Please comment on recent results --Thanks and stay safe

[gillwrayhk]

Could someone please interpret my recent blood test? I recently had my dose increased from Thyroid 60mg to 90mg. Maybe my dose needs to go down a little? Been on tablets since 2012. These are my results today:-

TSH A 0.27 ref:-0.32-5.04mU/L

T4 Free A 10.1 ref:-10.6-19.7 pmol/L

T3 Free 4.91 ref:- 2.60-5.80pmol/L

Thanks. Not being unkind but I don't think my Dr is too familiar with Thyroid conditions.

[SeasideSusie Remembering]

Gillwrayhk

What makes you think you may need to reduce your dose?

How do you feel?

When did you take your last dose of NDT before the test (it should be 8-12 hours)?

When on NDT results would usually show low or suppressed TSH, lowish in range FT4 and FT3 in the upper part of the range. If anything there's room for an increase in dose if you are still symptomatic and if you took your last dose 8-12 hours before the test.

[gillwrayhk in reply to SeasideSusie]

Hi, I followed the guidelines for blood tests from this site, i.e. earliest test, fasting, and a gap of 24 hrs between last dose of hormones. I usually take my tablets at 7.30am so I took the dose right after my blood test at 9.00am. I was very symptomatic before the increase of dose. Exhausted after a few hours of getting up, brain fog ++ etc etc. I do feel slightly better since the dose was increased but still not I used to ( was very energetic and not enough hours in the day!) My bloods before I increased the dose was :-

TSH A5.85 (0.32-5.04mU/L)

T4 Free A9.3 (10.6-19.7pmol/L)

Other Vitamin assays were within normal limits.

Thanks so much

[SeasideSusie Remembering in reply to gillwrayhk]

gillwrayhk

I followed the guidelines for blood tests from this site, i.e. earliest test, fasting, and a gap of 24 hrs between last dose of hormones.

That is for Levo only. You say you are taking Thyroid 60mg to 90mg so that suggests you are taking NDT and as mentioned the time gap for NDT is 8-12 hours. Because you left 24 hours then you have false low FT4 and FT3 results. If you tested with the correct time gap then your FT4 and FT3 would show higher and we can't accurately guess what those results would be. However, your FT4 would very likely still be very low in range although your FT3 would be in the upper part of it's range.

Some of us when on combination hormone replacement (T4 plus T3) are fine with a very low FT4 as long as the FT3 level is good; however, some of us need FT4 to be higher in range and we find that Levo plus T3 gives us the flexibility to adjust dose of each hormone to suit.

Other Vitamin assays were within normal limits.

Unfortunately that doesn't tell us anything other than they were somewhere in range. Optimal levels for us Hypos are

Vit D - 100-150nmol/L (40-60ng/ml)

B12 - top of range for Total B12, for Active B12 around 100+

Folate - at least half way through range

Ferritin - half way through range although I've seen it said that for females 100-130 is a good level and according to some experts the optimal ferritin level for thyroid function is between 90-110 ng/ml.

If your results aren't at these optimal levels, post them with their reference ranges (plus units of measurement for Vit D and B12) for further comment.

[pennyannie]

Hey there Gillwrayhk

It is my understanding that you dose NDT to the relief of symptoms and not to fit into a blood test range that was designed and introduced to be used alongside the introduction of synthetic thyroid hormones in around the 1970s.

Prior to this time NDT was the successful treatment for hypothyroidism for over 100 years and you dose to the relief of symptoms, as back then there were no blood tests anyway.

Increases in NDT should be at only 1/4 grain and slowly, weekly, up your dose by a 1/4 grain to the relief of symptoms. When, if, you get to 2 grains you stay on that dose for 6-8 weeks and then have a blood test to compare these T3 and T4 levels to your bench results from before you started this treatment option.

Your T4 may well be lower in the range and your T3 should be higher in the range than when on T4 synthetic thyroid hormone replacement. Your TSH will be low/suppressed and this does not matter. If your T3 hasn't improved in this trial period and you feel no relief of any symptoms NDT may not be the best treatment option for you to be taking.

If you are improved, but still with some symptoms, you need to slowly build up again from 2 grains by 1/4 grains every week. One week you will not feel as good as you should, a little nervous, anxious, irritable, you than drop back down to the dose you were on the previous week and that is your dose on NDT at that point in time.

Monitor daily your blood pressure and temperature :

No thyroid hormone works well if ferritin, folate, B12 and vitamin D are not at optimal levels and by this I do not mean, just somewhere, in the range.

I know from experience I need my ferritin at around 100 for optimal conversion of T4 :

My T4 comes in at around 30% through range and my T3 comes in at around 90% :

P.S. I'm with Graves Disease post RAI thyroid ablation and managing lingering Graves, thyroid eye disease and hypothyroidism.

[gillwrayhk in reply to pennyannie]

Thanks so much Pennyannie for your reply. I will study my results over the next few days along with your reply. My Dr only ever tests TSH routinely unless bloods out of range.

[pennyannie in reply to gillwrayhk]

Hey there

Yes, unfortunately it does generally require a couple of blood tests that you may have to take for yourself.

I'm about 2 years into self medicating now and just take a yearly private test to see where my vitamins and minerals sit, as you may well still have to supplement for optimal conversion and wellbeing ;

[gillwrayhk in reply to pennyannie]

Thank you 😊