Hi would really appreciate some help with the results of my recent thyroid function test which really baffle me.
Test done October 2019.
Unfortunately prior to recent tests,my last TFT at endo clinic was 2017.
What prompted me to attend recent endo appointment was concerns I had about my rapid heart rate which woke me in the middle of the night out of the blue.
On several occasions I was woken with my heart rate pounding so fast and powerful in my chest. God I was terrified…felt as if my heart was going to explode…literally!!! I needed help, yet my whole being told me not to move and to stay calm which I managed to do by controlling my breathing despite the fear. It took over an hour for my heart rate to return to a somewhat normal level whereby I knew it was safe to move by taking slow baby steps.
Of course my only option was to get myself to A+E which I did.
After each onslaught was left with a ache in heart and felt really unwell which lasts for a few days. (self prescribed: aspirin helps with the pain)
Three times, after each attack ,I took myself to A+E and they carried out the usual tests. On the last visit to A+E I was advised by attending A+E doctor to go see my GP because according to him the dose of thyroxine I was taking was too high. This was the same conclusion reached after my previous two visits in the middle of the night to A+E.
Hence I went to see endo doc instead of GP and voiced my concerns about levothyroxine affecting my heart.
Endocrinologist comments: I have given her a follow up appointment in 4 months time. If her thyroid function tests show high T4 levels since she has symptoms we will reduce her dose of levothyroxine. If they are in normal range and she continues to have palpitations it will be well worth getting a 72 hour Holter monitor tape to look for arrhythmias with a follow up appointment with a cardiologist. Once I have the results I will be in a better place to advise her further……..
Blood tests done was FBC, Calcium Profile, Liver Function Test, Urea & Electrolytes plus Thyroid.
Have only provided TFT results below
TFTs
Euthyroid levels
TSH 0.31 mU/L 0.30 - 6.00
Free T4 20.2 pmol/L 10.0 - 22.0
Free T3 4.2 pmol/L 3.6 - 6.4
Thyglob ll
****NB Method change: Thyroglobulin now measured by IMA*****
Thyglob ll <0.1 Ug/l
Thyglob abs 10 klU/L
Brief history: Thyroidectomy 1992 due to cancer of thyroid.
Medication: 100mcg levothyroxine daily. Sometimes I take 300mg of asprin for a few days, self prescribed.
Can anyone one please explain thyroid blood results in relation to endos comments
paragraph above.
Thank you most kindly
Sorry endo comments have not shown up in bold text
Written by
dragon51
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These are all in range and don't suggest overmedication. If anything your FT3 is low in range at 21.43% compared to your FT4 which is 85% through range. When on Levo only most people feel best when TSH is 1 or below with FT4 and FT3 in balance in the upper part of their ranges. Your results suggest poor conversion of T4 to T3.
What are your current levels for Vit D, B12, folate and ferritin? These need to be optimal for thyroid hormone to work properly and good conversion to take place.
I'm actually rather surprised that your endo suggests waiting 4 months to consider a 72 hour holter monitor. Has your GP not suggested getting this done?
thank you for your swift reply. Had bloods done by blue horizon June this year....b12 ok and vit D. Have been taking folic acid because this was low and I also take B complex. Not sure what ferritin is though. How can i find out if levels are optimal? I just take the supplements and hope for the best..... Suppose the best thing to do is get another blood test done by blue horizon.
Have decided to go see my GP this week to discus the findings that endo sent him. My intention is to tell him that I am not prepared to wait 4 months for a holter monitor.
So pleased you have worked out that poor conversion of T4 to T3 is evident from the results. At least I can tell GP this,( thanks to you), because he would have just blinded me with with jargon...
What surprised me is a+e failed to send my GP any information regarding the 3 visits to a+e with issues concerning my heart.
I am not one of those people who run to a+e with the slightest problem. God only knows where I would go if I had another attack like the last 3. The attacks were horrendous and I cannot understand that the ECG revealed no after effects of the trauma to my heart.
