Please help to understand my latest blood results. Very low TSH, low FT4 and still feeling very tired also having hand tremors.

[Ester78]

Dear Members,

Would you be so kind enough to help me figuring out what is going on with me?

I'm currently taking 2 grains of Thyroid-S in the mornings and ACE.

Here are my latest results:

THYROID:

TSH 0,013 mIU/L Ref: 0.4 - 4.0

FT4 13.9 pmol/L Ref: 11.5 - 22.7

FT3 5.09 pmol/L Ref: 3.1 - 6.8

Anti-TG <0,9 IU/ml Ref: < 4.0

Anti-TPO 0.95 IU/ml Ref: <10.0

IRON:

Iron: 18.9 umol/L Ref: 8.8 - 29.9

Ferritin: 143 ng/L Ref: 20 - 300

Transferrin: 2.05 g/L Ref: 2.0 - 3.6

TIBC: 51,7 umol/L Ref: 42.8 - 85.6

VITAMINS And MINERALS

B12: 409 pmol/L Ref: 133 - 675

Folic acid: 54.2 nmol/L Ref: 8.1 - 45.3

Vitamin D: 165 nmol/L Ref: 75 - 250

Calcium: 2.48 mmol/L Ref: 2.2 - 2.65

Phosphate: 1.28 mmol/L Ref: 0.81 - 1.45

Magnesium: 0.89 nmol/L Ref: 0.77 - 1.03

Can you please help me if I am overmedicted or undermedicated? It seems like my FT4 levels are still quite low and FT3 is not high enough so i assume i can not be overmedicated. Should I start increasing my Thyroid-S and should I start supplementing some iron? According to Janie and STTM website optimal iron is around 23ish for ladies.

Please please help because i still dont feel completely okay. I feel quite tired and I have some hand tremors as well and I dont know what to do. It is so hard to figure out how to self-treat myself due to not having any reliable endos here.

Thank you in advance.

I wish all the wonderful members a very Merry Christmas Holidays!

[SlowDragon Administrator]

Many people split their NDT into two doses ...morning and afternoon

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 .

If/when taking NDT make sure to take last half or third of daily dose 8-12 hours prior to test, even if this means adjusting time or splitting of dose day before test

Is this how you do your tests?

If you took last dose 24 hours before test, result is false low Ft3 result

On any NDT, it’s typical to have very low TSH and low Ft4. Most important results is Ft3 result.....plus how you feel

What vitamin supplements are you currently taking

[Ester78 in reply to SlowDragon]

Thank you very much for your kind reply.Yes, I took my last dose of NDT 24 hours prior to my blood test.

Unfortunately I still feel very tired but sometimes I have better, more energetic days.

I take only prenatal vitamins due to I am trying to get pregnant. I also take Bio Kult probiotics, magnesium bisglycinate and some peppermint oil capsules for digestive problems along with enzymes.

That's about it.

But I don't take anything 2 more hours after taking my NDT.

[tattybogle]

There is a specific type of 'fine tremor in the fingers' that is associated with high thyroid hormone levels and overmedication, and i have found this to be a reliable sign in my self, and a slight reduction in dose has stopped the tremor. The test is~ hold arms out in front, and look for very fine tremor in just the fingers... is this what you have ?

However, your fT4 and fT3 results do not really suggest overmedication , but i suppose the fT3 could simply be a bit higher than your personal set point, we are all different.

The TSH is very low , but that's quite usual in someone taking NDT or T3, so doesn't prove overmedication.

do you have any other symptoms that might point to overmedication ?

Frequent bowel movements? feeling warm ? faster heart rate etc ?

[Ester78 in reply to tattybogle]

Dear Tattybogle,

Thank you very much for taking the time to reply.

To be honest I experience this hand tremor when I try to do some fine movements with my hands. For example when I try to place my contact lenses onto my eyes. Or when I try to hold something between two fingers.

No, not really. I don't have frequent bowel movements or rapid heart rates. But in the previous few days I felt some temporary pain in my heart. Sometimes I feel hot at nights but I suppose it's due to my irregular female hormones.

[tattybogle in reply to Ester78]

the 'tremor sign' is specifically when not using the hand/fingers for anything , just hold arms up/ out in front , fingers loosely outstretched..... that is how the doctor checked ... and if i remember correctly from when i had it ,it is not there when actually using the fingers.. more like a vibration. if that makes sense.Tat.

x

[Ester78 in reply to tattybogle]

Dear Tat,

Yes, thank you that makes a lot of sense. I will try to do that test.

