Confusing Blood Test Results

[ShonaGreen]

Hi, I'd welcome your thoughts on recent results please, some seem a bit strange and I'm unsure whether I need to change dose (currently on 50mg Levothyroxine and 25mg Liothyronine). I had the test at 9am, fasting and took meds after the test. I use the Better You sprays for Vit D and Vit B, and also Igennus Super B Complex.

TSH - 0.033 (0.27 - 4.2)

Free T3 - 4.84 (3.1 - 6.8)

Free T4 - 8.76 (12 - 22)

TgAb - 225 (<115)

TPO - 15.2 (<34)

Folate Serum - 8.27 (>3.89)

Vit B12 Active - 111 (>37.5)

Vit D - 60.5 (50 - 175)

Cortisol - 214 (166 - 507)

DHEA - 1.49 (1.65 - 9.15)

FSH - 43.7

LH - 24.8

Oestradiol - 548

SHBG - 116 (32.4 - 128)

As I'm taking Liothyronine, I understand this will affect my Free T4 levels, but should it be this low? I've seen an improvement since starting Liothyronine 3 months ago, when I'm feeling good it's great, but still have bad periods with low energy, fatigue, short of breath, headaches and dizzy. So I'm wondering if I should consider increasing dose? At my last Endo appointment, he advised me to decrease Levo to 25mg whilst increasing Liothyronine to 25mg. As this felt like I was just balancing my dose, rather than improving it, I stuck with Levo at 50mg. My GP also agreed with this and still prescribes this.

Medichecks commented that I'm likely to be in the menopause due to high FSH and LH, but Oestradiol should be lower if this was the case? I've had a Mirena coil for the last 5 years with no periods during this time. It was removed a few weeks ago and having another coil in a few weeks time. It's possible that I could be in the menopause but I'm 43 years so still a bit young.

Also wondering about DHEA and Cortisol levels as these are decreasing with each blood test. But maybe this has something to do with taking Liothyronine too?

Many thanks in advance for your help, I really appreciate it!

[SeasideSusie Remembering]

ShonaGreen

TSH - 0.033 (0.27 - 4.2)

Free T3 - 4.84 (3.1 - 6.8)

Free T4 - 8.76 (12 - 22)

50mcg Levo, 25mcg T3.

Was your last dose of Levo 24 hours before the test, and last dose of T3 8-12 hours before the test (splitting dose of T3 and adjust time the day before if necessary)? That will help us to interpret the results better than just "took meds after the test".

When on combination therapy we are very individual as to where we need our hormone levels to be. I'm on combo therapy and if that was my FT4 level I'd be bedbound. I would expect to see it in range, how low you could go and still feel well is only something you can know.

However, it was suggested when you posted results at the end of January, when your FT4 was 10.3, that you increased your Levo to 75mcg, did you not do that?

If you took your last dose of meds at the correct time then it would seem you need more Levo. That will raise your FT4 and also raise your FT3 (depending on how much natural conversion you have).

If you took last dose of T3 more than 12 hours before the test then you have a false low FT3 and you can only know if that dose suits you when you see a true result from proper timing of last dose.

Folate might be better in double figures.

Vit D is too low, it's recommended by the Vit D Council/Vit D Society to be 100-150nmol/L.

No Ferritin result?

Can't comment on cortisol, I'm not au fait with cortisol blood tests.

Hopefully someone else will comment on your sex hormones, not something that I know anything about.

[ShonaGreen in reply to SeasideSusie]

Hi SeasideSusie , thanks for your reply. Yes my last dose of Levo was 24 hours before the blood test, and Liothyronine was 10 hours before the test (took 15mg at 6am and 10mg at 11pm).

I stayed at 50mg Levo as thought it would be better to increase Liothyronine first (from 20mg to 25mg) as it might have been a bit much to increase Levo to 75mg at the same time. At the time I was also worried that the GP might change my Levo prescription from 50mg to 25mg as requested by the Endo, so I didn't want to take the chance just in case!

