Advice please on results

[Karan49]

Just wanted an opinion on my recent blood test.

Plasma TSH 0.18 0.30-4.20mU/L

Plasma free T4 14.8 9.00-19.00omol/L

Plasma T3 3.6 pool/L 2.60-5.70omol/L

I have been in 75 levothyroxine for just over a year. I am type 2 diabetic on Metformin. Constantly exhausted.

Thank you Karan

[SlowDragon Administrator]

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also EXTREMELY important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially if you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies

Ask GP to test vitamin levels

On metaformin low B12 is EXTREMELY Common

What vitamin supplements are you currently taking?

Do you have Hashimoto’s?

You may need to get full Thyroid testing privately as NHS refuses to test TG antibodies if TPO antibodies are negative

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 do your tests?

Ft4 is only 58% through range

Ft3 on 32% through range

So you are poor converter of Ft4 to Ft3

Improving vitamin levels can improve conversion

Plus you really need dose increase in levothyroxine, but GP may be reluctant as a TSH is low

NICE guidelines Might help if your dose is currently lower than this weight guideline

nice.org.uk/guidance/ng145/...

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

Post re how to push for dose increase in levothyroxine

healthunlocked.com/thyroidu....

[Karan49 in reply to SlowDragon]

Thank you. All the tests you say I should request are out of the question at my practice. I can of course pay privately. I wonder however if it is proven that my conversion from T4 with T3 needs correcting, then how does one get T3 prescribed ? And if we can’t get it prescribed what is the alternative action to increasing our flagging energy levels? I have spoken to my Dr and he says he just can’t prescribe it, he says he knows an endocrinologist in London that champions T3 but I still don’t understand how I would obtain it? Can it be bought in this country? Thanks and sorry for so many questions. Ps are you saying I would be a candidate for T3 ? I appreciate your thoughts.

[SlowDragon Administrator in reply to Karan49]

Your GP could and should test vitamin levels

But probably majority of UK patients on this forum can’t stand the argument and get full testing privately

First step is to get full vitamin testing

Getting 25mcg dose levothyroxine increased by GP

Improving low vitamin levels essential before considering adding any T3 alongside levothyroxine

Do you have Hashimoto’s?

If yes then trying strictly gluten free diet likely to help or be essential

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...

If after these steps, Ft3 remains low then you have clinical need of T3 and should be prescribed on NHS

T3 is not routinely prescribed, but it can and should be prescribed if needed

But you’re not at that stage yet