Any one shed any light on my results please?

[Sixties123]

Hi I've just had my most recent blood test results. I feel tired even after like 10 hours sleep I dint wake refreshed, I am snappy and weepy. I have no energy and weak legs . If I do any housework like Hoover or clean the bathroom that's me done for the day and my face is like a beetroot and sweaty.

Serum TSH < 0.02 mU/L range 0.30-4.50

Serum ft3 4.7 pmol/L range 3.10-6.80

Serum ft4 11.4 pmo/L range 11.0-22.0

Serum folate 9.5 range <2.5

Serum vitamin b12 666 range 197-771

Serum ferritin 116 range 23.0 -400.00

Is there anything obvious? I take 100mcg levothyroxine and 25 mcg t3 split in 2 doses am and on

I have Graves disease and had RAI now being treated for hypothyroid

Any advice appreciated

Regards lesley

[crmavb]

Hello from what I know, your T4 is very low. Perhaps you need an increase of levothyroxine. The T3 you are taking is suppressing your TSH which will make it hard for the drs to agree you need an increase. I wonder if you stopped your T3 for 24 hours rather than 12 before having your bloods taken, then your TSH might be in range. Good luck

[Sixties123 in reply to crmavb]

Hi thank you for taking the time to reply and offer advice, x when my bloods were taken my last dose of thyroid meds were 24 hours before . Does this change what you think in any way ? Thanks again regards Lesley

[crmavb in reply to Sixties123]

I was guessing because I had a similar TSH and thought if I only left a bigger gap between my last dose and the blood draw I might have been within the limit. I also don’t know what RAI means.

I’ve increased my levothyroxine recently from 75mcg (my T4 was always on the lowest rung eg. 12 out of a possible 22) up to 150 mcg/125mcg and within 2 weeks my T4 went up to 16 and I feel so much better. My problem is I did the increase without the drs consent. I was feeling lousy and asked for an increase I was told to provide a list of symptoms. Now when you feel like crap it can be hard to even think straight, let alone write a list. So I found some existing medication, as I have a history of being on NDT and T3 but my T4 was always low, and increased myself. Now I’ve got a drs appointment this afternoon with a semi understanding dr. The one who asked for a list of symptoms. The one who thinks you should never increase a dose if your TSH is suppressed. But thankfully not the dr who told me to stop all meds when I was pregnant last year, what wacko thinking. I had a miscarriage anyway even without following her advice. But she could get in trouble for that if I reported her.

Anyway sorry for going on about me. I hope you get some answers.

I do find iodine helps me and low dose naltrexone , and benfortiamine, for energy.

[Sixties123 in reply to crmavb]

Thank you and so sorry to hear about your miscarriage , that must be extremely hard to cope with .

Regards

Lesley

[Hidden in reply to Sixties123]

I am on NDT so have a completely suppressed TSH as well. This means I need to go mainly by symptom-relief, but labs can be helpful too because i have found that when I did not feel optimal, my lab results would tell me why.

Contrary to what some claim, I have found my FT4 levels to play a role as well (and not just FT3, even though that is said to be the active hormone).

I need my FT4 levels to be at least midrange or slightly above (so, 1.1-1.2; ref used by my lab 0.7-1.5), and my FT3 levels at the top of range in order to feel fine and rid myself of all symptoms. As soon as my FT4 levels drop below 1, I feel less well, and the first hypo symptoms appear. Interestingly enough, I have found that low FT4 levels (<1) tend to make me feel cold.

NDT contains a fixed ratio of T3 and T4, and I have been considering lately adding some T4 to see if that could raise my FT4 levels without raising my FT3 levels.

Since you are on two separate meds, it should be easier for you to tweak your dosage. However, what works for one person does not work for another. You need to find YOUR sweet spot, by adding either a little T4 or a little T3 (not both at the same time or you won't know what works for you).

Your symptoms indicate you are not yet optimally treated, your FT4 levels are at the bottom of range, and your FT3 levels only about midrange so it could be you need to raise both meds or just one of them, but there is room for a raise and that should make you feel better.

[Sixties123 in reply to Hidden]

Hi thanks , I have been on ndt before and i did feel better on it bit my own gp scared me to death about it and i stopped taking and that is how i ended up on levo and t3. I think.the batch i bought online has so.ething wrong with it either weaker or a fake batch as i dont feel any boost after taking it .

Regards lesley

[Hidden in reply to Sixties123]

I guess your GP freaked out because your TSH was suppressed, and told you that NDT is unnatural or unregulated or something like that...? You should not care less. NDT is just as safe as any synthetic T3 or T4 drug.

