Latest results show low TSH, high FT4 but have hypo symptoms, seeing endo next Monday

[glowing_cat]

Hi, this is my second post on this forum. I need some help interpreting my latest figures from a prick blood test I did with Thriva. As they use wide ranges I've included 'normal' and 'optimal' ranges that they highlight in their results. I took this test on Monday 18 Jan in the morning on fasting stomach and not having taken B-complex for a week (since it includes biotin).

I am currently trialling Levo 75 mcg for one month and I have been taking it since 30 December. I am due to see a new endocrinologist on Monday after users on this forum advised I seek out a new one (more about that below the results).

TSH: 0.17 (0-10), where 0.27 - 1 and 2.5 - 4.7 is deemed normal and 1 - 2.5 is considered optimal range. My value is considered abnormal.

FT3: 5.9 (0-10), where 3.1 - 5 is considered optimal and 5-6.8 is seen as normal. My value is considered normal.

FT4: 25.1 (0-30), with 12-17 considered optimal and 17-22 is in normal range. My value is considered high.

T4: 171 (0-300), where 66-181 is considered normal. My value is considered normal.

TgAB: 67 (0-300), 0-155 considered normal. My value is considered normal.

TPOAb: 226.7 (0-200), 0-34 considered normal range. My value is out of range.

Vitamin B12: 132 (0-300), where 37.5 - 188 is seen as normal range. My value is considered normal.

Ferritin: 37 (0 - 400), where 13-44 is seen as normal, 44-150 is seen as optimal range. My value is considered normal.

Folate: >45.4 (0- >60.8), where 30-60.8 is seen as optimal range. My value is considered optimal.

Vitamin D: 111 (0-250), where 75-120 is seen as optimal, and 50-75 and 120-175 is seen as normal levels. My value is considered optimal.

I have been on 75mcg after an initial 3 months on 50mcg, but the previous endo did not want to raise my Levo and I had to send some very angry emails to get it my way. He had me do a diabetes test instead of a full thyroid test so I only found out my TSH and FT4, some vitamin levels and that I don't have diabetes.

The results from that test in December were:

TSH: 1.93 (0.35 - 4.94)

FT4: 14.6 (9.0 - 22.0)

Vitamin D: 64 nmol/L (75 - 150). My value was deficient.

Iron: 9.8 umol/L (8.0 - 25.0)

Ferritin: 24 ng/mL (5 - 204)

Vitamin B12: 592 pg/mL (187 - 883)

Since December I have been taking Vitamin D 20,000 iU capsules 2 times/weekly because I felt like I was getting very sluggish after 3 days (although my endo said it should be enough with once a week). Out of my own initiative, I have been taking iron supplements 2 times/day to raise my levels. The Thriva test does not measure iron but my ferritin levels have improved somewhat. I suspect my body still has issues absorbing iron, despite supplementing twice daily and also eating iron-rich foods, including meat, spinach, beans and lentils. Moreover, I supplement with Vitamin B complex and magnesium.

While many symptoms have improved, I still struggle with fatigue, a protruding goitre and double chin, puffy face, fluctuating weight, memory loss, and draining periods. I still have a strained heart and palpitations but less common than before going on medication. Cold hands, loss of breath and some brain fog is still commonplace. My mood has improved on the whole and I have not had a proper mood swing. I am not particularly stressed as I am only working part-time, but I want to go back to full-time work, though I don't think have the energy for it right now.

I suffered thyrotoxicosis in 2018 - that was misdiagnosed for hyperthyroidism and IBS - and went completely untreated for more than two years before I managed to find the previous endo who prescribed me Levo in October 2020, when my results were significantly worse (see below, taken with a private lab). That endo diagnosed me with subclinical hypothyroidism and autoimmune thyroid disease (Hashimoto's).

TSH: 5.5 (0.4 - 4.0). My value was out of range.

FT4: 16 (10 - 22)

FT3: 4.4 (3.3 - 6.0)

TPOAb: >1300 (>60). My value was out of range.

TRAB: <1.0 (0 - 1.8)

Vitamin D: 62 (50 - 178). My value was considered low, in need of supplementation.

