And rightly so. The rT3 test is very expensive and doesn't give you any useful information. It will tell you if you have over-range rT3, but not why. High rT3 doesn't cause symptoms, anyway.
The tests you really need are:
TSH
FT4
FT3
TPO antibodies
Tg antibodies
vit D
vit B12
folate
ferritin
That will give a clear picture of what is going on.
First step is to get FULL thyroid and vitamin testing
How much levothyroxine are you currently taking?
Do you always get same brand of levothyroxine?
Have you had thyroidectomy or RAI or autoimmune hypothyroidism?
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 or after Graves’ disease
Ask GP to test vitamin levels
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?
Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins
Wow that’s a lot of info thank you. I don’t have recent test results and can’t really get in at the moment. May need to get an independent test done then.
Levothyroxine is an extremely fussy hormone and should always be taken on an empty stomach and then nothing apart from water for at least an hour after
Many people take Levothyroxine soon after waking, but it may be more convenient and perhaps more effective taken at bedtime
Allow a gap of 24 hours between last dose of hormones and the test which should also be the very earliest and take it afterwards. Always book your blood test long before you are due to get it, and you'll be able to get the earliest, fasting (you can drink water) blood test.This method helps give the highest level and may prevent doctor reducing your dose of thyroid hormones.
You are legally entitled to printed copies of your blood test results and ranges.
The best way to get access to current and historic blood test results is to register for online access to your medical record and blood test results
UK GP practices are supposed to offer everyone online access for blood test results. Ring and ask if this is available and apply to do so if possible, if it is you may need "enhanced access" to see blood results.
In reality many GP surgeries do not have blood test results online yet
Alternatively ring receptionist and request printed copies of results. Allow couple of days and then go and pick up....or ask that they post results to you (in current virus situation)
Important to see exactly what has been tested and equally important what hasn’t been tested yet
Poor conversion of Ft4 (levothyroxine) into Ft3 (the active form of thyroid hormones) is often poor when vitamin levels are low
Naturally our own thyroid (when working correctly) makes 80% Ft4 and 20% Ft3.....many many people struggle on just levothyroxine.
Getting vitamin levels optimal can improve conversion...so that’s first step and to check you are on high enough dose of levothyroxine too
Remember all blood drawn has to be at the earliest possible, fasting (you can drink water) and alow a gap of 24 hours between last dose of levo and test and take afterwards. This helps keep the TSH at its highest (doctors seem to only look at the TSH result). TSH means 'thyroid stimulating hormone' and is from the pituitary gland - not thyroid gland It is highest early a.m. and drops throughout the day and may mean a reduction instead of an increase.
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