Latest blood results - now overmedicated?

[malohant]

Hello wonderful people of HU

Please can I trouble you for a little help/advice about my recent blood tests?

TSH 0.02 (0.27-4.2) : -6%

T4 130 (66-181) : 56%

FT4 23.7 (12-22) : 117%

FT3 5.9 (3.1-6.8) : 76%

TPO 205.8 (0-34) : 605%

TG 29.4 (0-115) : 26%

This is my first set of full results - my TSH was over 300% of range in Feb and Apr but came down to 36% in July, my Free T4 was -67% in Feb but up to 16% in Apr. Free T3 was 51% in July. I'm on 100mcg levo, have been for about 12 weeks. When going up to 100mcg I initially felt improvement but then (when I was given a different brand) went downhill again.

I should also add that I thought I was following the general advice given here - morning test, don't eat beforehand, but I misunderstood the 'take levo 24 hrs before' part and thought it was over 24hrs - I actually took it about 34 hours before. Does this mean for example that my FT4 is likely even higher?

I used Thriva and they gave some interpretation with the results, but I'd like to check that with the HU hive mind. They suggest that I'm now overmedicated (which I could see making sense, with the benefit of hindsight) but that my continuing fatigue and general grouchiness are not due to my thyroid itself. They also don't explicitly mention Hashimoto's / Auto Immune Thyroiditis but I think the TPO antibodies confirm that as a diagnosis?

As mentioned previously healthunlocked.com/thyroidu... my ferritin, vit D and B12 are all low; I have been taking vitamin D supplements for about a month (with little effect), introducing K2 a couple of weeks ago and magnesium this week (adding things gradually to try and see what makes a difference). I have also tried to improve my diet, eating more oily fish, pate and red meat, I have cut out gluten and soy and am limiting dairy -I used to eat a big bowl of cereal with milk for breakfast, now I have a fruit smoothie with oats which if nothing else has helped with constipation!

I'm due to talk to my GP next week - they also did blood tests on the same day, about an hour later, but I have no idea yet what exactly they were testing - and would like to have some idea of what to expect them to say, and what I should be saying in return. Before these results I had assumed I needed to increase my dose but that seems not to be the case!

Many many thanks as always, I really value the time taken to respond.

I hope you are all having your best days

M x

[SeasideSusie Remembering]

Malohant

We don't need percentage for TSH, we just need the result/range as the aim of a treated hypo patient on Levo, generally, is for TSH to be 1 or below with FT4 and FT3 in the upper part of their ranges. Once on thyroid hormone replacement then the TSH is largely irrelevant as it's not a thyroid hormone (it's a pituitary hormone) and it's the thyroid hormones (FT4 and FT3) that tell us what we need to know.

In fact it's best to give results/ranges rather than percentages for everything when wanting interpretation of results.

but I misunderstood the 'take levo 24 hrs before' part and thought it was over 24hrs - I actually took it about 34 hours before. Does this mean for example that my FT4 is likely even higher?

If you took your Levo before the test you'd get a false high. By taking the Levo 34 hours before the test you've got a false low result.

They also don't explicitly mention Hashimoto's / Auto Immune Thyroiditis but I think the TPO antibodies confirm that as a diagnosis?

TPO 205.8 (0-34) : 605%

Again, we don't need percentage, just the result/range.

Yes to Hashi's.

They suggest that I'm now overmedicated (which I could see making sense, with the benefit of hindsight) but that my continuing fatigue and general grouchiness are not due to my thyroid itself.

TSH 0.02 (0.27-4.2)

T4 130 (66-181) : 56%

FT4 23.7 (12-22) : 117%

FT3 5.9 (3.1-6.8) : 76%

Your FT3 is within range (and it's FT3 that tells us if we're overmedicated) but bear in mind that because you left 34 hours after your last dose of Levo then you have a false low FT4 result and possibly your FT3 is a bit lower than normal too. Your FT4 is over range with a false low so if you left the correct amount of time your FT4 would be even higher. You could reduce your dose of Levo slightly to bring FT4 back into range, it will very likely lower your FT3 a bit as well, but you could see how you feel on a slight reduction and then reassess. Maybe try a reduction of 12.5mcg. And try to stick to the same brand of Levo every time.