Had bloods done by blue horizon June this year....b12 ok and vit D. Have been taking folic acid because this was low and I also take B complex. Not sure what ferritin is though.
Which Blue Horizon test did you do? If it tested Vit D and B12 it was probably the Thyroid Plus Ten or Thyroid Plus Eleven and it would have included Ferritin. Ferritin is your iron store.
Why are you taking both folic acid and a B Complex? A B Complex contains either folic acid (not recommended) or methylfolate (the recommended form) and if you have a good quality supplement like Thorne Basic B or Igennus Super B there will be enough methylfolate for your needs, you wont need a separate folic acid.
I just take the supplements and hope for the best
That's rather a haphazard approach. When we supplement we should check out levels at least once a year, Vit D twice a year. We need to know we are taking an appropriate dose, too much or too little isn't a good idea.
What surprised me is a+e failed to send my GP any information regarding the 3 visits to a+e with issues concerning my heart.
I'm not. I had a visit to A&E for heart issues and my GP wasn't sent any information. I didn't even have any monitoring when in A&E. I had a 1 minute ECG, one blood pressure test and a blood test, then left alone for 3 hours by which time things had settled down and the doctor said everything was normal so go home.
If my T4 is not converting appropriate T3 could this have an impact on the heart
Yes I imagine it does, every part of our body needs T3. Also, see the following:
Although it is well known that hyperthyroidism can produce atrial fibrillation, it is less well recognized that hypothyroidism can predispose to ventricular dysrhythmias.6 In almost all cases these cardiovascular changes are reversible when the underlying thyroid disorder is recognized and treated.
Hi Susie managed to find blood results from Blue Horizon for May 2019:
Ferritin 72.8 Vit D 81 B12 618 plan to get another blood test soon.
Taking your invaluable advice and I stopped taking the B complex. The folic acid i taking is: Cytoplan - Methylfolate 400ug. Willing to change this if need be.
Sadly, your experience in A+E was the same as mine............ Honestly
i am loosing faith in the NHS but I got an appointment with GP tomorrow morning and I plan to discus endo report with him. In a nutshell going to focus on poor conversion of T4 to T3 and effects this is having on my heart. The link you sent me, which I have briefly read, is certainly informative and eye opening. It has really helped me come to understand that my concerns are totally justified.
Going by past experience the likelihood is I will be told by GP that I have nothing to worry about.......! Another ploy is he will blind me with medical science......!
Here is my planned response whatever my GP comes up with: "Oh yes doctor I have been rather overly concerned about poor conversion issue and effects on my heart. Furthermore, you have blinded me with science and I feel so utterly stupid but I have one request for you doctor which is: Will you give your consent so that I can go see a private Cardiologist?"
Thanks a million Susie your help and advise is priceless!!!!!!
I'd wait and see what your new blood test shows, you may need to supplement ferritin and Vit D (Vit D is recommended to be 100-150nmol/L).
I would suggest you take a B Complex only as this contains all the B vitamins and keeps them balanced. Thorne Basic B contains 400mcg methylfolate per recommended dose of 1 x capsule, Igennus contains 400mcg at their recommended dose of 2 tablets.
As for your response to your GP, I'd change this:
Will you give your consent so that I can go see a private Cardiologist? to this:
Will you please write me a referral to a private Cardiologist.
That's just me being picky, I don't need my GP's consent for anything.
NHS information about referrals for private referrals:
My GP surgery has a certain number of 24 hour ECG monitors. I was able to get one done within about a week. But the results did take 2 months to be analysed, I was told the analysis is outsourced, not done within the NHS. On the basis of the results I then got a cardiology referral.
So definitely worth asking your GP about having a 24 hour one done. Sounds to me like A&E used thyroxine as a scapegoat to blame, as others have said your blood results don't show over medication at all.
TSH is only just in range and is very low in range.
Free T4 is close to top of range.
Patient is over-medicated.
What I see :
Your Free T4 is 85% of the way through the range. This is quite high in range. Some people feel at their best when Free T4 is this high in range, so it wouldn't concern me.
