confused about my blood test results: my results... - Thyroid UK

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confused about my blood test results

bambuko profile image
12 Replies

my results were as follows:

TSH - 1.15 miU/L (0.27-4.2)

T3 - 3.15 pmol/L (3.1-6.8)

T4 - 23.8 pmol/L (12-22)

TA - 24.5 kiU/L (<115)

TPA - 155 kiU/L (<34)

I am currently on 200 mcg Levothyroxine and GP wants to test TSH to adjust it...

p.s.

I am also diagnosed with PA (injection every 6 weeks and doing fine)

I had low vit D, taking 5000 IU of D3 plus K2, bringing D to 70 nmol/L, which I am happy with.

Can you please help me, to make sense of these thyroid blood results?

comments from medicheck's doc re. T3/T4 seems to say that I am both hypo and hyper ? or that I am taking too much of Levothyroxine?

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bambuko
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SlowDragon profile image
SlowDragonAdministrator

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 did this test

Assuming you did ....

Your conversion of Ft4 to Ft3 is EXTREMELY poor

FT4 is 118% through range

Ft3 only 1% through range

Helpful calculator for working out percentage through range

chorobytarczycy.eu/kalkulator

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)

Vitamin D is often not high enough at 70nmol

Getting vitamin D at least around 80nmol and around 100nmol maybe better

ncbi.nlm.nih.gov/pubmed/218...

vitamindsociety.org/pdf/Vit...

What about folate and ferritin levels ?

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

Presumably you knew you have Hashimoto’s ?

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 intolerance. Second most common is lactose intolerance

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find strictly gluten free diet reduces symptoms, sometimes significantly. Either due to 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 strictly gluten free diet for 3-6 months

If no noticeable improvement, 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...

bambuko profile image
bambuko in reply toSlowDragon

Thank you SlowDragon!

“... thyroid blood tests should ideally be done as early as ...Is this how you did this test..”

Yes, that’s how it was done (thanks to advice here on HU)

“...Your conversion of Ft4 to Ft3 is EXTREMELY poor ...”

What can be done about that?

Sounds like I need to educate myself better...

“...Vitamin D is often not high enough at 70nmol...”

It is a lot better than what it was when I started...

GP had me on 1000 IU/day which was clearly not enough, so I added 4000 IU/day as a first step.

“...What about folate and ferritin levels ?...”

Ferritin – 188 ug/L (30-400)

Follate – 13.42 ug/L (>3.89)

“...Presumably you knew you have Hashimoto’s ? ...”

I was guessing it (runs in the family)

Blood test just confirmed my guess

Having said so, knowing it doesn’t make any difference to the treatment?

“...Changing to a strictly gluten free diet may help reduce symptoms...”

Almost three years ago started on very low carb lifestyle, eliminating also wheat, barley, rye.

No tea, no coffee, no alcohol.

Lost fair bit of weight, but also, totally eliminated IBS!

Years of conventional advice to increase fibre only made it worse, so this unexpected side effect of low carb diet was very welcome!

ps how do I edit my reply to include bold text to highlight something?

don't seem to be able to do it on my browser?

SlowDragon profile image
SlowDragonAdministrator in reply tobambuko

So ....you have probably done as much as possible to help improve conversion already

Though recommend getting vitamin D a bit higher ....suggest you keep going until up around 100nmol

Do you supplement folic acid, or a daily good quality vitamin B complex......or is folate naturally that good?

Yes I found lower carb was good for ...but don’t go “No carb” that makes conversion worse

Gluten free diet helps thousands of us

Have you tried lactose free

Next step.....getting T3 prescribed and slight drop in levothyroxine

greygoose profile image
greygoose

comments from medicheck's doc re. T3/T4 seems to say that I am both hypo and hyper ? or that I am taking too much of Levothyroxine?

Oh, you've got to laugh! It's really not worth asking for the Medichecks doctor's comments, because they don't know anything more about thyroid than your common or garden GP. They've had no extra training. And, they come out with rubbish like this!

