Blood results? Under or over

[Toddy66]

Tsh 23 T4-11 T3- 3

Under or over ? Ive just had more bloods done and endo are calling me this friday to discuss. At moment Im on 125 mg of levo. I had Radio iodine treatment last july . Thank you in advance .

[Meanbeannyc]

TSH.. 23?! Or 2.3?

[Toddy66 in reply to Meanbeannyc]

Sorry that should be 25

[Meanbeannyc in reply to Toddy66]

Then, yes, UNDER medicated. You don’t feel like garbage with those results?

[JAmanda]

Under! Well probably. Do you not have the ranges?

[Toddy66 in reply to JAmanda]

No this is the only info i have

[pennyannie]

Hey there again Dawn :

OK - a TSH of 23 and a T4 at 11 and a T4 at 3 and if I use the range of T4 being 12-22 and T3 being 3.1-6.8 : you look to be very undermedicated. RAI seriously messes up blood tests :

Primary hypothyroidism caused by RAI is more difficult to treat : I remember when my TSH rose to mid teens I believe that was when my thyroid finally " gave up " - I too was on around 125 T4 :

RAI can also trashes vitamins and minerals and you need ferritin, folate, B12 and vitamin D at optimal levels for the T4 - Levothyroxine to work and convert to T3 in your body.

I now know I need my ferritin at around 100, my folate at around 20. my B12 at around 70+ /500+ ( depending whether active/serum is tested ) and my vitamin D at around 100:

Can you get these vitamins and minerals tested as these are as important as taking your T4 medication - though you probably feel at present that it's not working well for you.

How are your eyes - can I just add that if you are using any lotions, potions, gels and drops that they are all preservative free.

Can I just add that I too had " these flu like symptoms " that you have been told are fibromyalgia - when optimally medicated on thyroid hormone replacement I have found these aches, pains and that general malaise associated with influenza have disappeared.

[Toddy66 in reply to pennyannie]

Thanks for the info im talking to endo on friday Ive made notes of what you have said and will discuss it with him thanks again . Im actually feeling terrible . Using preservative free eye drops my eyes look slightly better although rather sore Im waiting on another appointment . Thanks again .

[Toddy66 in reply to pennyannie]

I take vit d but i will increase the dose thank you x

[pennyannie in reply to Toddy66]

I'm not suggesting you increase your vitamin D - what level is it at ?

We need all 4 - ferritin, folate, B12 and vitamin D measured, monitored, and built back up to optimal levels as RAI can trash these core strength and vital building blocks that need to be at decent levels for Levothyroxine to work effectively.

I am so sorry you are so unwell - do you someone who can support you through all this ?

[Toddy66 in reply to pennyannie]

Jyst got my recent bloods tsh o.04 t4 20 and t3 is now 4.8 so changed since november am I now hyper again thing is I dont feel it as my metabolism is very slow very constipated never had this before its ever since I went under its not corrected itself yet x 🤔consultant said he would keep my levo at 125 mg until next blood test and like I said im talking to endo on friday 😁

[pennyannie in reply to Toddy66]

Dawn :

Your results do not show hyper - your results show hypothyroidism :

Your metabolism is slow, and constipation a sign of hypothyroidism.

You will now only " be corrected " by optimal thyroid hormone replacement as your own thyroid has been burnt out and disabled in situ :

Ignore the TSH - you do not have a thyroid, you have had RAI thyroid ablation and your feedback loop broken :

The TSH blood test is the least reliable measure of anything :

Your T3 and T4 are I think in range, do you have these range numbers ?

Why do you have a consultant and an endocrinologist ?

Sounds confusing ?

Your T3/T4 conversion ratio is coming in at just over 4 ( divide your T3 into your T4 ) : The acceptable ratio is said o be anywhere between 1/3.50 - 4.50 : with most people feeling more well when they come in under 4 :

You will need to be looking at improving this and optimal levels of ferritin, folate, B12 and vitamin D will help you.

T4 - Levothyroxine is a storage hormone and needs to be converted by your body into T3 the active hormone that the body runs on.

You are more likely hypothyroid - though some symptoms, sadly, show up as both a hyper or hypo symptom :

There are a full list of symptoms on the Thyroid uk website if you want to take a look :

[Toddy66 in reply to pennyannie]

The consultant sorry I shouldve said the nuclear dr who gave me the radio iodine he has been prescribing my levo and doing my blood test overseeing it all so im still hypo which is what i feel . Why would he say i was over ill mention all of this to the endo on friday thank you . I will also ask for vit test etc also i take seleium x

[pennyannie in reply to Toddy66]

Your nuclear doctor is just looking at the TSH blood test result which is at 0.04 :

In primary care this is all they general do as the yearly thyroid function test is just a TSH which is not acceptable for us, but it seems, that's just how it is, and why many of us on this forum have to resort to private blood tests.