Iron: 5 (9 - 34). My value was out of range.

Ferritin: 18 (7 - 120)

Vitamin B12: 444 (156 - 672)

Folate: 41 (>7)

Arguably, my latest results seem to indicate I have thyrotoxicosis/hyperthyroidism but I have none of the symptoms, having been there before. On the contrary, I still have many hypo/Hashi symptoms and I know some patients are doing perfectly well with very low TSH levels.

Since I will be seeing the new endocrinologist on Monday, I wonder what I should demand in terms of treatment. Before seeing the results, I was considering raising my Levo, but having seen them I'm thinking it might be an idea to introduce T3? The endocrinologist is known for taking a holistic approach to health issues and also prescribes NDT, which I am open to trying if it sorts out my issues.

As I've consistently been deficient in Vitamin D for years up until recently, how do I maintain the values that I have now? Do I keep up with two capsules of 20,000 iU weekly?

Any tips on raising iron levels?

Any other things that look out of the ordinary? I'm tired of doctors saying "everything is in range."

Grateful for any advice

[glowing_cat]

Hi Hidden , my latest TSH is 0.17. Sorry if all the figures are confusing. Is it still worth raising levo?

Agree on ferritin. Do you know a decent range for hypo patients?

[glowing_cat]

Thanks for the recommendation. Will have a look.

Nope, never had NDT but open to trying if the next endo wants to prescribe it. I've only been on Levo since October, so four months now.

[SlowDragon Administrator]

Current results possibly suggest you might be SLIGHTLY over treated......but I would resist any reduction and retest again in another 8 weeks

Normally we say you should test 6-8 weeks minimum after any dose increase

All vitamins significantly better

Vitamin D...you now need to reduce to maintenance dose.....possibly 2000iu daily. Trial and error what dose suits you, may need more in winter

Ferritin still a work in progress but definitely going in right direction

Important to do full iron panel test every 2-3 months if supplementing

Are you on strictly gluten free diet?

[glowing_cat in reply to SlowDragon]

Thanks for your message SlowDragon . I agree with your view and will ask to stay on this dose. Perhaps once the other vitamin levels improve, I might not have to change my levo dose if the blood tests turn out alright and my remaining symptoms improve. Time will tell.

I was strictly gluten-free for about two years because I was very sensitive (tested negative to coeliac), though I have been eating sourdough bread on and off for some time, but I don't know if it counts as gluten. I've been enjoying some pastries recently, so not strictly gluten-free but it's only because I can finally enjoy some treats... Should I cut them out entirely for 3-4 months and see how levels improve?

Will trial and error on vitamin D and check with the endocrinologist on Monday if he can advise on it.

[glowing_cat]

Thanks, I was wondering whether I was not reacting well to the synthetic stuff or if Levo levels were not high enough. What do you take?

[SeasideSusie Remembering]

glowing_cat

Thriva have a very confusing way of reporting results. Please ignore their "normal", "abnormal" and "optimal" figures. If you go to your Thriva account there will be a link to a downloadable pdf of your results and they have the correct reference ranges on there, it will look like this:

healthunlocked.com/thyroidu...

So taking the correct results for your recent test:

TSH: 0.17 (0.27-4.20)

FT3: 5.9 (3.1-6.8)

FT4: 25.1 (12-22)

T4: 171 (59-154)

TgAB: 67 (0-115)

TPOAb: 226.7 (0-34)

Vitamin B12: 132 (37.5 - 188)

Ferritin: 37 (13-150)

Folate: >45.4 (8.83-60.8)

Vitamin D: 111 (75-176)

* Did you leave off Levo for 24 hours before this test?

As I've consistently been deficient in Vitamin D for years up until recently, how do I maintain the values that I have now? Do I keep up with two capsules of 20,000 iU weekly?

The Vit D Society and Grassroots Health recommend a level of 100-150nmol/L.

If you're happy with 111nmol/L then you now need a maintenance dose, or you could aim for 150 which may be better in the current Covid situation.

