T 4

[foxglove]

I've recently had a thyroid test (monitormyhealth.com.) and t4 has come back as 10.7 which is reported low, TSH and T3 normal (so they say) Any significance in T4 being low?

[RedApple Administrator]

foxglove, it would be helpful if you could say what thyroid medication and dose you were taking when the test was done. And how long between the blood draw and your last dose.

[foxglove in reply to RedApple]

Taking Thyroid-S About 12Hours between blood draw and last dose

[SeasideSusie Remembering]

A few weeks ago you were asking about NDT. Have you changed from Levo to NDT? If so when did you change, how long between changing over to latest test?

Please also give reference ranges for test results, saying "low" and "normal" makes it impossible to interpret your results.

[foxglove in reply to SeasideSusie]

Hi,

TSH 2.24 (range 0.27-4.2 mU/L))

T4 10.7 (range 12-22pmol/L)

T 3 3.7 (range3.1-3.68 pmol/L)

Change to NDT 5weeks ago,

[SeasideSusie Remembering in reply to foxglove]

So are these results from a test done after changing to NDT? Guessing 4 weeks after changing?

When was last dose of NDT before test?

[foxglove in reply to SeasideSusie]

Correct!!!

[SeasideSusie Remembering in reply to foxglove]

Sorry, I edited my response whilst you were replying.

When was your last dose of NDT before the test?

[foxglove in reply to SeasideSusie]

About 12 hours

[SeasideSusie Remembering in reply to foxglove]

OK, thanks.

First of all, you should really have left 6-8 weeks before testing after changing from Levo to NDT, or for any change of dose. As you changed from Levo to NDT you need to give time for the Levo to completely leave your system and your levels to settle down with the new combination of T4 and T3.

But to answer your question about whether low FT4 is significant, when taking NDT it tends to lower FT4 due to the T3 it contains. It also generally tends to lower TSH, maybe even suppress it.

If we assume that these results are a true reflection of your current thyroid status:

TSH 2.24 (range 0.27-4.2 mU/L))

T4 10.7 (range 12-22pmol/L)

T 3 3.7 (range3.1-3.68 pmol/L)

Then your TSH is a lot higher than one would expect to see when someone is taking NDT. Your FT4 is below range and when taking NDT it's a very individual thing where one needs FT4, most people need it somewhere within the range, some are fine with it low in range, others need it high in range. One also expects to see FT3 in the upper part of it's range when on NDT.

So all in all your results suggest that you are undermedicated with your NDT.

How much are you taking?

[foxglove in reply to SeasideSusie]

I am taking 1gramme. Of course I realise I should not have been so "eager" to get bloods done...patience NOT my middle name. Have learned the hard (and costly way) how not to do things!

My last test when on Levo (OCT.) TSH 4.9 _ this is the only thing docs. test and it had risen from last year ( 3.4) so clever me thought I would go it alone.

[SeasideSusie Remembering in reply to foxglove]

I am taking 1gramme.

As you are taking Thyroid-S then it's 1 grain (which is 60mg)

Do you know the protocol for increasing NDT? If not then this is what is recommended:

1) Start with 1/4 of a grain (15mcg), stay on this dose for 7 days and if no adverse reactions add another 1/4 of a grain (1/4 morning, 1/4 afternoon).

Stay on a total of 1/2 a grain for 3 weeks.

2) Then add another 1/2 grain, total 1 grain daily, 1/2 grain morning, 1/2 grain afternoon. As long as no adverse reaction, stay on this dose for 3 weeks.

3) Then add another 1/2 grain, total 1 and 1/2 grains, 1 grain morning, 1/2 grain afternoon. As long as no adverse reaction, stay on this dose for 3 weeks.

4) Then add another 1/2 grain, total 2 grains, 1 grain morning, 1 grain afternoon. As long as no adverse reaction, stay on this dose for 3 weeks.

5) If you need further increases then 1/4 grain at a time with 3-4 weeks between increases, until you find your sweet spot. If you become overmedicated (symptoms of overactive thyroid) drop back to previous dose.

As you are already on 1 grain then you are at stage (2) so I would continue from there. Please remember to take it slowly, frustrating as it is, it's the only way to find your optimal dose.

[foxglove in reply to SeasideSusie]

Thanks for your kind and helpful reply, yes frustrating is the word!. I had quite a "Rude" and insulting phone call with doc. when I said I was concerned. Told me that until TSH was over 5 there was no need to do anything. As I have a lot of probs.- health and otherwise I was upset, I am not a confrontational sort so gave in. At my stage in life I nee docs. more than they need me. A bit of a doormat but that's me!

I'm grateful for your guidance will continue on I grain for a bit till I'm sure about it, then will gradually increase as you advise

[SlowDragon Administrator in reply to foxglove]

When adequately treated on NDT your TsH will likely be very low, FT3 at top end of range and often FT4 low in range

Obviously if you have to have NHS blood test a very low TSH greatly alarms doctors

You were extremely poorly treated by all your GP's. On Levothyroxine dose should be increased in 25mcg steps until TSH is under 2. Most important results are FT3 and FT4.......even on Levothyroxine we frequently need high enough dose ...that TSH becomes suppressed

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,

"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)."

You can obtain a copy of the articles from Thyroid UK email print it and highlight question 6 to show your doctor

please email Dionne at

[e-mail]

At what ever age .....To have been left on 25mcg for years is criminal

Levothyroxine doesn't "top up" your own thyroid output, it replaces it

Regardless of age we need the correct dose.

NICE guidelines

cks.nice.org.uk/hypothyroid...

The initial recommended dose is:

For most people: 50–100 micrograms once daily, preferably taken at least 30 minutes before breakfast, caffeine-containing liquids (such as coffee or tea), or other drugs.

This should be adjusted in increments of 25–50 micrograms every 3–4 weeks according to response.

The usual maintenance dose is 100–200 micrograms once daily.

[foxglove in reply to SlowDragon]

Typed out reply but don't think I posted. If you could read my reply to Seaside Susie I think that explains my position I'm weary of docs. just now and have many probs beside health to sort Thanks for your time and concern.

[foxglove in reply to SlowDragon]

Thanks for reply and explanation. I have a long history of not agreeing with docs. in general, but I'm tired of it all! I made a mistake of using Monitor My health, their print out and opinion not as easy to understand (at least by me ) as Blue horizon. I used M...health as it was cheap, perhaps the usual you get what you pay for. Still it's made me "sit up and take notice"!!!

[SlowDragon Administrator in reply to foxglove]

Cheapest including vitamin levels is Medichecks

£99 often on offer at £79

£25 extra for private blood draw.

Results emailed to you 2-3 days later

Important to maintain optimal vitamin levels

All thyroid blood tests should be done as early as possible in morning before eating or drinking anything other than water and last (small split ) dose NDT 8-12 hours prior to blood test

On increased dose of NDT you are likely better to split dose anyway

Some do half dose am and half dose pm

Some do 2/3 dose and and 1/3 dose pm

[foxglove in reply to SlowDragon]

hanks, will investigate medichecks, continue on 1grain thyroid-S meantime and take things from there! I seem to have got into a right muddle. I'll have to cultivate patience!!!....tell me how?

[SlowDragon Administrator in reply to foxglove]

Took me 26 years to get well.

Only with help of this forum and full testing....getting vitamins optimal was key

[foxglove in reply to SlowDragon]

Sounds familiar...at least there is help on hand.