[malohant in reply to SeasideSusie]

Thank you SeasideSusie!

Apologies for the unnecessary percentages - I wasn't sure what was needed and what wasn't so I included all results, ranges and percentages but have made a note for the future!

I am getting confused with what you mean by false low, so can I check - I think what you're saying is that while my FT4 is at 117% in this test, my 'normal' under current circumstances (taking 100mcg levo every 24hrs) is likely to be a higher percentage, ie even further out of range. Is that correct?

And yes, I now stick to Actavis manufactured levo, I have learned that lesson!

Many thanks again

M

[SeasideSusie Remembering in reply to malohant]

Malohant

I am getting confused with what you mean by false low, so can I check - I think what you're saying is that while my FT4 is at 117% in this test, my 'normal' under current circumstances (taking 100mcg levo every 24hrs) is likely to be a higher percentage, ie even further out of range. Is that correct?

Yes. To get the level of the normal amount of circulating hormone you would take your last dose of Levo 24 hours before the test.

But please, let's forget about percentages and stick to numbers.

You left 34 hours so your result is showing a lower than normal level (a false low).

So because your FT4 result is 23.7 (12-22), and is a false low, if you'd left 24 hours since last dose your level would be higher and maybe something like 27.5 (12-22) and this shows overmedication. You should probably reduce your Levo, maybe just 12.5mcg for now and retest in 6-8 weeks then reassess.

What you need is for your FT4 to be approx in the upper quarter of the range which would be around 19.5ish and FT3 more or less in balance with FT4 so that might be about 5.5+. Of course, we all have to find the levels where we feel best, it's a very individual thing.

[malohant in reply to SeasideSusie]

Thank you! Sorry if I made things unnecessarily confusing. Very much appreciated!

[SlowDragon Administrator]

How long since you changed brand of levothyroxine back?

If you don’t feel over treated, suggest you ask to stay on current dose levothyroxine and work on improving low vitamin levels with supplements

Retest thyroid levels in 6-8 weeks

[malohant in reply to SlowDragon]

I was improving up until mid-May, when I was changed from Almus (Actavis) to Mercury. I took Mercury for 6 weeks, then was given Teva (which I started on 6 months ago, and felt awful). I called my GP, she wrote a new prescription asking for Actavis and after less than a week of Teva I changed back to Northstar Actavis on 25th July.

I wouldn't know what overtreated feels like. My legs and glutoids are constantly achingly tired, sometimes I can push through it and sometimes I can't. Recently I have been having trouble getting a full night's sleep, waking up after 5 or 6 hours and that being that. I'm still irritable, sluggish and very conscoius of my limited energy levels - I guess that's still hypo symptoms?

I'm waiting to talk to the GP to see what tests they came back with but then intending to see a nutritionist, to try to figure out ways to improve my nutrition and vitamins.

Thank you so much

M

[SlowDragon Administrator in reply to malohant]

So thyroid levels need retesting 6-8 weeks after changing back to Activis (now called Accord)

What were vitamin D and folate results?

[malohant in reply to SlowDragon]

Folate was 14.0 (3.9-20.0). Vit D wasn't tested, but at the end of July it was 55 (50-175), hence I am now taking supplements. I figured, as the GP said she wouldn't be testing Vit D, it was the best supplement to start with.

This was when my GP said to retest - has it not been 6 weeks? Oh (just checked calendar) I guess its only 5 weeks. Is that bad?

[SlowDragon Administrator in reply to malohant]

Likely to settle further ....retest at 12-14 weeks after last change

[malohant]

Just had my GP's results back (online):

TSH was identical, FT4 was within 0.5 (5%) and TPO antibodies were off the scale. Basically all the same.

Additionally, serum B12 is up to 426 (>180 ), and serum ferritin is up to 89 (30-400). Everything else in range.