Thyroid result interpretation Plz

[Toto88]

Hi everyone - can anybody help me interpret my recent thyroid test results plz ? My TSH is 4.07 (range 0.27-4.2) Free T3 is 3.64 (range 3.1-6.8) Free thyroxine is 16.4(range 12-22) Thankyou x

[SeasideSusie Remembering]

Toto88

Are you diagnosed hypothyroid?

If so, what thyroid meds/dose are you on?

Interpretation varies depending on the above.

[Toto88 in reply to SeasideSusie]

I have had hypothyroidism since my 30’s - these are results from medichecks done the other day. I’ve been v unwell since last July & seeing a private endocrinologist because even though everything is coming back within normal range it looks like I’m not in my personal opinion optimal ! I’m v v nearly out of the so called ‘normal’ range - especially TSH & my T3 is quite low ? At the moment I take 50mcg levo one day & 75mcg the next.

[SeasideSusie Remembering in reply to Toto88]

Toto88

How long have you been taking Levo? 50mcg is a starter dose so your current dose averages 62.5mcg daily which is very low.

The aim of a treated hypo patient on Levo, generally, is for TSh to be 1 or lower with FT4 and FT3 in the upper part of their reference ranges.

TSH is 4.07 (range 0.27-4.2)

This is way too high and needs to come down to 1 or lower.

Free thyroxine is 16.4(range 12-22)

This is 44% through range so is on the low side.

Free T3 is 3.64 (range 3.1-6.8)

This is 14.59% through range so it's low.

Calculator here: chorobytarczycy.eu/kalkulator

You need an increase in your Levo - 25mcg now, retest in 6-8 weeks. Repeat until levels are where you need them for you to feel well.

Once your TSH is down to around 1, your FT4 should have risen quite considerably and we can then see where your FT3 lies and see from FT4 and FT3 results how well you convert T4 to T3. T4 is a storage hormone and converts to T3 which is the active hormone which every cell in our bodies need.

Did you also have thyroid antibodies tested - TPO and Tg?

For thyroid hormone to work properly we need optimal nutrient levels, did you also test

Vit D

B12

Folate

Ferritin

If so, please post results/ranges.

[Toto88 in reply to SeasideSusie]

Thank you for replying to me - I’m still awaiting my Vit D test that was done yesterday but my ferritin done late Jan 2020 is 28 ug/L (11.0-307.0) - thyroid peroxidase abs - TPO antibodies < 33 iu/mL (0.0 - 60.0) Ref range - Negative less than 60 Equivocal 60 -100 Positive greater than 100

Vitamin B12 - 536 (145-914)

Folate 14 (4.0-20) Iron is borderline I’ve been told - 10.5 (10.7-32.2) - I’ve started taking 200mg ferrous sulphate even though my GP says I don’t need to take anything for my iron ! I’m so v ill as I last mentioned in my post to you - yesterday I had an occipital nerve block done in hospital which hasn’t as yet helped but it may take a few weeks I’ve been told ! I’m seeing the endocrinologist as mentioned on the 18th March & am hoping he will def up my levo & add T3 ! The ringing in my ears/pain & hypersensitivity - chronic neck & jaw pain & head pain is relentless ! I’m freezing cold all the time recently & I cannot regulate my temp properly ! What would you say with regards to the other test results I’ve uploaded plz ? Thanks again for all your help x

[SeasideSusie Remembering in reply to Toto88]

Toto88

ferritin: 28 ug/L (11.0-307.0)

Iron:10.5 (10.7-32.2)

I’ve started taking 200mg ferrous sulphate even though my GP says I don’t need to take anything for my iron !

Oh dear! I do wonder about doctors at times

Your ferritin is 5.74% through range and your serum iron is below range. These suggest iron deficiency and testing haemoglobin, MCV and MCH (in a full blood count) would indicate if it was iron deficiency anaemia.

I can't comment on the iron supplement you are taking, iron is complicated so I wont suggest anything, but it's very likely that a doctor who had your best interests at heart would find out if it was iron deficiency or iron deficiency anaemia. The treatment may very well be the same - iron tablets - but I can't say any more than that except that maybe 1 tablet might not be enough.

