High TSH but good FT3?

[Jacs]

I’ve managed to get a blood test done which included FT3 (a minor miracle!) but whilst my FT3 is good, the FT4 is quite low and the TSH high. I realise that FT4 can be on low side when supplementing with T3, but usually my TSH is fairly stable.

Should I be increasing T4? I’m not feeling too bad, usual tiredness in eve but no more than usual. I’d appreciate any advice. Results below:

TSH 7.63 (0.27-4.2)

FT4 7.2 (12-22)

FT3 6.2 (3.1-6.8)

Thanks

[SlowDragon Administrator]

Looking at previous posts, you are taking T3 as well as levothyroxine?

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

Is this how you do your tests?

Do you have Hashimoto’s?

When were vitamin levels last tested?

What vitamin supplements are you currently taking?

[Jacs in reply to SlowDragon]

Hi slowdragon, yes that’s how i took the blood test - T4 not quite 24 hrs but > 14 hrs

I do have hashis, am taking 25mcg T3 and 50 or 75 of T4 (usually 50)

At mo just taking good quality multivitamin, magnesium spray, krill oil, vit C and sometimes ashwaghanda (when stressed)

My vit levels have been pretty good (hence dropping some supplements) and I’ve had plenty of sunshine recently so vit D should be good

I’m a bit baffled at rising TSH?

[SlowDragon Administrator in reply to Jacs]

Well your results suggest you are under treated

Many of us need good Ft4 and good Ft3

50mcg levothyroxine is only a starter dose

Ft4 is well below range

Suggest you increase levothyroxine to 75mcg per day and retest in 6-8 weeks

Do you split your T3 normally?

Did you split the dose so that took 1/4 tablet 12 hours prior to blood test ?

Multivitamins are not recommended on here.

When did you last test levels?

See Greygoose last reply on here re multivitamins

healthunlocked.com/thyroidu...

[Jacs in reply to SlowDragon]

I have previously been on as much as 150 /175 T4 but I felt absolutely awful - got a lot better after seing Dr P some years ago and taking nutri thyroid & nutri adrenals, but ultimately i was taking so many tablets I went onto T3 and reduced T4. Felt a lot better since and have been pretty stable.

I used to take B12, b complex, vit d too but all those are pretty stable too, which is why I’m a bit perplexed.

I split my T3 into 2 doses, half first thing and half around lunchtime. i take my T4 at night. This prevents the 3pm slump i used to get, and generally feel OK till about 10pm

I know that multivits are generally frowned upon but i think (maybe naively) that biocare (no iron) are ok when levels just need maintaining - sarah myhill suggests them

I’ll get re-tested and up my T4 as it seems that’s what’s missing -i posted as I wondered if this was a common scenario

[SlowDragon Administrator in reply to Jacs]

Many of us find endocrinologists reduce levothyroxine when adding in T3

Often Ft4 then drops too low and low Ft4 starts causing symptoms, even though Ft3 is good

[Jacs in reply to SlowDragon]

Thanks for the feedback Slowdragon 😊