The only thing about NDT is that it contains a fixed ratio of T3/T4, so may not be optimal for everyone. Some do well on NDT alone, some add a little T4 or T3, others do better on synthetic combos. No way of knowing before you've tried.

When you say there is something wrong with your latest batch, do you mean batch of synthetic T3 (or NDT)...?

[Sixties123 in reply to Hidden]

Hi yes she said it wasnt licensed and therefore she couldn't prescribe and also said I'd get atrial fibrillation and its irreversible. I meant t3 as I bought it online and there have been threads about poss weaker strength or fake batch and my batch number is the same as the one they mention . Thanks for taking the time to reply to me. Lesley xx

[Hidden in reply to Sixties123]

Well, I guess what she meant is that being hyperthyroid (either from overmedication or an overactive thyroid) can cause atrial fibrillation, but that does not happen because you are on NDT but because you take too much T3 for your needs and NDT contains T3. Theoretically, you can overdose on T4 as well and end up with the same side effects, only T3 is stronger so likely to affect your heart more directly. But doctors are sadly ignorant when it comes to thyroid hormone replacement and how it affects the body.

[Lalatoot]

Your Ft3 is low for someone on t3. It is too low or too high Ft3 that causes our symptoms. Many repot that they need their Ft3 to be around 75%through range. Your tsh is low and expectedly so as you take t3. Your ft4 is low which is again expected as you are on t3. However some are fine with ft4 low in range while others need it in the top third. It is a case of finding where you feel well.

[Sixties123 in reply to Lalatoot]

Hi Lalaloot, thanks so much for replying . In your opinion should I be increasing t4 and decreasing t3 ? Kind regards Lesley x

[Lalatoot in reply to Sixties123]

If your last dose of t3 was 24 hours before the test then you have a false result for Ft3. Ft3 gap should be 12 hours before test. 24 is too long. Can't suggest any changes if this is the case.

[Sixties123 in reply to Lalatoot]

I csnt believe it I thought I was doing it correctly leaving 24 hours before my bloods. They wont repeat them now as labs wo t do more often than they seem appropriate.

Thanks again

[SlowDragon Administrator]

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .

Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

If/when also on T3, make sure to take last dose 8-12 hours prior to test, even if this means adjusting time or splitting of dose day before test

If you left 24 hours between last dose of T3 and blood test, this is too long. Shows false low

But as others have said, you may find you need higher dose of Levothyroxine. Some of us need good FT4 and good FT3 levels

If you normally split dose, then just take 2nd dose 12 hours before blood test

How you take your T3

Have you tried splitting T3 into 3 doses per day, at equal 8 hour gap, as your normal regime.

1/2 tablet waking, 1/4 tablet 8 hours later, 1/4 tablet at bedtime

What about vitamin D levels?

As you have Graves, Are you on strictly gluten free diet ?

[Sixties123 in reply to SlowDragon]

Hi feel stupid for not taking the 1/2 t3 tablet roughly 12 hours prior to bloods . So I've now cocked up my results.

[SlowDragon Administrator in reply to Sixties123]

Never mind, remember next time

As others have said......Trying slightly higher dose Levothyroxine should increase your low FT4

[Sixties123 in reply to SlowDragon]

Thanks slowdragon do you think my gp will agree if I explain to her ?

[SlowDragon Administrator]

I agree it doesn't work for everyone.

But it's always worth trying for 3-6 months

Many people are astonished at improvements. Even if they had no gut symptoms before.

[Lalatoot]

I was on carbimazole on and off for years and I never managed to go into remission. Every time I tried I went hyper again. My body could not get balanced on carbimazole and I had to take citalopram to stave off the anxiety. I was a physical wreck too. I was ready to destroy my thyroid with RAI as I felt I had a better chance of getting balanced and a life being hypo. It is not an easy decision but one that everyone has to make for themselves.

[Celestialbeing]

Concerning your facial flushing, if you have any gastrointestinal, bowel issues such as diarrhea, frequent BM; very low or very high blood pressure/heart rate; told you had Crohn’s, IBS, IBD... these, along with profuse flushing (often mistaken for rosacea) can indicate further testing for what is known as NETs - Neuroendocrine tumors that can be carcinoid cancer. There are very specific blood tests and imaging to help diagnose this.

[Sixties123 in reply to Celestialbeing]

Oh my word this is scary ! What bloods are these ? X

[Celestialbeing]

CgA, pancreastin, neurokinin A, 5 HIAA plasma. There are more but theses are the ones to start with. Also, very important to get EGD scope and colonoscopy. There is a special site to learn all about the tests, codes, symptoms. Some medullary thyroid cancer people (MTC is really a neuroendocrine cancer of the thyroid) also have NETs carcinoid elsewhere.