Interpreting blood test results help

[Hyperbee]

Hi, I have an overactive thyroid due to Graves’ disease. I did a blood test this morning and just received the results (private healthcare really is amazing!), I would really appreciate if someone could please help me interpret them:

TSH 0.00 mlU/L (0.3 - 5)

FT3 7.0 pmol/L (3.6 - 10.4)

FT4 23.2 pmol/L (7.5 - 21.1)

My FT3 is under control, yay! It was 46.1 only a month ago, and I was convinced I was going to die of a heart attack any second. Very pleased that’s controlled now.

I’m confused as to why my FT4 is still high? And why do I still have 0 TSH?

I was on a high dose of carbimazole (40mg in the morning, 40mg at night), and am guessing I now need to decrease it to avoid going hypo. Or should I wait until my T4 is normal too, before decreasing the carbimazole? When can I expect my TSH to increase?

Of course I’m going to see my doctor about this, but I’d like to be able to interpret my own results too. Thanks in advance

[Lalatoot]

The body and cells take longer to recover - so they are playing catch up with your blood results.

TSH again takes longer to settle at a new level so it is playing catch up. Having said that some hyperthyroid patients never see their TSH get back into range. It can just stay suppressed.

I would imagine that your doctor will start tapering off the carbi.

[Hyperbee in reply to Lalatoot]

Thank you for your insight

[Georgetterosewater in reply to Lalatoot]

Very interesting to hear about the TSH being slower and possibly remaining suppressed. I have Graves too and my TSH just won't move up. But, my T3 and T4 are within normal range now with the help of Tapazole.

[asiatic]

Wow 80 mg. is a hefty dose of Carbimazole. I have never heard of anyone being on more than 40 mg. I would want to reduce that dose asap. I imagine you would go hypo soon and would want to titrate down.

[Hyperbee in reply to asiatic]

Thanks I’m seeing my doctor on Friday, in the meantime I’ll reduce the dose. I’ve already taken 40mg today (right after the blood test), but I think I’ll take even less tomorrow

[Lalatoot in reply to Hyperbee]

You can't reduce that quickly. You need to do it over weeks rather than days.

[Hyperbee in reply to Lalatoot]

Surely I would go hypo then? It only took me a month to get my FT3 from 46 to 7

[asiatic in reply to Hyperbee]

I agree with lalatoot that you would be wise to titrate down slowly. No more than 5 mg. before retesting.

[Hyperbee in reply to asiatic]

Surely I would go hypo then? It only took me a month to get my FT3 from 46 to 7

[asiatic in reply to Hyperbee]

Yes you probably will go hypo so you need to be closely monitored by your doctor and dose adjusted as necessary to reach the lowest effective dose that keeps fT4 and fT3 at higher end of range.

[SlowDragon Administrator]

TSH is much slower to respond

Ask GP to test vitamin D, folate, ferritin and B12. These are frequently too low with Graves

[Hyperbee in reply to SlowDragon]

Sorry I’ve also had those done!

Folate: 5.3ng/ml (>2.7)

Ferritin: 16ng/ml (10 - 120)

B12: 345ng/L (160 - 800)

I didn’t do vitamin D, but I’ve been supplementing for a long time with 75ug (equivalent to 3,000IU) daily

[SlowDragon Administrator in reply to Hyperbee]

Ferritin low. Should ideally be at least half way through range

Ask for full iron panel test for anaemia

Iron and ferritin are complex

Folate and B12 on low side

Supplementing a good quality daily vitamin B complex, one with folate in not folic acid may be beneficial.

chriskresser.com/folate-vs-...

B vitamins best taken in the morning after breakfast

Igennus Super B complex are nice small tablets. Often only need one tablet per day, not two. Certainly only start with one tablet per day after breakfast. Retesting levels in 6-8 weeks

Or Thorne Basic B or jarrow B-right are other options that contain folate, but both are large capsules

If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before any blood tests, as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

Low B12 symptoms

b12deficiency.info/signs-an...

Suggest you test vitamin D

vitamindtest.org.uk

[Hyperbee in reply to SlowDragon]

Wow thank you so much for your helpful response!

[Hkm2281]

I have been diagnosed with graves disease, but I'm still waiting to see an endocrinologist. I'm interested to read your post and see that carbimozole has been successful. I honestly cant wait to go on it as I just don't feel great.

[Hkm2281 in reply to Hkm2281]

Also did you have TRAb tested, I'm interested to hear other peoples results?

[Hyperbee in reply to Hkm2281]

I did get TRAb tested and was told I had Graves, but I never asked for those results. That was many years ago when I didn’t take an active role in my healthcare as I assumed the doctors knew best... You’ll come to realise with thyroid issues that’s not usually true. Lol.

[Hyperbee in reply to Hkm2281]

Definitely very successful, it may take longer for you though. Don’t assume it will be a month like me as I was put on a very high dose due to being extremely thyrotoxic. My resting heart rate was 130! My endo thought it was in my best interests to get my thyroid hormones down as quickly as possible. But you will feel SOOOO much better once you’re on it. I actually have a good quality of life now and can walk up a flight of stairs without almost passing out! Yay!

But it’s strange your GP didn’t put you on a starting dose of carbi. Usually they do while you’re waiting for your endo appointment so you’re not just left untreated

[Hkm2281 in reply to Hyperbee]

I know, I honestly thought he would as I too had a fast heart rate. He immediately put me on 160mg propanalol but then left everything else. It just doesn't make sense to me, why don't you treat the cause of the fast heart rate. I really hope they put me on a high dose I can cope with everything except my hair failing out. Its really depressing.

[Hyperbee in reply to Hkm2281]

That’s quite strange, but not surprising... a lot of doctors are quite ignorant when it comes to thyroid issues. If possible I would see a different doctor and ask for carbimazole, say how crap you’re feeling etc. Sadly you’ll have to pester a few doctors before you get what you need!

[Gymgirl]

80mgs is a lot. Defo suggest a reduction when you see your GP. Just for info...I was on 40mgs and my Endo dropped dose from the 40 directly to 10mgs. Im taking none now... crossing my fingers for remission, bloods tomorrow, so we will see. All the best. x

[Hyperbee in reply to Gymgirl]

Thanks for sharing your experience. I dropped down to 20mg today (10mg in the morning, 10mg at night). It wouldn’t make sense for me to continue taking such a high dose knowing it would make me hypo.

Good luck for tomorrow!!

[Gymgirl in reply to Hyperbee]

That sounds like a really sensible drop. Make sure you re-do bloods in 6-8 weeks to make surve you are still on track. My TSH also took months to come back to being detectable even though T4 and T3 had been in range for months, so don't worry too much about TSH for now. x

[Hyperbee in reply to Gymgirl]

Thanks for your advice and reassurance. Wishing you all the best and hoping you’re in remission very soon!