Am i overmedicated now? On T3/T4 new bloods

[MishB]

Hello again lovely people

Hashimoto sufferer on T3 10mcg and T4 125mcg combo since last tests in Nov time on your advise..PrivateEndo wanted 100mcg but was advised levels still looked low and to try T4125mcg and was feeling great on this..( see old posts)

.(did reduce back to 100mcg 2 weeks before bloods ...to try not to skew results too much to his eyes)

New blood work in and saw Private Endo for a review ..(.lying to him that i take 100T4)

Blood tests taken at usual 0830, fasting and no T4 24 hrs and took T3 at 10.30pm...all same as previous bloods

Am i now overmedicated? Endo wants to reduce T4 to 100/75 alt days as TSH too supressed....arghhhh...didnt even comment on T3 being over range!!!! Sadly although i get my T3 from him not convinced he really knows what he is doing, as looks at TSH...hence rely on you guys help

Bloods11.2.2020

FT3. 5.9pmol/L (2.5-5.7)

FT4. 14.4 pmol/L (9-20)

TSH 0.04 mu/L (0.35-5) (edited not 0.004 as prev entered)

Note hBA1c was also retested 3.12.19 and raised again 54mmol/mol (20-42)

Have been diagnosed type2 diabetic...Endo now pushing GP to prescribe metformin...which i think i am happy to take now as only lost 1/2stone since last august despite doing nearly dry january...didnt loose anything !!!

Any thought please on these new results and how i need to interpret them and my T4 dosage...was feeling good on 10/125?

Thnak you in anticipation xx

[SeasideSusie Remembering]

.(did reduce back to 100mcg 2 weeks before bloods ...to try not to skew results too much to his eyes)

Well, that sort of muddies the water really, because you don't have an accurate FT4 result and it could also affect your FT3 result depending on how much natural conversion you have.

FT4. 14.4 pmol/L (9-20)

Even if you'd stayed on your normal dose of Levo it's very likely that your FT4 would be in range so that probably wouldn't be a problem.

FT3. 5.9pmol/L (2.5-5.7)

This is a touch over range. Did you split your T3 dose the day before and take half at 10.30pm?

TSH 0.004 mu/L (0.35-5)

This is what's upsetting your endo, they don't like to see a suppressed TSH, but that's just what taking T3 does, if he doesn't understand that then why is he prescribing T3 to patients if he can't interpret the results properly.

[MishB in reply to SeasideSusie]

Hi Seaside Susie...noooo i didn't half T3 dose at 10.30pm took full 10mcg as had to give up splitting tablet into 4s as crumbled too much...but was this my mistake....memory issues so poss forgot told to do before...may need to type out instructions to myself in run up to blood tests so consistant...Ha ha

And apologies typo on the T4 is under range but 0.04.. put too many 0 in...sooo sorry...will edit post if i can....

as i say worried me first time that he looked at my TSH when started T3 bcak in august ...and was dismissive over the T3 readings...but beggers cant be chooser and he is my only way of getting T3 as NHS not able to supply due to cost!!!

[SeasideSusie Remembering in reply to MishB]

I think if you had split your T3 dose into 2 and only taken 5mcg at 10.30pm you may have a lower FT3, I think it would most likely be within range.

Even with your TSH being 0.04, it's still suppressed and will be because you are taking T3. Adjusting your Levo dose wont necessarily make that come back into range so I don't know how you're going to satisfy the endo where that's concerned.

[SlowDragon Ambassador]

Many of us need GOOD levels of Ft4 and Ft3

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)

on T3, make sure to take last 1/2 or 1/3rd of daily dose 8-12 hours prior to test, even if this means adjusting time or splitting of dose day before test

When were vitamin D, folate. Ferritin and B12 last tested ?

[MishB in reply to SlowDragon]

Hi SlowDragon...that was my mistage took 10mcg..T3...my full dose 10 hrs before...going to write down my instuctions on this now so can refer to before future tests

I had asked gp to do forms for the other tests but not given to me!....i am on

On mg,vitD,folic acid, and B12 inj every 8 weeks. admittedly these havent been retested since July 2019

Ferritin 224 (20-275ug/l

Folate 19.1 (2.7-34)

B12. 969 low is <145

VIt D. 167 (50-150nmol)