What is happening is that you aren't converting all that T4 to T3. So, your FT4 is over-range and your FT3 is right at the bottom of the range. In fact, you are a very, very poor converter. And just testing TSH won't tell you that, so it would be a very bad idea to allow your doctor to dose by the TSH. But, I doubt he knows enough about thyroid to understand that. You need a referral to an endo that will prescribe you T3 to add to a reduced dose of levo.

Did you know you have Hashi's? Hashi's people are often bad converters, so there's probably not much you can do about it - except add T3. But, you could try a gluten-free diet, and taking selenium. That could improve your conversion a little. :)

bambuko profile image
bambuko in reply togreygoose

Thank you greygoose!

“...What is happening is that you aren't converting all that T4 to T3...”

Will need to do some reading to understand it!

Although I must admit that I dread trying to do it,

when my GP freely and happily admits that “... it is complicated...”

“..., I doubt he knows enough about thyroid to understand that...”

See my comment above

“...You need a referral to an endo that will prescribe you T3 to add to a reduced dose of levo...”

I guess private is the only way?

“... Hashi's people are often bad converters, so there's probably not much you can do about it - except add T3...”

I feel like giving up...

“...But, you could try a gluten-free diet...”

Already doing it

greygoose profile image
greygoose in reply tobambuko

“...What is happening is that you aren't converting all that T4 to T3...”

Will need to do some reading to understand it!

T4 is basically a storage hormone, bit like have staples in the larder - tinned food, flour, eggs, sugar, etc. - so that there's always something to eat.

T4 has to be converted to T3 the active hormone, needed by every single cell in your body to function correctly. How that happens is complicated, but you don't need to worry about that at this stage. The main point is, with you, it isn't happening very well. Finding out why is a huge task, one that your doctor would not be willing to embark on, even if he were capable. As I said, you could try taking selenium to see if that helps. Selenium is one of the elements necessary for conversion. If it doesn't, then it would be best to cut your loses and seek out a source of T3.

It is still possible to get T3 prescribed on the NHS, if you find an open-minded/knowledgeable endo - not necessarily private - private doctors aren't always better. Or, you could look into buying your own on-line - although that is getting harder and harder. You could try posting a new question asking people to PM you their trusted sources.

I feel like giving up...

Why would you do that? There are thousands of people on here who have fought their way through. No reason why you can't do the same. :)

bambuko profile image
bambuko in reply togreygoose

That's good explanation - thank you!

as for "giving up".... can't help the way I feel :-) and that's probably part of the problem

greygoose profile image
greygoose in reply tobambuko

Meuh… I'm not into patient-blaming. If your FT3 is low, your brain isn't going to be firing on all cylinders. I believe in having a temper-tantrum, screaming, crying, breaking something if you must, then just getting on with it. It perks you up no-end. :)

Lora7again profile image
Lora7again

The Medichecks clinicians are not thyroid experts and I always ignore their unhelpful comments. They once said to me you have "normal thyroid function" even though I have a multinodular goitre and high antibodies because of Graves' (if only what they said was true). I just use them to check my thyroid levels and my vitamin levels and nothing else.

McPammy profile image
McPammy

From your results I’d say you are a poor converter T4 to active T3.

Without T3 being optimal mid to top of range you will struggle.

I had very similar results with my T4 over the range and T3 right at the bottom of its range. And my TSH was suppressed due to too much levothyroxine. After going private only i was prescribed T3 medication. It was like a miracle. I also had the DIO2 Gene test which came back positive. This showed the reason why I was hardly converting T4 to active T3. I’d go and see a private only Endocrinologist as seeing an NHS/private Endocrinologist they mostly will not prescribe T3 medication as private or NHS they still follow NHS rules. So private only you could have a T3 trial for 3 months to see how you improve. Then go to NHS with those results and hopefully they will agree to prescribe on the NHS. This is what happened to myself. I now get T3 from the NHS. If you need details of my private only Endocrinologist please message me.

tamina786 profile image
tamina786 in reply toMcPammy

Hey would you able to give information about your endocrinologist

bambuko profile image
bambuko in reply toMcPammy

Thank you McPammy

message on it's way

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