I will make a note of this for when I can hopefully start 😀

[SeasideSusie Remembering]

Timing of last dose of Levo won't have had any real effect on TSH, that depends on timing of blood draw and whether you have eaten or had caffeine containing drinks before the test.

I think you can see that taking your Levo 3 hours before the test last time meant that your FT4 result was showing that your hormone level was at it's peak (it peaks 2-4 hours after ingestion of Levo) and your new test, with the proper time gap, is showing a more normal circulating level.

Your results show that you are a poor converter of T4 to T3.

[Bramble83 in reply to SeasideSusie]

Yes I didn’t understand that about the TSH- the first one was done at 8.30am (when it was 1.48) and the second one was done at 9.50am (when it was 0.11) as they didn’t have an earlier appointment. I hadn’t eaten anything or drunk anything except water, for either.

I’ve got a review on Wednesday with the endocrine- antenatal team, as I’m now 12 weeks pregnant. Do you think they’ll try and lower my dose because the TSH is low, or because my FT3 and FT4 are in range, might they leave them as they are?

[SeasideSusie Remembering in reply to Bramble83]

I'm afraid I have no way of knowing what they will do.

[Bramble83 in reply to SeasideSusie]

Just had confirmation from my endo to stay at 100mg Levo 😀

[Lilian15]

Here is information from Professor Anthony Weetman

Quote: The problem with using free T4 measurements if a patient is taking thyroxine is that the level fluctuate after taking thyroxine treatment. Therefore, within the few hours after ingestion there can be a ten or fifteen per cent level difference in level compared to twelve to twenty four hours after ingestion.

[Bramble83 in reply to Lilian15]

Its really interesting- it seems it made quite a huge difference to my results; over 25%

[MaisieGray in reply to Bramble83]

Not wishing to be pedantic, you can't actually say that. Yes it is 25% more than the previous test result, and may be elevated over what it would have been if you had left the longer gap; but you don't know for certain what it would have been had you left the longer gap ie it might in any case, have been different from the previous test result and the shorter gap then exacerbated the differential. But don't get hung up on percentage differences that are only assumptions in any case.

[Bramble83 in reply to MaisieGray]

Okay thanks 😀