I have been hypothyroid (hashimoto's) for years and recently had an annual blood test. My results are as follows:
T4 - low (9.1)
T3 - high (9.6)
TSH - very low (can't recall the value)
I take 50mcg T4 and 40 mcg T3 (Cytomel). I need Cynomel to function day to day. My doctor wants to reduce all my medication but I know I will go into a downward spiral if I do. My blood tests have never truly reflected my symptoms. Can anyone explain these above results and what I should do? The doctor has said I can go away to do some research before making any changes.
Any help is much appreciated! Hope everyone is staying safe and well!
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Night19
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In order to respond, and due to the fact that labs differ in their machines so members need the ranges to be quoted, i.e. ranges are in brackets after the numbers - example below:
Can anyone explain these above results and what I should do?
It's essential to have the reference ranges that come with results so that we can interpret them. Results vary from lab to lab so there's no "guessing", they just can't be interpreted without the ranges from the lab that does the test.
If you are in the UK and have online access to results then the ranges should be there, otherwise you'd need a print out from your surgery and the results will be on the printed sheet. We don't rely on verbal or hand written results given to us by surgery staff, mistakes can happen, hence we always advise a print out.
What we can tell you is that when taking a combination of Levo and T3 (or T3 or NDT) then TSH tends to be low, even suppressed, that is just what T3 does. Also, it tends to lower FT4, so your results, as you have expressed them, are no surprise.
However, assuming that your tests are Free T4 and Free T3 (FT4 and FT3) then from ranges we normally see here we can tell you that your FT3 is very likely to be over range which would suggest that you are overmedicated with T3.
When we take a combination of Levo and T3, it's very individual where we need our FT4 and FT3 levels. Some need both in the upper part of their ranges, some are fine with a low in range FT4 with FT3 in the upper part of it's range, but it's not usual to feel well with FT4 below range. So it could make sense to reduce your T3 dose but not your Levo dose, in fact you may benefit from an increase in your Levo dose. It can be a long and frustrating journey tweaking doses to arrive at the right balance for you.
Also important is timing of last dose of hormone replacement before the blood draw. Last dose of Levo should be 24 hours before test and last dose of T3 should be 8-12 hours before test. Taking your meds any closer to the blood draw gives a false high result, taking them too far away gives a false low result.
When did you take your last dose of T3 before the blood draw for this test?
As you have Hashi's, have you tried a gluten free diet? Some members have found that adopting a strict gluten free diet can help, although there is no guarantee.
Gluten contains gliadin (a protein) which is thought to trigger autoimmune attacks so eliminating gluten can help reduce these attacks.
You don't need to be gluten sensitive or have Coeliac disease for a gluten free diet to help.
Supplementing with selenium l-selenomethionine 200mcg daily is said to help reduce the antibodies, as can keeping TSH suppressed.
Hashi's and gut absorption problems tend to go hand in hand and can very often result in low nutrient levels or deficiencies. It's essential to test Vit D, B12, Folate and Ferritin and address any problems. You are welcome to post these results, including reference ranges (plus units of measurement for Vit D and B12), for comment and suggestions for supplementing where necessary.
Thanks so much, this is really helpful! I will get a hold of the exact values and reference ranges for more clarity and post them here.
I take my medication at night so around 10pm. The blood test was then at 9am.
I had my B12, iron and Vit D tested at the same time. The doctor said the B12 and iron was fine but Vit D was borderline, however, like you say I will post the values and ranges as this site seems to know a lot more than GPs!!
If you're taking T3, then your TSH is going to be low, and is of absolutely no value. Forget it. FT4 is also going to be lowish. The important number - and the number to dose by - is the FT3. BUT, you have Hashi's. so, just because your FT3 was high at the time of the test, doesn't mean it always is. Levels jump around due to the dying cells depositing their stores of hormone into the blood from time to time. It doesn't necessarily mean you are over-medicated. And, this is something that doctor seem incapable of getting their heads round. So, if I were you, I would agree to trialling a lower dose, ON CONDITION that your doctor doesn't change your prescription. Because in a very short while, you may need to go back to 50 mcg T4 and 40 mcg T3 - which isn't excessive, given that your thyroid is being slowly destroyed.
And, in any case, you should never, ever reduce T4 and T3 at the same time. One at a time. I would start with the T3, if I were you. Because I cannot imagine why your doctor wants you to reduce your levo if your FT4 is low. More medical lack of logic! You must proceed on the assumption that your doctor really has no idea what he's doing, but at least he told you to do your own research. Just hope he allows himself to be guided by your research results.
Thank you! This is also really helpful. I will reduce my T3 first and see how it goes. I agree that it looks as though my T4 could even be increased, but I will do that after adjusting T3.
Yes I'm very happy that they are allowing me to do some research. Theres always a silver lining!!
Don't reduce your T3 by more than 5 mcg at a time. And, remember this could just be a Hashi's 'hyper' swing, in which case you would feel worse if you reduce your T3. When is he planning to do your next lot of tests?
I would not reduce until you do your research because your Doctor doesn't seem to understand thyroid disease or how to treat it. This site does know more than a lot of Doctors and even some Endocrinologists and I am talking from personal experience now. Don't let yourself become ill like I did by taking my Endocrinologist's advice and letting him overdose me on PTU. I was bedridden for nearly two years because I took my GP's advice when I asked for Levothyroxine and he refused to give it to me because of NHS guidelines. I then had to buy Thyroid S from Thailand and self medicate because I was going rapidly down hill. Sometimes we have to take our own health into our own hands because Doctors will not treat us ... I did and I do not regret doing it.
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