Confused over blood work

[Lozzer66]

Hi all...I haven’t been active on here for some time and have just been getting on and doing my own thing with my thyroid.Ive settled for months on a combination of Thai ndt 1.75 grain + 25 mg levothyroxine as I seem to feel better with t4 higher on the range than what I achieve on ndt alone ......Anyways I did a Medichecks ultra vit 2 weeks ago (early morning/fasting no levo for 24 hr and no ndt from 12 hr previous to test...my bloods were pretty much the same they’ve been for a while ....anyway then 1 wk later I needed some bloods doing at gps and didn’t bother doing early morning or fasting as I wasn’t interested in seeing what my thyroid bloods were doing again(it was for various other blood work but doc said we’ll do thyroid as it’s been a year )and if I hadn’t taken the afternoon appointment I would of had to wait almost 3 weeks for appointment!!Anyways ..I know it wasn’t fasting and I’d had meds that morning but would my results be this different just because of that reason ??I have not felt good for some time but Medichecks testing always made me rule thyroid out ...now I’m wondering if maybe I am over medicated?..Thoughts please ...?Results as follows :

Medichecks :

Tsh 0.005 (0.27-4.2)

FT4 16.2 (12-22)

FT3 5.8 (3.1-6.8)

Folate 9.64 (>3.89)

Act B12 150 (37.5-188)

Vit D 90.9 (50-175)

Ferritin 112 (13-150) (I know vit d/folate could be better)

GP thyroid test :

TSH < 0.01 (0.30-6)

FT4 15.8 (10.40-24.50)

FT3 8.3 (3-7.10)

I think gps lab tested t3 because of suppressed tsh ,many thanks

[greygoose]

You don't look over-medicated on either of those results. Your FT3 is in-range. Your TSH is suppressed because of the T3 in NDT. Just having a suppressed TSH doesn't automatically mean you're over-medicated - it doesn't mean anything on its own. But, how you feel is far more important. Do you have any symptoms that lead you to believe you're over-medicated?

[Lozzer66 in reply to greygoose]

I know not on the first set but they were fasting and no meds so T3 probably higher in reality but I think you’ll see from my second lot at gps my FT3 is over range at 8.3 (3-7.10 )...Tsh doesn’t concern me at all ..suppressed is good

[greygoose in reply to Lozzer66]

Well, no, why would the T3 be higher than it says on the results? T3 is at it's highest early morning. Your results were correct for that time of day. Fasting doesn't have any effect on the FT3 result.

It's true that you can't really compare results if they're not done under almost exactly the same conditions, but even so, if the results are in-range, then you're not over-medicated.

But, I confess, I did read the range for the second set incorrectly. My bad. But, how long did you leave between your last dose of NDT and the blood draw? If it were less than eight hours then that would make a difference.

[Lozzer66 in reply to greygoose]

I was lead to believe that leaving off the ndt for at least 12 hrs before blood draw it could actually be a tad higher?..I could be wrong .....On the gps blood draw it was taken at 1.15pm and I took my ndt at 6 am in morning as usual so yes 45 mins less than 8 hrs

[SeasideSusie Remembering in reply to Lozzer66]

I was lead to believe that leaving off the ndt for at least 12 hrs before blood draw it could actually be a tad higher?..

Leaving NDT off for 8-12 hours gives the normal circulating hormone level.

Leaving longer than this time gap gives false low hormone levels. Any closer to blood draw gives false high hormone levels. The most important result being FT3 when on NDT.

Graphs of the daily rhythm of all hormones - TSH, FT4 and FT3 - are in the first post of this thread. These would be natural hormones so if you are producing any T4 and T3 yourself then you can see when your body produces the most and when it produces the least, and this may have some bearing on your results:

healthunlocked.com/thyroidu...

To compare your free hormone levels accurately:

Medichecks:

FT4 is 42% through range

FT3 is 72.97% through range

GP:

FT4 is 38.3% through range

FT3 is over range at 129.27 %

[Lozzer66 in reply to SeasideSusie]

My last dose of ndt was approx 12.5 hr before the draw with Medichecks so if I’d have left 8-12 hrs instead of 12.5 hrs between last ndt dose and blood draw FT3 would have been higher than 5.8 and a more accurate picture?

[SeasideSusie Remembering in reply to Lozzer66]

It may have been marginally higher but there's not a lot of difference between 12 and 12.5 hours. I always try to go straight down the middle and time my last dose of T3 to be 10 hours before blood draw.

