Had Medicheck blood test done on 1st September at 11.37am. No thyroxine for 24 hours or food and drink. Had thyroid cancer six years ago, had it removed.
Tsh 0.49 mlU/L 0.27 - 4.2 (R)
Free T3 4.31 pmol/L 3.1 - 6.8 (R)
Free Thyroxine 23.1 pmol/L 12 - 22 (R)
Ferritin 95.3 ug/L 13 - 150 (R)
Folate Serum 4.49 ug/L > 3.89 (R)
Vitamin B12 Active 41.5 pmol/L > 37.5 (R)
Vitamin D 97.7 nmol/L 50 - 175 (R) lab info deficient <30 Insufficient 30 - 50 consider reducing dose >7.175 I do not take any supplement for vitamin D or any other vitamins, just thyroxine T4, 62.5 mg a day, no T3. Anything higher then 62.5 mg i felt ill, heart palpatations, high blood pressure, water retention in my legs.
After six years of trying to get answers from doctors, ive never had any of my questions fully answered, its always left me totally confused as if i was the only one who was having problems with their medication. I have screenshot the charts that came with my results and will try to upload them if it would be of any benefit to whoever is going to be kind enough to be checkjng my results.
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Odinil
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Your free T4 is slightly over-range but free T is less than 1/3 through range (32.7%) - suggesting you are a classic "poor converter" - so if not feeling tip-top you would be very likely to benefit from a bit of lio adding to your levo. It's possible but tricky to get it prescribed on the NHS - it's endo-only and not many will, so if yours is unsympathetic, it would be worth getting the list of T3-friendly endos from Dionne at Thyroid UK - tukadmin@thyroiduk.org - and/or a sep post asking for recommendations near-ish to you.
As regards your nutrients, I'd say folate and vit B12 both look low to me, but I'll defer to the wisdom of SeasideSusie and SlowDragon who know much more abut these than me
I will discuss B12 with my gp and work on my folate supplement.
Should i wait to see if by getting my B12 and Folate at a good level, if it makes a difference to my low T3 and my high T4 result proving that i am a poor converter.
Obviously improving B12 and folate will help improve your conversion.
Currently your T3 is around 32% through its range whilst your T4 is at over 110%: and since you can only take a relatively low dose of T4 would hazard a guess that Levothyroxine doesn't suit you very well.
Since you have lost your own natural production of T3 and T4 which is said to be about 100 T4 + 10 T3 : I just think it logical to introduce a trial T3 alongside the T4 to see if that's produces a better outcome for you.
I'm now taking Natural Desiccated Thyroid and seem relatively well on 1 + 1/2 grains which equates to 57 T4 + 13.50 T3 ( T3 is said to be about 3/4 times more powerful than T4 ) which if you then extrapolate out equals around the 110 number quoted above - but it could just a fluke as it's all guess work anyway !!!!
If you do then list them to discuss with your GP and ask for testing for B12 deficiency and Pernicious Anaemia. Do not take any B12 supplements or folic acid/folate/B Complex supplements before further testing of B12 as this will mask signs of B12 deficiency and skew results.
Once your B12 is sorted and you have started either B12 injections or supplements, then you can add a B Complex containing 400mcg methylfolate which will help raise your folate level. Also include folate rich foods in your diet.
Vitamin D 97.7 nmol/L
This is pretty good. The Vit D Council recommends a level of 125nmol/L and the Vit D Society recommends a level of 100-150nmol/L.
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So that means i must sort my B12 and folate out first before making any changes to my levo T4 as it was mentioned that it looks like i am a poor convertor to T3
Would suspect you have low folate and low B12 BECAUSE you are on very low dose levothyroxine (unless you are very petite?)
But improving low vitamin levels first should then result in subsequent thyroid tests showing you need dose increase in levothyroxine
You are poor converter of Ft4 to Ft3
Ft4 is over 100% through range but Ft3 languishing at only 32% through range
Improving low folate and low B12 by supplementing should improve conversion
But you may still need addition of small dose of T3 alongside levothyroxine
guidelines on dose levothyroxine by weight
Even if we don’t start on full replacement dose, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until on full replacement dose
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.
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.
Because my FT4 was slightly over range i thought that meant my dosage was too high. I spoke to a gp at my surgery, when i discussed my blood results with her she pretty much closed me down, she didnt agree that i was a poor converter, said my Ft3 was in range. I asked about B12 injections, she said no she couldnt prescribe them only a endo can do that. She's now asking me to have another blood test for tsh and T4 and vitamins, when i tried to say i had just got my results from Medicheck only two weeks ago she insisted i have tests done again. I see my nhs endo December, my usual endo has left so not sure how good the new one will be. The gp at my surgery wasnt happy when i repeated some of the things i have learned from this website, they dont like it if you know more about a subject then they do. You mentioned getting a pernicious Anaemia test and a serum methylmalonic acid blood test so i am going to ask for these to be done. Whether gp will im not sure. I am not going to take supplements for b12 and folate until i get the blood tests done. I will get another Medicheck blood test before i see the endo at the hospital in December, i also have to get a hospital blood test done in readiness for my appointment a couple of weeks before seeing endo, not sure what reaction i will get presenting all my results. Why is it so hard to make doctors, endo's listen to you, surely the way forward is to work together we all want the same result, to feel well. Its so frustating.
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There’s a ludicrous tendency to look at each symptom in isolation rather than at the whole body and complex interaction between gut health, stomach acidity and hypothyroidism
Low stomach acid is extremely common as result of low Ft3, this leads to low vitamin levels as we need high stomach acid to break down foods
Low vitamin levels leads to lower Ft3 and spiral downwards
If GP won’t test for PA you could just try supplementing vitamin B complex and B12
Igennus Super B is good quality and cheap vitamin B complex. Contains folate. Full dose is two tablets per day. Many/most people may only need one tablet per day. Certainly only start on one per day (or even half tablet per day for first couple of weeks)
Or Thorne Basic B or jarrow B-right are other options that contain folate, but both are large capsules
If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before any blood tests, as biotin can falsely affect test results
taking a B12 supplement and a B Complex (to balance all the B vitamins) initially for first 2-4 months, then once your serum B12 is over 500 (or Active B12 level has reached 70), stop the B12 and just carry on with the B Complex.
Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,
"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.
In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l.
Most patients will feel well in that circumstance.
But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.
This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."
(That’s 58% minimum through range)
You can obtain a copy of the articles from Thyroid UK email print it and highlight question 6 to show your doctor
please email Dionne at
tukadmin@thyroiduk.org
Professor Toft recent article saying, T3 may be necessary for many especially after total thyroidectomy
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Help with blood test results please
Can you help with new thyroid blood test results, please 
Blood Test Results 
Latest Blood Tests - Advice needed please!!
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