My Ferritin was 160 which is lowest it's been since I started testing (it was 200 a year ago). I don't take any iron supplements but don't think it's high enough to be any concern?

I'm using the Better You Vit D & K2 spray at the moment. I think I may need to consider taking something else as well at this, or instead of?

[SeasideSusie Remembering in reply to ShonaGreen]

ShonaGreen

I would have said to increase Levo first to raise your FT4 which would have also raised your FT3.

I'm using the Better You Vit D & K2 spray at the moment. I think I may need to consider taking something else as well at this, or instead of?

What dose are you taking? Your current level suggests you need to take 4,000iu D3 daily to reach the recommended level. Do you also take magnesium, that is needed to help the body convert D3 into it's usable form.

[ShonaGreen in reply to SeasideSusie]

Thanks SeasideSusie , I'm taking 3 sprays of the Better You spray, so that's 3,000iu daily. I guess I can start taking 4 sprays. Or is there a different product I can buy that is stronger? I also use a magnesium spray as heard this was more effective that a tablet, hope that's right!

[SeasideSusie Remembering in reply to ShonaGreen]

ShonaGreen

I assume 4,000iu is 4,000iu however you take it so you could just take an extra spray for a while.

I don't know about topical magnesium spray being more effective, I don't like the feel of it so don't use it.

[SlowDragon Administrator]

Personally I think you need higher Ft4 levels and need dose increase in levothyroxine

Many of us on levothyroxine plus T3 need GOOD Ft4 and Ft3

So typically Ft4 at least 16

That would/should also increase your Ft3 slightly

Always stick to same brand of levothyroxine...

Are you on strictly gluten free diet?

[ShonaGreen in reply to SlowDragon]

Hi SlowDragon , I went gluten free for 4 months last summer but it didn't seem to make much difference, but it did highlight a few things that I can't tolerate, like white & brown pasta and pizza dough. Interestingly my TgAb antibodies are the lowest they have been, long may that last!

[humanbean]

What time of day was your blood taken for these tests?

[ShonaGreen in reply to humanbean]

Hi humanbean , the test was done at 9am.

[humanbean in reply to ShonaGreen]

Okay, in that case I think your cortisol should probably have been much closer to the top of the range.

Cortisol production has a circadian rhythm and should be at its highest around 8am - 9am. A rather cartoonish graph that gives you a rough idea of what I'm saying :

endocrinesurgeon.co.uk/imag...

For some suggestions on how to improve your cortisol, you may find this thread helpful :

healthunlocked.com/thyroidu...

...

DHEA production reduces as people age. But yours is below range and you might feel better if you were to supplement it. However, if you live in the UK it is actually illegal to buy it over the counter. It can be prescribed though. The problem is that it has been classed in the same category as anabolic steroids. (Stupidity in the bureaucratic mind apparently has no limits.)

The only DHEA product I could find in the BNF is this one :

bnf.nice.org.uk/drug/praste...

I have no clue whether you could persuade a GP to prescribe DHEA. Nor do I know whether being prescribed it is a good idea.

I think Angel_of_the_North has mentioned taking DHEA. She may have some useful info on it.

If you want to know more about your cortisol then you could do a private saliva test, which is more informative than a blood test. The best one available is this one :

regeneruslabs.com/products/...

It uses sensible reference ranges which don't include zero, provides actual results rather than results which are "less than something" and includes a DHEA result.

For more info on the company see this link :

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

[ShonaGreen in reply to humanbean]

Thanks humanbean , that's really useful info about how to increase cortisol levels, will do some more research on this.

I did the saliva test with Regenerus about 9 months ago, it showed low cortisol levels throughout the day with low DHEA and commented that it established phase 3 HPA dysfunction.

Following this I had cortisol blood test, which was 295. Also had a short synacthen test, I responded normally although baseline cortisol level was low. It was done at lunchtime and was all a bit frantic as the nurse had trouble taking my blood every half an hour so the test took a lot longer than it should, and didn't test ACTH either.

I gather from my endocrinologist that cortisol over 200 is still seen to be normal, only a problem when it goes below 200, hopefully I won't reach that stage!