Your Free T3 is approx 21% of the way through the range. This is very low, and is hugely different to your Free T4. T3 is the active thyroid hormone. Low levels gives people the symptoms they have when hypothyroid.
For many people the best levels of Free T4 and Free T3 are roughly around 3/4 of the way through the range for Free T4, and at least halfway through the range for Free T3.
You are clearly a poor converter of T4 to T3. Having no thyroid makes this problem very likely to occur because in a healthy person with a healthy thyroid the thyroid makes about 20% - 25% of the body's entire T3 supply. You no longer have that available to you.
If you lowered your Levo dose there is a very good chance that your Free T3 would drop further and make you feel worse. (Free T4 is the raw material from which the body makes the rest of the body's T3 outside of the thyroid.)
Your endo has concentrated on just your TFTs. But has he tested iron, ferritin, vitamin D, vitamin B12 and folate? They all have some involvement in the correct functioning of conversion of T4 to T3 and how well the body can make use of thyroid hormones.
Personal anecdote : Low iron and/or low ferritin give me tachycardia (fast heart rate). Keeping my iron levels as close to optimal as possible helps to keep my heart rate much steadier. A very high blood sugar has the same effect - tachycardia. Are you diabetic or pre-diabetic? Is it possible you are, but don't know it?
Getting basic nutrients optimised is extremely important if you are going to have a chance of feeling well.
But the biggest issue is that your Free T3 is far too low, and your doctor should be prescribing T3 for you. You could reduce your Levo by, say, 12.5 mcg per day, and add 10mcg - 20mcg T3 per day. Some people do well with T3 taken once a day at the same time as they take Levo. Others do best with T3 in divided doses. We're all different.
Some of the results in an FBC may give you some limited info on your nutrient levels, although if you are low in both iron and vitamin B12 (and/or folate) some of the results of an FBC can be misleading. Getting the nutrients themselves tested is best. Perhaps you can type in the FBC results with reference ranges.
Hi HB (humanbean).....I finally get to reply to your most welcome message. There is a lot to process here but what particularly caught my attention was the section where you asked if I was diabetic or pre diabetic. Over the past few months I have given a little thought to the possibility that I might be diabetic..... Why?
Here comes the boring bit...... Every night I take my dog to the beach and troll the sand dunes for over an hour at a moderate pace. On several occasions I went so weak and barely had the energy to walk yet i carried on walking slower and slower to the point where i virtually could not go on and I would have to sit down but the weakness consumed me. I felt like my life source (energy) had totally deserted me. It was virtually impossible to speak......! Skin was slightly clammy and felt shaky in my stomach.
As we humans are prone to do, I soon made a connection which was I ATE A NOUGAT BAR ABOUT AN HOUR BEFORE THE WALK........... ! The sugar rush (which I did not notice) wore off hey? Normally I do not consume sugary stuff. No more nougat bars for me now its grapes instead.
Your other information is certainly helping me understand thyroid problems a lot more which is invaluable to me and others. Thank you so much.
I off to see GP tomorrow to discus T4 T3 conversion issue. Will ask for blood test for diabetetes
If you would like to avoid the highs and lows from sugar there is still a lot of sugar in grapes too unfortunately, 4tsps (16g) in just 3 or 4 ounces of grapes. How about some nuts, olives or cheese? Good pictorial pages here to compare foods:
Could you wear a fit bit to keep a track of your heart rate whilst waiting for the heart holter.
I used to think my heart was racing at times. I found out that it wasn’t my heart. I did have a heart holter for 7 days. It was actually my cortisol raging. Cortisol and thyroid are closely linked. I too have a T4 to T3 conversion issue. I was only getting up to 8% through the T3 range. I am positive DIO2 gene tested from one parent. What fixed my thyroid levels and my cortisol was being prescribed T3 medication. Although initially I had to do this privately. Now the NHS prescribe also recently.
I keep my fit bit on now and monitor my heart rate. The only thing I found that can make it spike for me are certain brands of Levothyroxine. T3 does not make my heart rate spike. The best Levothyroxine that doesn’t spike my heart rate is Wockhardt brand.
