High Free T4

[wsn104]

My thyroid labs are always off. My free t4 has been mildly elevated for at least the last 10 years. No matter what dose my levoxyl is or how high my tsh is, my free t4 is always elevated. Why is this and what can I do?

November 4, 2019

TSH 2.07 uIU/mL

T4 - 1.87

THYROXINE13.38 ug/dL(4.60 - 12.00ug/dL)

T3 UPTAKE0.93(0.76 - 1.25)

FREE THYROXINE INDEX(12.444.40 - 11.40)

TRIIODOTHYYRONINE1.11 ng/mL(0.80 - 2.00 ng/mL)

ANTITHYROID PEROXIDA15.5 IU/mL(<=8.9 IU/mL)

12:57pm

112 mcg Levoxyl everyday

September 26, 2019

TSH 4.03 uIU/mL

T4 - 1.83

11:18am

112 mcg Levoxyl everyday

September 11, 2019

TSH 3.02 uIU/mL

10:23am - fasting

112 mcg Levoxyl everyday

August 30, 2019

TSH - 1.87

T4 - 1.98

Dose - 125 mcg with half a pill on Sunday of Levoxyl

On Lo Loestrin

Jul 30, 2019

TSH - 1.17

T4 - 2.07

Dose - 125 mcg every day

4:39pm

On Lo Loestrin

June 24, 2019 - 1:26pm

TSH - 3.46

T4 - 1.70

Dose - 125 mcg alternating with 112 mcg every other day of Levoxyl

On Lo Loestrin

April 5, 2019

TSH - 3.48

T4 - 1.64

Dose - 112 mcg every day of Levoxyl

2:40pm

On Lo Loestrin

Feb 26, 2019

TSH - 1.11

T4 - 2.22

Dose - 125 mcg of Levoxyl

1:20pm

On Lo Loestrin

Jan 10, 2019

TSH - 10.46

T4 - not taken

Dose - alternating 100mcg with 112mcg of Levoxyl

1:47pm

On Lo Loestrin since december 1, 2018

[SilverAvocado]

Hi wsn104, unfortunately most of these results are only TSH, which can only tell us a limited amount. The most recent result is a full thyroid panel, which tells us a lot more.

TSH stands for thyroid stimulating hormone. This is a chemical messenger made in the pituitary to tell the thyroid to make more hormone. It is raised when hormone levels in the body are low. In a person with a healthy thyroid it would be about 0.8-2, but once on thyroid hormone replacement most people will need it at the low end, 1 or below, often well below the range.

Looking at your January result, you've got a TSH of 10.46, this is very high and shows you were very undermedicated. After that you have a decent increase, but the TSH comes back still a little high, a few dose adjustments and the TSH hovers around 2-3. These are all elevated TSH results showing you need more hormone. But it's hard to say much more without seeing a full thyroid panel. Unfortunately doctors tend to try and do things with TSH only, which is really working in the dark.

Finally in November you've got some more complete results. Although I think you have a totalT3 instead of freeT3 so it isn't everything we need.

We can see again that TSH is elevated, telling us you need more hormone.

You've then got what looks like totalT4 and freeT4, and both are a little elevated. It's okay go go over range with freeT4 a little if symptoms justify it, so this isn't a disaster but doesn't quite match the TSH saying you don't have enough.

But then we see the totalT3 and it is scraping the bottom of the range. These are low levels of T3, most people need this high in range to feel well. A shame you don't have a freeT3 to fully confirm, but I'd say this is a classic case of poor conversion, and you need to introduce some T3 to your dose.

When taking T4-only tablets, these contain only T4. This is a storage form of the hormone, and needs to be converted into the active form, T3, in your body. Unfortunately, particularly when we've been left sick for a long time, our bodies are sometimes not good at doing this. In that case we need to take some T3 to supplement.

It's very important for you to be dosed on complete thyroid test results and not just TSH, because your test results are a bit more complicated.

You've also got raised thyroid peroxidase antibodies, which confirms you have Hashimotos auto immune thyroid illness.