Hello,
my free t3 result has come back at 4.6, which is above the top limit.
My other results are within limits.
Do I reduce my t4 tablets or my t3?
I take 75mcg levo, and 12.5mcg of tyromel.
Thank you.
Have added my results
Free t3 4.6 pg/ml
free t4 1.14 ng/dl
t4 7.81ug/dl
CJH81
It would be better to post your full set of results, with reference ranges, so that we can make a better, informed suggetion, just saying "above the top limit" and "within limits" isn't very helpful, we need to see where within or out of range they are.
I will post my result sheet, thank you.
Did you do blood test as early as possible in morning before eating or drinking any thing apart from water and last dose levothyroxine 24 hours before and last half dose T3 8-12 hours before test ?
Are vitamins all optimal
CJH81
Can you please add the reference ranges for your results, as requested. Without them we can't see where your results lie within or outside of the range. The reference range should be at the side of the results on your print out, possibly in brackets.
Also, do you have a TSH result/range.
I don't know why - but I didn't get a TSH this time.
T3 free was 4.6 Range 1.8 - 4.2
T4 free was 1.14 Range 0.71 - 1.85
T4 Total was 7.81 Range 4.5 - 17.5
Hope this helps.
Many thanks for your time with this.
I always feel that I get better & more info. from here, than from my GP.
Sad to say, but it is a fact.
Regards,
Caroline
x
CJH81
I don't know why - but I didn't get a TSH this time.
T3 free was 4.6 Range 1.8 - 4.2
T4 free was 1.14 Range 0.71 - 1.85
T4 Total was 7.81 Range 4.5 - 17.5
Don't worry about the TSH, it's going to be low anyway as you take T3, and it's not really that important, the FT4/FT3 are the important results.
I take 75mcg levo, and 12.5mcg of tyromel.
Med's taken 12 hours before bloods.
Do you mean Levo was taken 12 hours before test as well as T3?
We should take our last dose of Levo 24 hours before testing, it's 8-12 hours for T3 and NDT.
You are just a tiny bit over range for FT3.
* How do you feel?
Some people need their FT3 at the top of the range with a lower FT4 when taking combination therapy.
Do I reduce my t4 tablets or my t3?
If you took your Levo only 12 hours before the test, your FT4 is measuring a bit higher than the normal circulating amount (which would be measured if you'd taken last dose of Levo 24 hours before). So with your FT4 only 37.72% through range, and it being higher than it would be if last dose was 24 hours) I wouldn't be reducing dose of Levo if it was me.
As for reducing T3, if you are feeling overmedicated then you might want to try a reduction, but I think that if you'd taken your Levo the advised 24 hours before then your FT3 might well have shown in range (you probably still have some T4:T3 conversion).
Many thanks for all your help, although I still find it all a "little" confusing! I had the latest tests done, as I am suffering with hot flashes, especially at night, and I am past menopause. Tiredness, achy, clumsy, heat intolerance etc. has become the norm. and I was hoping for an answer regarding my medication doses. Not sure what to do really.
CJH81
I was hoping for an answer regarding my medication doses
Well I have addressed that to a degree and asked you some questions which you haven't answered so nothing definitive could be said. There is so much more that we need to know to be able to help you.
1) Do you mean Levo was taken 12 hours before test as well as T3?
We need to know when you took your last dose of Levo.
We advise 24 hours before the test to give your normal level of circulating hormone which is what you should base your dose of thyroid meds on.
As mentioned above, the 8-12 hour time gap is for T3 and NDT only.
If you took your Levo 12 hours before the test then you have a false high FT4 result which would mean that your normal circulating amount of FT4 would be lower than this test shows and in that case you wouldn't want to lower your dose of Levo because your FT4 would reduce even further
2) How do you feel?
You say you feel tired, achy, clumsy, heat intolerant.
Well, tiredness can be a symptom of hypothyroidism, but it can also be low ferritin.
Achy - a bit non specific but muscle and joint aches and pains can be low Vit D.
