After successful Radiodine treatment in December, I'm now in Graves' remission and three months into Levo treatment for hypothyroidism. So far so good and I felt immediately better when placed on Levo 125mcg in December. I've just had my second post radioiodine consultation and they've increased Levo to 150mcg. I'm hoping that this will stop the small patches of dry skin, increase my metabolic rate and help reduce my appetite. I'm exercising regularly and would like to increase that to level to at least counter the effect of such a voracious appetite. So my latest results:
TSH - 6.6; Free T3 - 2.9; Free T4 - 15.7
I know the upper safe (NICE?) limit of T4 is around 27, so I have some play on that. When diagnosed with Graves, I had a T4 of 57 and apart from the tremors, the occasional palpitation and some muscle weakness, I felt great and was at my lowest weight since I was 18. I was also quite regularly knocking out 100 mile cycle rides. I know that I was putting my heart under significant stress, so that couldn't and can't go on. But I am in a process of rebuilding fitness after the Graves and a recent ear operation. I'm 59 and at present weigh about 115kg. On diagnosis three years ago I weighed 90kg and was was cycling fit. I've always been 'bulky'.
Are these results consistent with the amount of prescribed Levo? Is there anything more I can do?
Written by
CyclingDog
To view profiles and participate in discussions please or .
I know the upper safe (NICE?) limit of T4 is around 27, so I have some play on that.
Not quite. Every lab has their own reference range and there is no generalisation. The aim of a Hypo patient when on Levo, generally, is for TSH to be 1 or below with FT4 and FT3 in the upper part of their reference ranges. So it depends on the reference range that comes with your result and we see varying ranges here, eg mine is 7-17, then we also see 9-19, 11-23, 12-22, and others. I haven't seen one go up as high as 27 so I have no idea whee that figure comes from as a "safe upper limit", with my range I would be very overmedicated, and with all the other ranges we see on here it would still be overmedicated.
TSH - 6.6; Free T3 - 2.9; Free T4 - 15.7
If you can please add the reference ranges that came with these results we can interpret them properly, but because TSH ranges tend to be very similar we can tell you that yours is too high, it will be over range, and it's very likely that your FT3 is below range as most start at around 3.
When doing thyroid tests we advice:
* Blood draw no later than 9am
* Nothing to eat or drink before blood draw other than water
* Last dose of Levo 24 hours before blood draw
This gives the most accurate results, did you do your test this way?
It is essential that you are monitored on T3 and T4 blood test results and not a TSH - whilst under the hospital this should be the appropriate action, but be aware, once discharged back into primary care you might find maintaining T3 and T4 blood test very difficult.
T3 and T4 should be maintained within range, though some people need their T4 slightly over range, and generally speaking most people feel well when both T3 and T4 are balanced and in the upper quadrants of the ranges at roughly a 1/4 ratio T3 to T4.
Your metabolism was running too fast when hyperactive and now you are at the other end of the scale with hypothyroidism and reliant on thyroid hormone replacement to regulate and replace your own thyroid production.
A fully functioning working thyroid would be supporting you, on a daily basis with approximately 100 T4 + 10 T3.
T4 is replaced with Levothyroxine, T3 with Liothyronine and I read T3 is about 4 times more powerful than T4.
I just think if there has been a medical intervention both these vital hormones need to be on the patients prescription for if, and maybe when required, to restore T3 and T4 balance and a level of wellbeing acceptable to the patient.
Some people can get by on T4 alone, some people simply stop converting the T4 into T3 at some point in time, and some people simply need both these essential hormones dosed and monitored independently.
Your body needs to convert the T4 into T3 - the body runs on T3 - and this can be compromised if your ferritin, folate, B12 and vitamin D are not maintained at optimal levels, and not just in the range anywhere, which some medical professionals work to. Your metabolism has been to both extremes of metabolism during this period and please don't underestimate the importance of supplementing if low in the vitamins and minerals.
RAI slowly burns out the thyroid in situ, and you may find in time that you need to increase your maintenance of all things thyroid.
The thyroid is a major gland responsible for full body synchronisation, your mental, physical, emotional, psychological and spiritual wellbeing, your metabolism and inner central heating system.
You might like to take a look at a book written by a doctor who has hypothyroidism - Barry Durrant- Peatfield writes is an easy, sometimes insightful way about all things thyroid and though we don't now have this amazing, major little gland, we do need to know all that it does so we can try and compensate accordingly.
Your might like to take a look at the Elaine Moore Graves Disease Foundation website - this lady has Graves and went through RAI in the late 1990's and finding no help with her health issues wrote a book to help others who maybe in a similar position. She was and still is a medical researcher and now a leading expert in all things Graves Disease, and there is an open forum, much like this amazing website where Elaine takes an active role if the community are unable to respond.
Please do your research as in my experience Graves is a poorly understood and badly treated autoimmune disease and it will be in your best interests to read up and become your own best advocate.
You will need blood retested in 6-8 weeks after each dose increase (or brand change) in levothyroxine
Have you had vitamin tests?
Low vitamins are EXTREMELY common;with Graves’ disease or Hashimoto’s, especially if under medicated
Your results show you were very under treated
For full Thyroid evaluation you need TSH, FT4 and FT3 plus tested. Also EXTREMELY important to test vitamin D, folate, ferritin and B12
Ask GP to test vitamin levels
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?
Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies
Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have special offers, Medichecks usually have offers on Thursdays, Blue Horizon its more random
Guidelines on dose by weight, suggests you may need further increase
But we often need to increase slowly and vitamin levels need to be optimal too
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.
Many people find Levothyroxine brands are not interchangeable.
Once you find a brand that suits you, best to make sure to only get that one at each prescription.
Watch out for brand change when dose is increased or at repeat prescription.
Many patients do NOT get on well with Teva brand of Levothyroxine. Though it is the only one for lactose intolerant patients. Teva is the only brand that makes 75mcg tablet. So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
Help to interpret blood results
Help interpreting blood results?
Help interpreting blood results.
Blood results interpretation required
Recent blood results, help interpreting