Esther

[pennyannie]

Hello Ester

When on NDT it's usual for the TSH to be low/suppressed and generally optimal medication will be a lower T4 than you might expect and a higher T3 than than might expect if you were previously on Levothyroxine.

How long have you been on this dose and how long did you leave between last dose and blood draw?

If this is your first blood test result on NDT did you take a bench mark of T3 and T4 blood test numbers before you started this NDT so to have something to compare this to ?

P.S. I don't know what interactions ACE may have on thyroid hormone replacement but would suggest if you can leave as wide a gap between taking these two it might just help.

I see in a previous post you have been diagnosed with Hashimoto's Disease did you have a scan, as your antibody levels do not seem over range ? This disease does present with transient " hyper swings " when the immune system attacks the thyroid sending it a bit haywire.

However the swing does swing back but with your thyroid gland being a bit worse for wear and damaged, and over time you will probably find that you need to increase your thyroid hormone replacement as your glands production becomes more erratic, disabled and eventually dies.

[Ester78 in reply to pennyannie]

Dear Penny Annie,

Thank you very much for your kind explanation.

I have been on this dose for 6 weeks now and this one was my first blood test while on NDT. Unfortunately I couldn't afford a private blood test any earlier than this.

Probably it was a mistake not to test previous NDT raises but I couldn't deal with it financially.

Previously back in the end of May I had the following results:

TSH 3.94 Ref: 0.55-4.78

Ft3 4.49 Ref: 3.5-6.5

Ft4 15.72 Ref: 11.5-22.7

Anti-TG 130 Ref: 0-60

With gluten free Paleo diet I could lower my antibodies which made me pretty happy but I feel pretty tired.

I never take anything with my NDT. I take my ACE two hours after taking NDT.

[pennyannie in reply to Ester78]

OK so NDT was used successfully for over 100 years prior to the introduction of blood tests, ranges, guidelines and the " science " of medicine.

If a doctor suspected hypothyroidism a slither of pig thyroid would be dispensed for the patient to chew on : at the follow up appointment if the patient had improved a bit , but not enough, a larger slither would be given - so forth and so on until the patient felt relief of all symptoms.

So your TSH is now low suppressed which is as one expects when on NDT :

Your T4 has dropped a little and your T3 risen a little :

So it's all going in the right direction but the difference in your T3 not that significant :

If you feel a bit better and only stopped at 2 grains because you thought you should, I'd continue to go low and slow increasing up by 1/4 grain every week until you feel you are going a bit backwards, and maybe feeling anxious and uncomfortable.

At which point you drop back back down to the previous week's dose, and that's your dose on NDT at this point in time.

No thyroid hormone works well if ferritin, folate B12 and vitamin D are not maintained at optimal levels :

I have no knowledge of the implications of the other supplements you are taking so now out of my depth.

P.S. The hand tremor generally associated with " hyperthyroid " is, I believe, on the middle finger only, that was my only physical symptom when diagnosed with Graves along with clammy palms.

[Ester78 in reply to pennyannie]

Dear Penny Annie,

You are wonderful. Thank you very much for the throughout information and for the encouragement I'm on the right track.

I will follow your suggestion and increasing my dose a little bit every week.

[pennyannie in reply to Ester78]

OK then - I 'll take that !!! Thank you :

You can see from your results that you are not overmedicated.

Your T3 is in range at around 10 points into a range of 30 - so around 30% through :

However I do not know about monitoring thyroid hormones during pregnancy and if your medical team will be comfortable with you taking a thyroid hormone medication on which they may have limited knowledge and no guidelines to refer to.

[shaws]

Because you are taking NDT, your blood test results will be different, due to the fact it contains all of the hormones a healthy gland would do. So the emphasis should be on how the person 'feels' on particular doses and when on an optimum symptoms should resolve.

[Ester78 in reply to shaws]

Dear Shaws,

Thank you very much for your reply.

Then I assume I still need to increase.

[shaws in reply to Ester78]

If you are still symptomatic then small increases should be made until you feel well. If you feel 'overdosed' drop to previous dose and hopefully that would be your optimum.

When NDT was first used it saved the lives of patients and there were no blood tests at all, so all the emphasis was on 'how the patient felt'. I believe small increases were added to the dose until person felt better and had no symptoms.

If, at any time, it was felt it was 'too much' you dropped to previous dose. That then would be your daily dose until you felt symptoms returning then you would add a little more.

[Ester78 in reply to shaws]

Dear Shaws,

Thank you very much. It was very helpful and encouraging.

😊