FT3 low in range. How do I help GP understand this could be the cause of some of my symptoms?

[SmPea]

Latest NHS test results:

24.12.20

FT3 3 pmol/L (2.60 - 5.70)

TSH 0.91 mu/L (0.35 - 4.94)

Very unhelpfully lab did not do FT4!

Previous NHS test:

16.10.20

TSH 0.38 mu/L (0.35 - 4.94)

FT4 14.5 pmol/L (9 - 19)

FT3 3.9 pmol/L (2.6 - 5.7)

Medichecks Nutrition test 23.9.20

Ferritin 101.00 ug/L (13 - 150)

Folate 6.34 ug/L (>3.89)

B12 Active 94.800 pmol/L (>37.5)

Vit D 84.10 nmol/L (50 - 175)

Magnesium 0.96 nmol/L (0.66-0.99)

CRP HS 0.42 mg/L (<5)

I also had 9.00am Serum Cortisol checked on 24.12.20

397 nmol/L (150.00 - 600.00)

My most concerning symptom is unintentional weight loss. I have lost 2.5 stone in 3 years. Hashimoto’s diagnosed 2011 and have been on 100ml Levothyroxine for many years.

I have been gluten free since September 2020 and it does seem to have calmed down digestive/bowel problems.

I’ve had lots of tests including colonoscopy, endoscopy ultrasound on ovaries/bladder/kidneys. All normal.

I am coming to the conclusion the main problem is my thyroid levels. However my symptoms of weight loss doesn’t seem to reflect that I have Hashimoto’s?

I am at a bit of a loss to know how to get help from NHS. There is clearly something wrong the weight loss, muscle loss, recurring ‘buzzing sensations in my thighs and upper arms, light headed, dry eyes, hungry all the time. To add to this in the last few days joint and back pain and something that looks like a gout attack in my ankle!

Sorry for long post but hopefully it’s sufficient information for you good people to be able to shine a light on what I could do next - particularly in educating my GP but also the mystery of the weight loss!

[Hashimotosucks]

Buy either the StopTheThyroidMadness or Datis Kurazian book ( world-leading expert on Hashimotos) and put post-it notes on the pages that clearly shows this has been proven to be true. I think they like to see things in black and white rather than being told by us who clearly know nothing. Even the symptoms are in our head right??!! lol

[SmPea in reply to Hashimotosucks]

Many thanks for your book recommendations. ‘All in your head’ I’ve been told by a number of GP’s and an Endo!! I always refuse the offer of anti depressants, gritting my teeth saying I know when I’m depressed and it isn’t now!

The energy needed to keep my frustration in check while trying to be heard is exhausting..... as many of you well know 😬

[SlowDragon Administrator in reply to SmPea]

Clearly your Ft3 is too low...but without Ft4 result we can’t tell if you have room to increase levothyroxine dose or need addition of T3 prescribed

As soon as they see someone who isn’t overweight they can’t believe you could be hypothyroid.

[SmPea in reply to SlowDragon]

In my initial reply I posted full Thyroid tests on 16.10.20 - Do you think these results demonstrate a need or T3 /T4 combo or at least an increase in Thyroxine?

[SlowDragon Administrator in reply to SmPea]

TSH 0.38 mu/L (0.35 - 4.94)

FT4 14.5 pmol/L (9 - 19)

FT3 3.9 pmol/L (2.6 - 5.7)

Ft4 is 55% through range

Ft3 is 42% through range

Helpful calculator for working out percentage through range

chorobytarczycy.eu/kalkulator

Was test done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test?

Suggests pretty good conversion, but not on high enough dose levothyroxine

Obviously GP only looking at low TSH

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 Ft3 at 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 Thyroid U.K. at

[e-mail]

[SmPea in reply to SlowDragon]

Brilliant - thank you

[SlowDragon Administrator in reply to SmPea]

Unintentional weight loss

naturalendocrinesolutions.c...

[SlowDragon Administrator]

A significant minority of Hashimoto’s patients struggle to maintain weight unless optimally treated

What vitamin supplements are you currently taking ?

Vitamin D could be higher

Do you supplement magnesium

Folate result is low

In the week before any blood tests, presumably you stop vitamin B complex. Recommend, in that week, you replace with daily folate and B12 instead

You obviously need to get TSH, Ft3 and Ft4 tested together

cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code

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

monitormyhealth.org.uk/

[SmPea in reply to SlowDragon]

Thanks SlowDragon for your reply. Do you know if there is any research or book that discusses unintentional weight loss in some people with Hashimoto’s?

I do supplement Vit D 1000iug it’s clearly not enough so will increase.

I supplement Magnesium 300mg Viridian High Potency 1 or 2 caps a day depending on how my bowels are.

I seem to be always low in Folate even though my diet is good, rich in folate foods. I used to supplement with Igenus B complex - maybe I should start again?

[SlowDragon Administrator in reply to SmPea]

Yes definitely start vitamin B complex again ....but stop week before ALL BLOOD TESTS (replace with just folate and B12 that week)

supplementing a good quality daily vitamin B complex, one with folate in (not folic acid) may be beneficial.

This can help keep all B vitamins in balance and will help improve B12 levels too

Difference between folate and folic acid

chriskresser.com/folate-vs-...

Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid.

thyroidpharmacist.com/artic...

B vitamins best taken after breakfast

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

If looking for a magnesium supplement that doesn’t affect bowels - ReMag liquid....available via Amazon. Not cheap, but is effective