If you were not on thyroid hormone replacement and had not had RAI thyroid ablation and not with Graves Disease, which is known to distort and give unreliable TSH readings - maybe this doctor could be forgiven.

I came across similar problems and asked to stay under the hospital endocrinologist until I had a permanent address and a doctor who I thought knew about thyroid.

I think it is best that you stay under the care of the hospital who have experience and should know how to treat and monitor you, and more able to organise the full blood test.

You need to be dosed and monitored on your T3 and T4 blood test results and ideally these need to be balanced in the ranges.

If we take the guessed ranges as previously detailed your T3 is coming in at around 46% through the range and your T4 is coming in at around 80% through the range :

You could argue that you simply need the addition of a little T3 - Liothyronine to adjust up your T3 level : this maybe an option after the endocrinologist has exhausted all other routes in helping you recover your wellness with T4 only medication.

Sadly many medics seem to think that being anywhere " in the range " is acceptable.

It isn't and most people feel at their best when both T3 and T4 are in the top quadrant of the ranges with both T3 and T4 coming in at over 75% through the range.

If the range for T4 is 12-22 there is room for an increase in T4 and this might well increase your T3 :

Optimising your ferritin, folate, B12 and vitamin D will also improve your conversion of T4 into T3 which is the active hormone that the body runs on.

[Toddy66 in reply to pennyannie]

Thank you so much I will keep tou updated thanks for the information I will let you know what endo says on friday 😁x

[Toddy66 in reply to pennyannie]

Its quite shocking that drs /gps dont seem to take the thyroid going wrong very seriously when it can make someone so ill it doesnt seem right with what ive learned and how ive been feeling , ive learned a lot from you and slow-dragon I will try and fight my corner . Thank you so much 😁

[Toddy66 in reply to pennyannie]

No i haven't got any support unfortunately but thanks I will def ask endo if they will test my vit levels x

[pennyannie in reply to Toddy66]

I'm sorry read that - I had no support either :

Do you understand that you are now hypothyroid -

You will feel better if you can get your T3 higher in the range :

This may happen with a dose increase in T4 - Levothyroxine :

Optimal vitamins and minerals will also help with your overall wellness and conversion of the T4 into T3.

[Toddy66 in reply to pennyannie]

Yes i understand im hypo but the dr said yesterday morning I was over again then thats when I told him I cert didnt feel it . He then said he wouldnt lower my dose from 125 mg levo yet hence another blood test on the 10th feb . I will try and get more info from endo on friday 😁thanks for your reply and help 😁

[pennyannie in reply to Toddy66]

Yes, the endo should be more knowledgeable about how RAI and Graves can distort readings, especially a TSH, and this endo on Friday should confirm you are hypothyroid and should be looking to dose and monitor you on your T3 and T4 blood test results.

Keep us in the loop, and hopefully your Friday appointment will give you a bit more confidence in the endocrinologist and the system.

From memory I never saw the nuclear doctor again and I went through endo department and my local doctor would follow whatever recommendations the endo suggested :

[SlowDragon Administrator in reply to Toddy66]

How much vitamin D are you currently taking

When were levels last tested

You need to regularly retest vitamin D, folate, ferritin and B12

Extremely common to need to supplement virtually continuously to maintain optimal vitamin levels when hypothyroid

Ask GP/endo to test vitamin levels

NHS only tests and treats deficiencies

Likely to need to self supplement to maintain OPTIMAL Vitamin Levels

Do you always get same brand of levothyroxine

Which brand?

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)

Is this how you do your tests?

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...

If you can get GP to test vitamins and antibodies then 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/

Also vitamin D available as separate test via MMH

Or alternative Vitamin D NHS postal kit

vitamindtest.org.uk

List of hypothyroid symptoms

thyroiduk.org/signs-symptom...

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)

Many people when adequately treated on levothyroxine will have TSH well under one.

Very important to have optimal vitamin levels too as this helps reduce symptoms and improve how levothyroxine works

As you have Graves’ disease are you on strictly gluten free diet?

Frequently helps or is essential for many autoimmune thyroid patients

[Toddy66]

I will ask endo about vitamin blood test if they refuse i will get it done privately as im feeling so awful . I had bloods done again last week im just waiting on talking to endo to grt results . Also ive requested for the brand of levo not to be changed at all . Really grateful for your reply thank again 😁