Clumsy - well lack of co-ordination (especially hands and feet) - is that what you mean - can be a symptom of hypothyroidism.
Heat intolerance can be a symptom of both hypothyroidism and hyperthyroidism.
Have you had thyroid antibodies tested to see if you have autoimmune thyroid disease, aka Hashimoto's?
Why are you on a combination of Levo and T3?
Did an endo initiate this? If not what was it that made you add T3 to your Levo?
What were your results before adding T3?
What dose of Levo were you taking at that time?
Did you reduce your Levo when adding T3?
Did you know that nutrient levels need to be optimal before adding T3? Did you test yours first - Vit D, B12, Folate, Ferritin - very important.
How long has it taken you to get to your current doses of Levo and T3?
How have you felt along the way when you were altering doses?
When taking combination hormone replacement, some of us are fine with a low in range FT4 with FT3 in the upper part of it's range. Some of us need both FT4 and FT3 in the upper part of the range, it's very individual.
It's possible that you could do with less T3 and more Levo but you can see that it's far more involved that a simple "Do I reduce my t4 tablets or my t3?"
Thank you so much - again! There are a lot of things to be considered in the list. I will work my way through it.
I may need to take more of my Ferritin, if only it could be that simple! x
If you were in my area the range for F23 is 3.1 to 6.8 so you would be within range - I dont understand why these Labs have different ranges in different areas of the Country. No wonder we all struggle so much. Nobody is singing from the same page as far as results are concerned! Im in Devon by the way but I wouldnt be surprised if other areas in Devon have different ranges too. It doesnt make sense to me!
JaneCx
Thank you Jane, I'm a Devon girl too!
That is the range for T3 my results are in and I am in Bristol. I do not understand the different lab results, they are confusing. Does your T4 ranges go from 12-22?
Jane Chapple
I dont understand why these Labs have different ranges in different areas of the Country.
Basically lab ranges are based on local population and the testing equipment.
If you were in my area the range for F23 is 3.1 to 6.8 so you would be within range
No she wouldn't, because she wouldn't have that result if she was in your area.
You can only use the reference range that comes with your result, not a range from anywhere else.
The OP's FT3 result is 4.6 (Range 1.8 - 4.2). This, as a percentage, works out at 116.67% of range.
If she was tested in your area with your range of 3.1-6.8, her equivalent result (to be 116.67% of range) would be 7.4
Are you aware how the different Health Authorities establish 'normal'. If you go for a blood test, unbeknown to you, your blood may be used for several other tests which are unrelated to the test you've been sent for. The Area Health Authority then compiles the average of all tests, which is a vast range, discarding the top twenty percent and bottom twenty percent, they declare the middle sixty percent as 'normal'.
The different area results are NOT because they use a different test score, they depend entirely on the thyroid health of the people in the area, which differs from one area to another. Possibly some areas had more flouride in their water. Who knows? So when someone says 'if you lived in my area, you would be within range', she is absolutely correct. It's a lottery which depends entirely on the thyroid health of the general populace in the area and that is why the different 'normals'.
abirose311
So when someone says 'if you lived in my area, you would be within range', she is absolutely correct.
I disagree, as would many, if not all, responders here.
You can only use the range that comes with your result. You cannot put your result with a different range from a different lab.
abirose
"they depend entirely on the thyroid health of the people in the area"
This is incorrect.
There are several different makes of test machines.
The first and most important reason for differing Lab Reference Ranges is that the manufacturers of the test machines set standard rages for their machine, there are a few (Abbott, Roche, etc) and their standard ranges are different because their machines work differently.
If a Lab buy's a different machine, then the range will change.
This is the cause of the larger differences in Lab Reference Ranges.
The 'local element' has a much lesser influence.
Lab's 'adjust' the standard range that comes with the machine by taking 'local samples into account .
I have been told with some authority on here that the way this Local element is arrived at can be poor to say the least.