I now feel fantastic and go the gym 3/4 times a week.
Recommend you get full Thyroid and vitamin testing again
For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also EXTREMELY important to test vitamin D, folate, ferritin and B12
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)
Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have special offers, Medichecks usually have offers on Thursdays, Blue Horizon its more random
As SeasideSusie says...you don't need Folic acid and vitamin B complex. Just taking one or the other.
If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before any blood tests, as biotin can falsely affect test results
I was admitted to hospital with chest pains and a high heart rate and I was shaking and sweating my TSH 0.54. I think I was having a thyroid storm .... We are all different and I now feel well with a TSH of 0.70. I think you might need some T3 because it is very low and you might not be converting T4 to T3. Some people who have had their thyroid removed do well on NDT which you cannot get in this country. I purchase some Thyroid S from Thailand last year when I was going through and underactive period .... I have Graves' disease and Doctors don't have a clue how to treat it imho.
Just to say a fully functioning working thyroid would be supporting you daily with approximately 100 T4 - Levothyroxine + 10 T3 - Liothyronine.
T3 is said to be about 4 times more powerful than T4 - Levothyroxine.
T4 - Levothyroxine is a prohormone and your body needs to be able to convert the T4 into T3 which is the active hormone your body runs on, and I read the average person functions on about 50 T3 daily.
As you will see, you have lost your own natural ability to produce T3. but it is a crucial hormone and realistically without full thyroid hormone replacement, you have, in effect, been down regulated by about 1/5th of your daily requirements and potential wellbeing.
Running 20% under par, for any length of time, may compound, and possibly cause additional health issues.
Your conversion of T4 into T3 can be compromised if your vitamins and minerals are not optimal in the range and it is necessary that ferritin, folate, B12 and vitamin D are maintained at optimal levels to assist in the utilisation of the thyroid hormone supplements.
Some people can get by on T4 alone, some people, at some point in time, simply stop converting the T4 into the T3, and some people simply need both these vital hormones dosed and monitored independently, to bring them into balance and to a level of well being acceptable to the patient.
I just think that if there has been a medical intervention and the thyroid surgically removed, or ablated with RAI, that both these essential thyroid hormones should be on the patients prescription for if and probably when they will be needed to allow the patient full thyroid hormone replacement and an improved quality of life.
The thyroid is a major gland responsible for full body synchronisation, your physical, mental, emotional, psychological and spiritual wellbeing, you inner central heating system and your metabolism.
We currently have a problem with the prescribing of T3 within the UK.
I am with Graves Disease and had my thyroid ablated with RAI in 2005 - becoming very ill, some 6 years ago now. Thanks to this amazing site, I've managed to get myself back on track. It has meant that I have had to self mediate the full spectrum of thyroid hormones, as I found no help or understanding of my health issues within the current NHS system.
Your FT3 is far too low! This could be either low nutrients or poor conversion?
Have you had vit B12, vit D, folate and Ferritin tested? They need to be top of range to support T4 to T3 conversion.
As I understand it, in the absence of a thyroid the heart /bodyrelies on conversion to provide the T3 it requires.
If you do not adequately convert then it may be that it's the (unconverted) levo /low T3 that is part of your problem and the solution may be less levo with the addition of a little T3.
Sadly, because we are all different, with different needs, trial and error is usually the way forward!
Have you considered having a thyroid genetic test which will reveal (or not) the existance of a faulty gene, responsible for some of T4 to T3 conversion.
Your lab tests will show this - high FT3 and low FT3) but a positive test is more likely to convince medics to prescribe T3.....but, many medics are reluctant to offer T3. Madness!
It's a disgrace that your endo is leaving you to suffer for a further 4 months. He says, "once I have the results....." he already has a significant result. Low T3! Personally I would be looking for advice sooner than in 4 months time!
The thyroid/T3/ heart connection is significant.
However I'm clearly not a medic,... just another thyroid patient who, after medics failed to find a reason, has had to do a lot of homework in order to improve her ill health. Many of us here are in a similar position!
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