TPO antibodies < 33 iu/mL (0.0 - 60.0)

This is a negative result but it's possible to have negative TPO antibodies but positive Thyroglobulin (Tg) antibodies and that can suggest Hashi's. Tg antibodies are not usually tested at GP level, it's an endo who usually requests this. Plus, of course, it's possible to have Hashi's without raised antibodies. But the treatment is the same as non-Hashi's hypothyroidism (thyroid hormone replacement), it's just that when Hashi's is present some members have found that adopting a gluten free diet can help, and supplementing with selenium is said to help reduce antibodies.

Vitamin B12 - 536 (145-9.14)

Folate 14 (4.0-20)

If the unit of measurement for B12 is pg/ml or ng/L (they're both the same) then your level is just short of the level recommended in the book "Could it be B12?" by Sally M. Pacholok which states:

"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".

"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."

If the unit of measurement is pmol/L then that is 726pg/ml.

Folate is recommended to be at least half way through range and yours is 62.5% through range so that's good.

[Toto88 in reply to SeasideSusie]

Ok thank you v much for all your help - I’m taking vit B12 , Vit D, magnesium & 200mg ferrous sulphate at the mo ! I imagine then that the endocrinologist will want to know thyroglobulin results but I will wait till I see him. I feel almost like I’m allergic to something aswell as having all the pain ! If the HRT doesn’t really help after the next two months then I will prob just stop that but as mentioned before I do know it can interfere with the thyroid ! I’m just praying that by having an increase in levo & him poss adding T3 all my symptoms subside ! Every day is a fight for me & im pretty much bed bound apart from appointments- I’m going to change my GP soon aswell because she has been absolutely hopeless ! Thank u again for helping me & thank god for this site !! Best wishes x

[Toto88 in reply to SeasideSusie]

I also need to mention that last month I started on HRT - oestrogen patches & progesterone pills (the pills are only taken 12 days a month) the patches worn every day ! I realise this can interfere with thyroid aswell & I will be mentioning it to the endocrinologist ! I’m just trying anything & everything! Suppose u do when you’re so unwell x

[SlowDragon Administrator]

To have been left on such low dose of levothyroxine is very poor care

See GP for immediate 25mcg dose increase in levothyroxine

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 is in top third of range and FT3 at least half way through 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)

Also request that GP tests vitamin D, folate, ferritin and B12 plus thyroid antibodies NOW

Come back with new post once you get vitamin and antibodies results

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

Thyroid levels will need retesting 6-8 weeks after each dose increase

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)

Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies

thyroiduk.org.uk/tuk/testin...

For thyroid including antibodies and vitamins

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

If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3 £29 (via NHS private service )

monitormyhealth.org.uk/thyr...

If antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).

About 90% of all primary hypothyroidism in Uk is due to Hashimoto's.

Low vitamins are especially common with Hashimoto's. Food intolerances are very common too, especially gluten.

So it's important to get TPO and TG thyroid antibodies tested at least once .

Link about thyroid blood tests

thyroiduk.org/tuk/testing/t...

Link about antibodies and Hashimoto's

thyroiduk.org.uk/tuk/about_...

thyroiduk.org.uk/tuk/about_...

List of hypothyroid symptoms

thyroiduk.org.uk/tuk/about_...

[SlowDragon Administrator]

Levothyroxine should always be taken empty stomach and then nothing apart from water for at least an hour after

Many people take Levothyroxine soon after waking, but it may be more effective and more convenient taken at bedtime

verywellhealth.com/best-tim...

Many people find Levothyroxine brands are not interchangeable.

Once you find a brand that suits you, best to make sure to only get that one at each prescription.

Watch out for brand change when dose is increased or at repeat prescription.

Many patients do NOT get on well with Teva brand of Levothyroxine. Though it is the only one for lactose intolerant patients. Teva is the only brand that makes 75mcg tablet. So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half

healthunlocked.com/thyroidu...

Teva poll

healthunlocked.com/thyroidu...

No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.

Some like calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away

(Time gap doesn't apply to Vitamin D mouth spray)