Help with blood results please : Blood test... - Thyroid UK

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Help with blood results please

New2thyroid profile image

Blood test results.

So I had my T3 / T4 and TSH done.

Could someone else with making me understand them please:

TSH - 1mu/l (range is .27-4.2)

Serum free T4 - 11.1 pmol/L (range is 10.8-25.5)

Serum free T3 - 3.3pmol/L (range is 3.1-6.8).

Many thanks!

17 Replies
SlowDragon profile image
SlowDragonAdministrator

How much levothyroxine are you currently taking? How long on this dose?

Results show you are very under medicated and need 25mcg dose increase in levothyroxine. Bloods should be retested 6-8 weeks after each dose increase

Likely to need several further increases

The aim of levothyroxine is to increase dose upwards until Ft4 is in top third of range and Ft3 at least half way through range (regardless of how low TSH is) ...important to have optimal vitamin levels too as this helps reduce symptoms and improve how levothyroxine works

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also EXTREMELY important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially if you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies

Ask GP to test vitamin levels and thyroid antibodies

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .

Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Many thanks for this SlowDragon. I am taking all supplements (Vitamin D3 / iron / zinc / vit A / iodine and b complex). Will get the other tests done privately too as GP not in favour of antibody tests etc. Many thanks once again🙏

I would be very wary of taking vitamin A as it very easy to overdose and symptoms can be very nasty - think a chemical peel of your "insides".

OMG - didnt realise. Thanks sooo much!!!

SlowDragon profile image
SlowDragonAdministrator in reply to New2thyroid

90% of primary hypothyroidism is autoimmune thyroid disease also called Hashimoto’s

Iodine is never recommended for anyone hypothyroid, especially if you have Hashimoto’s

Essential to test vitamin D, folate, ferritin and B12 regularly

When were these last tested

Gosh and I was taking these based on the functional doctors recommendation. Thanks so much! I will stop the iodine and vit A.

My levels were last tested in June this year. Perhaps a repeat in Dec?

Many thanks once again!

SlowDragon profile image
SlowDragonAdministrator in reply to New2thyroid

What were results and ranges in June?

What vitamin supplements are you currently taking

Important to stop taking any supplements that contain biotin a week before ALL BLOOD TESTS as biotin can falsely affect test results

You need to get 25mcg dose increase in levothyroxine and retest thyroid 6-8 weeks later

The supplements were all within range. And yes I have been taking Biotin due to hair loss. So I should repeat my tests. Wish I knew that these supplements interfere with the results. I am currently on vit d, iron, vit C, biotin, selenium, zinc, iodine, vit A. I was taking magnesium but stopped it.

Based on the above I am discontinuing iodine and vit A.

I will stop Biotine and repeat my test.

Many thanks once again for all your help SlowDragon🙏

To go with vit D, you need magnesium and vit K2

SlowDragon profile image
SlowDragonAdministrator in reply to New2thyroid

Come back with new post once you get results

Make sure to do ALL thyroid tests as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

Stop taking ALL supplements that contain biotin a week before ALL BLOOD TESTS

Stop iron supplements a week before testing iron and ferritin

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also EXTREMELY important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially if you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies

Essential to test BOTH thyroid antibodies

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .

Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

I

Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins

List of private testing options

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Thriva Thyroid plus antibodies and vitamins By DIY fingerpick test

thriva.co/tests/thyroid-test

Thriva also offer just vitamin testing

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test

bluehorizonbloodtests.co.uk...

Thanks so much SlowDragon! Will do so.

SlowDragon profile image
SlowDragonAdministrator

Suggest you reread your previous post here

healthunlocked.com/thyroidu...

Email Dionne at Thyroid UK for list of recommended thyroid specialist endocrinologists...NHS and Private

tukadmin@thyroiduk.org

Many thanks SlowDragon. I have the list and will try to find the closest doctor. Assume I need to go with one that can recommend T3 (I an guessing I need T3?)?

SlowDragon profile image
SlowDragonAdministrator in reply to New2thyroid

Assuming you are still only on 25mcg levothyroxine?

No you don’t need T3, you just need to increase levothyroxine

SlowDragon profile image
SlowDragonAdministrator in reply to New2thyroid

Standard starter dose of levothyroxine is 50mcg (unless over 65 years old)

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

Also here

cks.nice.org.uk/topics/hypo...

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...

Hi Slowdragon

Quick question as I’m trying to soak everything in and sorry for being a pain but with a tsh of 1 (above) is it not likely that more levo would surpress the tsh? I know there is this consensus that tsh doesn’t matter but firstly it does to the gp’s 🙄 and secondly I am sure I have read that you shouldn’t for other reasons (trying to find where I’ve read that). In your experience/opinion is it just a case of everyone being different and with some another 25mcg may not surpress and some it will? Or was your thinking that probably supplements and time or day etc etc when blood was taken made the tsh level 1? Personally I upped mine 2 weeks ago and it’s already dropped like a stone. I am assuming it levels out but I would appreciate guidance on what is a more common occurrence if possible.

SlowDragon profile image
SlowDragonAdministrator in reply to Yeswithasmile

It takes months for levels to settle

I have replied in depth on your own post

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