Thyroid test results

[Jayjames]

Hi, I have received my test results, and am updating from my earlier post.

TSH 0.18

Free T4 16.17

Free T3 3.86

Would someone please take a look, is my T3 too low?

Thank you in advance

[SeasideSusie Remembering]

Jayjames

Can you please add the reference ranges that came with your results, ranges vary from lab to lab so we need your lab's ranges to interpret your results.

Also, how much Levo are you taking?

When did you take your last dose of Levo before the test (should be 24 hours).

Do you take a B Complex or Biotin? If so, did you leave it off for 7 days before the test?

[Jayjames in reply to SeasideSusie]

Yes TSH range 0.27-4.20

Free T4 range 12.0 -22.00

Free T3 range 3.1 -6.8

I tool my meds 24 hrs before doing the test the following morning, and I do take B12, and B6 but that was also 24 hours previous.

[SeasideSusie Remembering in reply to Jayjames]

Jayjames

The aim of a treated hypo patient generally is for TSH to be 1 or lower with FT4 and FT3 in the upper part of their ranges if that is where you feel well.

So your TSH is good but your FT4 is only 41.7% through range and your FT3 is just 20.54% through range. This suggests that you are undermedicated.

It's also important for nutrient levels to be optimal for thyroid hormone to work properly, if you haven't had them tested then you need

Vit D

B12

Folate

Ferritin

[Jayjames in reply to SeasideSusie]

Thank you very much for your advice, at the moment I take levothyroxine,75mg, does this mean I will need more, or will I need to take T3 aswell.?

[SlowDragon Administrator in reply to Jayjames]

Ask GP for next 25mcg dose increase in levothyroxine

Also very important to regularly retest vitamin D, folate, ferritin and B12

When were these last tested?

Even if we don’t start on full replacement dose of levothyroxine , most people need to increase dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until on full replacement dose

NICE guidelines on full replacement dose

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.

gp-update.co.uk/Latest-Upda...

Traditionally we have tended to start patients on a low dose of levothyroxine and titrate it up over a period of months.

RCT evidence suggests that for the majority of patients this is not necessary and may waste resources.

For patients aged >60y or with ischaemic heart disease, start levothyroxine at 25–50μg daily and titrate up every 3 to 6 weeks as tolerated.

For ALL other patients start at full replacement dose. For most this will equate to 1.6 μg/kg/day (approximately 100μg for a 60kg woman and 125μg for a 75kg man).

If you are starting treatment for subclinical hypothyroidism, this article advises starting at a dose close to the full treatment dose on the basis that it is difficult to assess symptom response unless a therapeutic dose has been trialled.

A small Dutch double-blind cross-over study (ArchIntMed 2010;170:1996) demonstrated that night time rather than morning dosing improved TSH suppression and free T4 measurements, but made no difference to subjective wellbeing. It is reasonable to take levothyroxine at night rather than in the morning, especially for individuals who do not eat late at night.

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...

[SeasideSusie Remembering in reply to Jayjames]

Jayjames

For now you need an increase in your Levo, 25mcg, to raise your FT4 and FT3. Retest in 6-8 weeks.

Before considering adding T3 you will need optimal nutrient levels so get those tested and post the results, plus reference ranges, plus units of measurement for Vit D and B12, on the forum.

If/when they are optimal, if your FT4 is higher in range and your FT3 is still low on range, that's when to consider adding T3.

[Jayjames in reply to SeasideSusie]

Thank you, that is so helpful, I feel relieved: I am 53 and have been in the same dose of levothyroxine for 25 years; I have explained to my GP how I felt, but they always said it was in range.

[SeasideSusie Remembering in reply to Jayjames]

All to common I'm afraid GPs only look at TSH and ignore FT4 and FT3.

TSH is useful for diagnosis but once on Levo it isn't an indictator of thyroid health. TSH is not a thyroid hormone, it's a signal from the pituitary. FT4 and FT3 are the thyroid hormones and tell us our levels and how well, or not, we are medicated. Unfortunately doctors don't seem to understand this, they're just not taught much at all about the thyroid at med school.

Also, they are taught little to nothing about nutrition so have no idea how important good nutrient levels are for us Hypos.

[Jayjames in reply to SeasideSusie]

Thank you, I will be making an appointment first thing Monday morning; At last a light at the end of the tunnel

[SlowDragon Administrator in reply to Jayjames]

If GP refuses to increase dose

Use guidelines on dose by weight to help push for dose increase

Email Dionne at Thyroid UK for list of recommend thyroid specialist endocrinologists

[e-mail]

[Jayjames in reply to SlowDragon]

Thank you, I will do that, I really appreciate your help

[SlowDragon Administrator in reply to Jayjames]

Don’t ever mention an Internet forum to a doctor...they will glaze over and stop listening

You can say Thyroid UK the NHS recommended support group

Or just print out NHS, BMJ or Nice links I gave you..

[Jayjames in reply to SlowDragon]

Thank you for the advice, i will say Thyroid uk. I haven’t seen my Doc for such a long time, so I’m hoping she will listen to what I have to say

[SlowDragon Administrator]

Did you do blood test as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test?

[Jayjames in reply to SlowDragon]

Yes I did, I had water only

[SlowDragon Administrator in reply to Jayjames]

Ask that vitamin D, folate, ferritin and B12 are included in GP test

Refuse to reduce dose based just on TSH

Insist GP test Ft4 and Ft3

[Jayjames in reply to SlowDragon]

I am going to refuse to lower my dose, I am not showing any hyper symptoms apart from being hot, but I’m told that’s my age: I still suffer with all hypo symptoms, thank you for supporting me