Hi all! A follow up to my post a few weeks back. Did an e-consult with GP and she sent me for blood tests. Unfortunately not all vitamins were tested but here is a start. I am wondering if anything can be deducted from these ( I know they are incomplete- there is no vit D and i dont know my current ft 3. I have had a recurring just within range ft4 (and ft3). Also always low ferritin- as low as 7 back in 2017 when i first started to have symptoms.
Current most bothersome symptoms:'
severe hair loss/breakage, very low libido, irritability, water retention/puffy face (generally feeling inflamed) worsened rosacea (inability to regulate temperature- unable to sweat). I wont speak to the GP until 13th Dec but i suspect because my numbers are mainly in range (ive highlighted the out of range ones) she wont do anything. I am currently on 50mcg euthyrox.
Please could u advise if these results can lead me in the right direction or if i should pay privately for a complete panel incl ft3 and vitamin d? Thanks very much
HBAC1 : 29
CRP <4 (0-6)
Sodium 133 (133-146)
Serum potassium 4.9 (3.50 -5.30)
Serum creatinine 62 (44-97)
eGFRcreat >=90
TSH 2.04 (0.35-5.5)
ft4 15 (10.5-21)
Albumin 45 (35-50)
Total bilirubin 11 (0-20)
Alkaline phosphate 55 (30-130)
serum ALT 20 (10-49)
CRP <4 (0-6)
Ferritin 25.9 (10-291)
B12: 628 (211-911)
Folate 18.58 (>5.38)
Total white blood cel count 4.1.(3.9-10.2)
Red blood cell. count : 4 (3.9-5.2)
Haemoglobin estimation 134 (120-156)
Haematocrit 0.402 (0.36-0.46)
Mean corpuscular volume : 100.6 (80-99)
Mean corpuscular haemoglobin : 33.4 (27-33.5)
Red blood cell distribution width : 14% (11-16)
Platele count: 293 (150-370)
Plateletcrit 0.25
Mean platelet volume 8.5
Platelet distribution width 42%
Neutrophil count 2.6 (1.5-7.7)
Lymphocyte count: 1.02 (1.1-4.5)
Monocyte count 0.25 (0.1- 0.9)
Eosinophil count 0.11 (0.02-0.5)
Basophil count 0.02 (0-0.2)
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Ivanab
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Your swelling symptoms clearly indicate you need to increase your levothyroxine. I'm a petite woman so my increases were 50mcg, 75mcg, and 88mcg. For the average person the doctor will probably jump from 75mcg to 100mcg. At some point you want to test the FT3 levels. For many years on 88mcg I didn't test my FT3 because I felt fine but when the fatigue came on I got the FT3 tested and it was low. If you've been on 50mcg for 6 weeks or you're having this swelling then you need to do an increase.
No fT3 done, but even without seeing what it is.....
if you're only on 50 mcg euthyrox ..... this is a very low dose,
When you see GP you could ask for a 25mcg increase to try and raise your fT4 a bit higher up the range and bring your TSH a bit lower. Most healthy peoples TSH is around 1 and this would be a better place to aim for . Just because thyroid test levels are 'in range' doesn't mean they are right for us individually.
The usual dose for Levothyroxine replacement ends up being somewhere between 75mcg and 125 mcg .
For Example....When i started Levothyroxine i was on 50 then a couple of months later up to 100 then about 4 months later up to 150, where i stayed for many years , then down to 125, and now 112.5.
For most of this time on 150 my fT4 was right at the top of the range. and my TSH was 0.05, because that was what i needed to take to feel even remotely well. And if dose was reduced i got constipation and was a zombie again. I'm not suggesting you will need to take that much or end up with out of range results to feel better, but just to show you that the ranges are quite large and there is a lot of room in your results to increase dose a bit and see how it feels.
I'm not any good on the other results though. Hopefully others will help with that bit.
Only NHS testing done, so not many fT3 results, but did get some , lucky me.Over about 4 years i got these % through range.
fT4) 108% fT3) 63% TSH <0.05 Levo150mcg
fT4) 85% fT3) 36% TSH 0.05 Levo150mcg
fT4) 59% fT3) 41% TSH 0.061 Levo125mcg
fT4) 66% fT3) 32% TSH 7.89 (don't ask !, i wanted to know if TSH would move, it did)
fT4) 111% fT3) 54% TSH 0.046 Levo125mcg
More recently ;
fT4) 206% ft3) not done TSH 0.04 Levo125mcg
fT4) 242% fT3) not done TSH 0.097 Levo 112.5mcg
fT4) 181% fT3) not done TSH 0.511 Levo 100mcg
fT4) 142% fT3) not done TSH 1.947 Levo 112.5mcg
So far.... so illogical.( Latest increase in Levo back to 112.5 mcg has resulted in TSH rising and fT4 falling ... go figure)Doctor probably thinks i'm lying about what dose i take , or don't take it properly, but these are honest results from taking dose carefully .. well, apart from the 7.89, that was me messing around.