[Lozzer66 in reply to SeasideSusie]

In your opinion then if you were me would you keep meds at what they are now rather than adding or taking away ...perhaps adding more ndt would actually take me over medicated?....thanks

[SeasideSusie Remembering in reply to Lozzer66]

You said in your opening post:

I’m wondering if maybe I am over medicated?

Do you feel overmedicated?

Which set of tests are you putting your faith in?

It's difficult to suggest anything with such different FT3 results and they really can't be compared because of the different circumstances.

I didn't do well on NDT. Now, many years later and with much different circumstances, I take Levo and T3 in a ratio nearer to 6:1 than the set ratio of NDT which tends to be 4:1. But we are all very individual in what doses of T4 and T3 we need and where we need our FT4/FT3 to be.

[Lozzer66 in reply to SeasideSusie]

It’s hard to know if I’m over medicated by symptoms alone because they are all pretty much the same symptoms for me either way so it’s bloods I rely on ....I’m starting to think ndt doesn’t suit me ...I may go back to levothyroxine......would you do a straight over swap to do this or lower ndt and add levo in small amounts ?Does taking ndt for a few years effect your ability to convert t4to t3 ?thanks

[SeasideSusie Remembering in reply to Lozzer66]

I have no idea if taking NDT affects ability to convert T4 to T3.

What was your conversion like before you started NDT?

I think if you go back to Levo only then you need to work out the equivalent amount of Levo to your current NDT plus Levo.

[greygoose in reply to Lozzer66]

Well, that could have an effect on the result.

I don't know who lead you to believe that 12 hours was too long, but they were wrong. Between 8 to 12 hours is best. But, it's impossible to say just how much difference leaving it too long or not long enough would actually make.

[Lozzer66 in reply to greygoose]

...Symptoms are the usual symptoms that I have when either hypo or over medicated fatigue/joint pain/palps /constipation/low mood ...with additional constant thirst

[greygoose in reply to Lozzer66]

Those symptoms sound more like hypo, to me. Although the joint pain could be due to low vit D.

[Lozzer66 in reply to greygoose]

Unfortunately for me it’s hard to say as I present with same symptoms when hypo as I am when over medicated...so I rely on these tests to show me what’s going on .....my temperatures are not amazing but last time I was over medicated my temperatures were rubbish too so hard to know whether to increase or decrease?....I’m beginning to wonder whether to come off ndt and try levothyroxine again ...possibly adding a small dose of ndt or t3 as I believe Thiroid (Thai brand )has dried up and I haven’t much left ......and I just can’t seem to feel/get it right doing what I’m doing even when my bloods are good ..

[greygoose in reply to Lozzer66]

A lot of symptoms can be both hypo or hyper/over-medicated. Which is why it's difficult for most people to go by symptoms alone. But, has there been a blood test done when you actually felt well? That would give you an indication of what you actually need by way of dose.

Levo + T3 is far more flexible and easier to control. NDT suits a lot of people, but not everyone by any means. It's all a matter of trial and error to find out what suits you best.

[Lozzer66 in reply to greygoose]

Hard to say really Greygoose but I think I seem to feel better with a higher T4 ....it’s so hard to know what is causing what and the temperatures I take don’t give me that good of a picture .....I think perhaps I’m more leaning to over medication as I’m not cold at all and have lost a few pounds recently even though I’m eating the same ...but even when I have been very hypo I’ve never had weight problems

[greygoose in reply to Lozzer66]

Then why not try reducing the NDT by 1/4 grain and see what happens?

[Lozzer66 in reply to greygoose]

I’ve done that before in the past and still felt rubbish really I wonder if the t3 in ndt doesn’t suit so it may be time to actually look at trying t4 only again or maybe t4 with a little ndt or t3 ....or I may lower ndt and add some more levo 🤷‍♀️ thanks

[greygoose in reply to Lozzer66]

All things worth trying.

[Lozzer66 in reply to greygoose]

Oh for sure Greygoose ...do you think taking ndt for a few years inhibits the ability to convert t4 to t3 if I was to go back to t4 only ....also could I just literally to a straight swap overnight of say back to 100 levothyroxine?thanks

[greygoose in reply to Lozzer66]

I'm afraid I can't answer that question. I went from NDT to T3 only. And, I think it's probably a difficult question for anyone to answer, because the reason that most people go onto NDT is because they don't convert very well, anyway.

But, I think that if you do a straight swop for levo, you're going to need more than 100 mcg. I'd start with at least 150 mcg, if not 200.