For example using just 100 lab staff (who may not live locally)to get the local range. Or only doing a local range properly once and then not updating it.
It is very difficult to find accurate information on how various
lab's achieve their 'local element' , how well, or indeed how often it is updated.
So while there are obvious frustrations with the many varied ranges , and it would obviously be much better for monitoring treatment if they could get it together to use the same range, the fact is , at the moment they can't.
It is important that people understand they MUST use the Lab Reference Range that comes with the test. I simply doesn't work to say 'if you lived in my area you would be in range'. The fact is, if they lived in your area their blood would have been tested using your Lab's machine , and so their Resultant FT4 number would then change, and have to be viewed alongside your labs range.
As an example, these are the different Lab Ranges i have had from the SAME hospital lab over 17 years (and i have not moved );
FT4
[13-26]
[11.2-26]
[11-24]
[9.5-20]
[8-18]
[7.9-14] - This latest one is an Abbott machine i believe.
You may not have moved, but I did, and I had two blood tests within three days of each other last year. One taken by my doctor in Epsom and the other at Kingston Hospital by my endo. My values T4, T3 and TSH values were the same on each test BUT the lab ranges were different. In Epsom my T3 was flagged as high and the same result in Kingston was considered normal (and normal by medichecks).
As for those changes in normal on your own area. Are you certain that doesn't reflect an overall decline in thyroid function in your area? I was told that every year each LHA revises what is normal according to the random bloods they test, so this years normal may not be next years!
I don't believe this just applies to thyroid hormone levels. Normal vitamin levels and other medical values are achieved in the same way, which is why they too have huge differentials in what is considered 'normal'.
Your test example is very interesting. I wish i had got some same time /different lab range tests to compare my most recent FT4's with, as i am ,like you, highly dubious of some of these different ranges.
The latest [7.9-14] change in my areas FT4 tests not only lowers , but also narrows the range considerably, and does seem to be giving me results that are a much higher %through range than the previous [8-18]
I can't prove it, because i have been through menopause and also am much less active now than i was at the time of the former [8-18] tests, and so i have to allow the possibility that this has changed my body's T4 need and this could account, at least partly, for my now very over-range results on the same dose, when previously i was near top of range. Annoyingly though, i missed a year of testing, and then the range had changed when i next had one,so like a say , i cant prove anything. But it seems you can.
I think it's unlikely that the local population has changed it's thyroid function to this degree. I'm much more inclined to suspect the manufactures and local authorities are the biggest influence in new ranges.
I asked the inventor of the FT4/FT3 tests his opinion on the [7.9-14] range, and his response was that it was too low and too narrow and he wouldn't give house room to any diagnosis based on this test......that he suspected it was done on an Abbott machine....and that he couldn't understand why the phlebotomists? couldn't see what rubbish they were using.
Add to that the difficulty in finding out exactly how the local adjustment is actually arrived at. and the whole thing stinks doesn't it.
I understand there are ongoing attempts by some to move this situation towards more standardised ranges for TFT's, but years on , no success yet.
I think this subject is something thyroid patients should make more noise about, ( in addition to everything else that is wrong with thyroid treatment in this country ! )
And that is best done by collecting examples such as yours, of concurrent tests processed on different machines or in different areas.
I intend to get a private test done on the same day as my next NHS test , because i think looking at my 17 yr history of results, there is something very wrong with the latest [7.9-14] FT4 range.
If you can be bothered to trawl through them in my profile, you may agree.
Thankyou for posting your example. it tends to confirm what i have been thinking.
Are you aware that not all labs use the same range? My lab uses the 2.77-5.27 pg/ml range for FT3. I am aware some labs use the lower range which tops out at 4.2. If you feel well, I wouldn't make a change in thyroid dosage. If you are having symptoms, I would be inclined to say you should stay on the thyroid dose you're at, and look elsewhere for nutritional level abnormalities and other hormone abnormalities. Have you had your TPO and TG antibodies evaluated to see if you have Hashi's?
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