You'd think they would see the need to do an fT3 on someone with fT4 at 242% through the range ie. 22.7[7.9-14].... but apparently not...so sadly i don't know if i've ever had fT3 above 63% of range.
For years my Levo was 113% in the reference range. It's the only way I could function on Levo only, but it still shorted me 20-30% in T3 that healthy people have. Despite high T4 levels my TSH was always around 1.5. T4 levels were knocked down to 82% and T3 levels were at 39%. TSH was 1.88. Thyroid disease is in need of a lot more research by competent people.
I agree, a good start would be for doctors and researchers to appreciate how much they DON'T know, and then show a bit more interest in some of the questions our results throw up.
Or.... they could just accept they have no idea what's going on really , and just use some common sense and try and get results on treatment to match those common in healthy people.ie. TSH 1ish and fT4 and fT3 in closer balance with each other by using levo and T3 together since they are both available.
I also agree with your point below about diabetics being trusted to dose insulin.
I think the conversation with GP once we start showing an intelligent interest in our thyroid treatment should go;
" I'm pleased to hear you've learned so much about your condition and how to interpret TFT tests.
If you want to be more involved in managing your thyroid levels together , first let's make sure you understand what the symptoms and risks of overmedication are.
I have to tell you that the NHS can only fund 1 or 2 thyroid tests a year, so if you want more you may have to pay for them yourself , but of course we'll be happy to run them for you.
Unfortunately the NHS can't afford T3 at the moment because of a price issue that is being investigated, but we are working hard to get that fixed , but in the meantime , if we decide together that you might benefit from trying a little T3 with your Levo would you be able to pay for it yourself ? we can give you a private prescription.
or you can apply to a Gov't ' hardship fund' for people who need it but don't have enough income"
.... How nice and civilised would that be.... Oh ... i ve just woken up and am back in the real world........but i enjoyed my dream while it lasted.
Hi All thanks so your replies. I have been on 50mcg for the last 2 years. Started at 25mcg which was increased after a year. I paid extra for ft3 in Czech rep as I am being treated there rather than here thanks to an endo (here in the UK) discharging me based on a face to face conversation without any bloods or ultrasound. My July 2020 were:
TSH: 2.120 (.380-3.5)
FT3: 3.3 (2.6-5.7)
FT4: 12.21 (9.01-19.05)
I am still unsure if this means that I need to get my vitamin levels optimal + have an increase in dose or if this already shows that I am a poor converter. Ferritin has been a problem for me as long as I can remember but was never investigated- I was just always advised to take iron temporarily. At this point, do I need to get the GP to do any further iron tests?
The increase in t4 dose is not a problem- I actually have enough meds to keep me going for a year (well based on the 50mcg dose) - Im just not confident enough to increase the dose myself.
Your levels are still low. Your TSH should be under 2 and closer to 1 or below 1. Your T4 is still on the lower side so you won't know if your conversion is poor unless you do two to three more increases of Levothyroxine. You may not feel better until your T3 reaches 4.8 and higher. I'm not a doctor so I can't tell you to dose yourself but doctors trust diabetes patients everyday to dose themselves with insulin when they need it. I think thyroid patients should be trusted in the same manner. Your results show a clear indication for more Levothyroxine. The next step after 50mcg is 75mcg. You can halve the 50mcg with a good pill cutter and add 25mcg to your current 50mcg dose. You would then stay on that dose for 6 weeks. It would be advisable after that to get blood labs done. After that if you're still feeling fatigued and your labs show there is room for increase then you can take two 50mcg pills per day for 6 weeks then test. If you find 100mcg of Levothyroxine per day too much then you can also take 75mcg for 4 days per week and 100mcg for 3 days per week. Again, I'm not a doctor but this is standard protocol.
Request 25mcg dose increase in levothyroxine from GP
Quote guidelines on dose by weight if GP is unwilling
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.
I have just used that useful calculator and basically my T4 is 27% and my T3 is 27.3% but what caught my attention was it said Hashemoto at the end in blue. Does that mean my results indicate I have Hashimoto? I have always been told I had Myexodema. I have another Private Endo Zoom meeting on Thursday and was going to ask to up my Armour as I’m still experiencing symptoms. Just wondering if I am on the right medication?
Should I be making a new post about this? Thanking you in anticipation 😁
Last 1/3 of daily dose NDT maximum of 12 hours before test
On NDT Ft4 is frequently low
Hashimoto’s is diagnosed by high TPO or high TG thyroid antibodies or by ultrasound scan of thyroid as 20% of Hashimoto’s patients never have high thyroid antibodies
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please see my latest test results 
Recent blood results after altering meds
Daughters recent blood result
Latest blood results...any help appreciated 
