Recent thyroid tests

[Rosemarysnotes]

I have been on levothyroxine for over 20 years. My recent test results show TSH 2.79, T3 4.1, free thyroxine 18 and antibodies 304. In the past, TSH over 2 was considered abnormal but this time says normal due to change in boundaries. Can anyone interpret these results before I go fight my GP, I am symptomatic with tiredness, cold and skin probless. Thanks

[SeasideSusie Remembering]

Please add the reference ranges for your results so that we can interpret them for you. You say the boundaries for TSH have changed, what were they and what are they now?

I take it you know that you have Hashi's, as confirmed by your raised antibodies. Are you strictly gluten free and supplementing with selenium l-selenomethionine as this has helped some members.

[Rosemarysnotes in reply to SeasideSusie]

Ranges are TSH .27 to 4.2

Free thyroxine 12 to 22

Free T3 3.1 to 6.8

[SeasideSusie Remembering in reply to Rosemarysnotes]

TSH 2.79 (.27 to 4.2)

free thyroxine 18 (12 to 22) = 60% through range

T3 4.1 (3.1 to 6.8) = 27% through range

These results show that you were undermedicated at the time of the test and will be responsible for your symptoms.

The aim of a hypo patient generally, when on Levo, is for TSH to be 1 or below or wherever it needs to be for FT4 and FT3 to be in the upper part of their reference ranges, if that is where you feel well.

You could do with an increase in dose of Levo, 25mcg now and retest in 6-8 weeks, further increases/retesting every 6-8 weeks if necessary until your levels are where they need to be to feel well.

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine (the magazine for doctors):

"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l. In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance. But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l. This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l).*"

*He recently confirmed, during a public meeting, that this applies to Free T3 as well as Total T3.

You can obtain a copy of the article by emailing Dionne at

[e-mail]

print it and highlight question 6 to show your doctor.

You can also refer to NHS Leeds Teaching Hospitals who say

pathology.leedsth.nhs.uk/pa...

Scroll down to the box

Thyroxine Replacement Therapy in Primary Hypothyroidism

TSH Level .................. This Indicates

0.2 - 2.0 miu/L .......... Sufficient Replacement

> 2.0 miu/L ............ Likely under Replacement

It would be worth testing

Vt D

B12

Folate

Ferritin

as these all need to be optimal for thyroid hormone to work properly, and when Hashi's is present it often tends to cause low nutrient levels or deficiencies.

TSH over 2 was considered abnormal but this time says normal due to change in boundaries.

I would actually question your GP and ask him to explain this. My TSH is suppressed, has been for donkeys years, and I am 71. My GP is TSH obsessed, I point out that my FT4 and FT3 are within range, it doesn't wash with her but is accepted by the Advanced Nurse Practioner, so I no longer discuss my thyroid with my GP but am happy to with the ANP.

[Rosemarysnotes in reply to SeasideSusie]

Thank you for this. It's always hard to get GP to listen to you..one even accused me of being neurotic and trying to do his job! I will print off all this before I go see them again..

[SeasideSusie Remembering in reply to Rosemarysnotes]

Don't tell your GP that you got this information "off the internet" or "from a forum". Tell him that your information comes from the charity ThyroidUK (whose forum this is), it will be better received, hopefully.

[Lora7again in reply to SeasideSusie]

I like the "charity" bit ...

[waveylines in reply to SeasideSusie]

Sounds like the 'discussions' I have with my GP Seaside Susie! I always point out that my thyroid hormones are in range so there is nothing to worry about. This usually leaves them stumped.....as they dont know what to say. Always makes me smile! (Even if my teeth are gritted!) I live in hope that theyre tired of these discussions as they know I know more than them. 😉

[Treepie]

How much levothyroxine are you taking?

[Rosemarysnotes in reply to Treepie]

75 mcg and 100 alternate days. Been on this dose for 4 years

[Treepie in reply to Rosemarysnotes]

Answer Seaside Susie re the ranges.

[Lora7again in reply to Rosemarysnotes]

That seems quite low ... my Dad is 78 and takes 100mcg because he is elderly.

[SlowDragon Administrator]

Your high antibodies confirm you have autoimmune thyroid disease also called Hashimoto's

Most Hashimoto's patients do best with TSH under one. Most important results are FT3 and FT4

If you can add ranges on these results please

For full Thyroid evaluation you need TSH, FT4 and FT3 tested.

Also EXTREMELY important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially as you have Hashimoto's and are under medicated

Ask GP to test vitamin levels

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)

Is this how you do your tests?

As you have Hashimoto's are you on strictly gluten free diet?

Hashimoto's frequently affects the gut and leads to low stomach acid and then low vitamin levels

Low vitamin levels affect Thyroid hormone

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common.

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps, sometimes significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

While still eating high gluten diet ask GP for coeliac blood test first or buy test online for under £20, just to rule it out first

Assuming test is negative you can immediately go on strictly gluten free diet




(If test is positive you will need to remain on high gluten diet until endoscopy, maximum 6 weeks wait officially)




Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse

chriskresser.com/the-gluten...

amymyersmd.com/2018/04/3-re...

thyroidpharmacist.com/artic...

drknews.com/changing-your-d...

restartmed.com/hashimotos-g...

The aim of Levothyroxine is to increase the dose slowly in 25mcg steps upwards until TSH is under 2 (many need TSH significantly under one) and most important is that FT4 in top third of range and FT3 at least half way in range

NHS guidelines on Levothyroxine including that most patients eventually need somewhere between 100mcg and 200mcg Levothyroxine.

nhs.uk/medicines/levothyrox...

Also what foods to avoid (eg recommended to avoid calcium rich foods at least four hours from taking Levo)

All four vitamins need to be regularly tested and frequently need supplementing to maintain optimal levels

[Rosemarysnotes in reply to SlowDragon]

Thank you. This is very helpful especially as one of the problems I was diagnosed with when trying to find the cause of my anaemia was diverticulitis. He level was 72 at the lowest...

[humanbean]

In the past, TSH over 2 was considered abnormal but this time says normal due to change in boundaries.

Are you over 60, by any chance? The NHS has decided that torturing older hypothyroid patients is perfectly okay, even encouraged, to save money.

[Rosemarysnotes in reply to humanbean]

Yes am 68 so that explains somethings

[SlowDragon Administrator in reply to Rosemarysnotes]

If you are on Levothyroxine, you still need dose high enough to bring FT3 and FT4 up to correct levels, regardless of your age

Very common for B12 levels to drop as we get older, so especially important to regularly retest all four vitamins regularly (at least annually as absolute minimum)