If you want to improve your level I'd suggest you consider maybe 2,500iu daily (17,500iu per week) and then retest in 3 months. When you've reached closer to 150nmol/L then you need to find your maintenance dose, this may be 000iu daily, maybe more or less, maybe less in summer than winter, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. You can do this with a private fingerprick blood spot test with an NHS lab which offers this test to the general public:

vitamindtest.org.uk/

I can see you're taking magnesium but are you also taking D3's other important co-factor Vit K2-MK7?

D3 aids absorption of calcium from food and Vit K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems such as hardening of the arteries, kidney stones, etc.

D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds if taking D3 as tablets/capsules/softgels, no necessity if using an oral spray.

Your fatigue could be due to low ferritin/iron.

Any tips on raising iron levels?

Are you eating liver? That's the best way to raise ferritin level.

[glowing_cat in reply to SeasideSusie]

Hi SeasideSusie and thank you for your informative message!

Thanks for clarifying Thriva's ranges and I've now downloaded the PDF, which has the same ranges you refer to above. This essentially only puts TSH as below range and FT4, TT4 and TPOAb as above range - what a relief! 😂 And yes, I had levo just over 24 hours before I took the test.

I am not taking Vit K2-MK7 as it's never been mentioned to me before. I'm only supplementing with the Vit D3 20,000 iU capsule I mentioned in my original post, and before that I took Vit D3 at 1,000 iU once or twice daily over two years. Are there any Vit D supplements that include Vit K2-MK7? Open to tablets and soluble supplements.

I'll do some research into viable Vit D levels, but I might stick to one capsule of 20,000 iU per week because it's still winter and given the Covid-19 situation.

Nope, have not been eating liver (can't recall ever eating it on its own) but I bought a liver pâté today so I will give that a try and see how I enjoy it and if it helps with iron. Don't iron transfusions also help in raising iron levels, even if momentarily?

[SeasideSusie Remembering in reply to glowing_cat]

glowing_cat

Are there any Vit D supplements that include Vit K2-MK7? Open to tablets and soluble supplements.

Yes there are but you have to be careful. Because both D3 and Vit K2-MK7 are fat soluble they must be taken with some form of dietary fat. If both are in the same supplement then they will compete for the fat. A tablet doesn't include fat so if it's a combined supplement in tablet form, it's possible that whatever dietary fat it's taken with may not be enough for both vitamins to be absorbed.

Oil based drops are possibly the best for absorption if wanting to take a combined supplement. I've never taken a combined one, I take an oil based softgel D3 and Vitabay K2-MK7 tablet which I take with either the fattiest meal of the day (at a different time of day to the D3) or with something like a full fat yogurt or chunk of cheese.

I'll do some research into viable Vit D levels, but I might stick to one capsule of 20,000 iU per week because it's still winter and given the Covid-19 situation.

That might be OK, my maintenance dose for my optimal level of around 150nmol/L is 5,000iu daily but not many of us need that much, many are fine with around 2,000iu, it's something we have to find out for ourselves by trial and error.

Don't iron transfusions also help in raising iron levels, even if momentarily?

Yes, but I have no personal experience so don't know much about them. But it's not iron you are needing to raise, you don't have a serum iron result, you have a ferritin result and that's different. Ferritin is our iron store and we can have a good serum iron level but a poor ferritin level. This is why we should do a full iron panel before taking iron supplements.

[Abestar in reply to SeasideSusie]

For Clarification would you not recommend BetterYou combined D3 +K2 spray, which I have following discussions here?Thanks

[SeasideSusie Remembering in reply to Abestar]

Abestar

For Clarification would you not recommend BetterYou combined D3 +K2 spray,

The spray has a different delivery method so is absorbed differently, through the mucous membranes in the oral cavity rather than the digestive tract which capsules/softgels/tablets are.

[Nanaedake]

Slowdragon's advice to retest in 6 to 8 weeks before making changes makes sense. You might have had a slight Hashi flare and things might settle down. If your FT3 is still over range then you will need to adjust the dose to bring FT3 into range.

[tattybogle in reply to Nanaedake]

Just to clarify because Thriva's ranges are confusing ; the fT3 is in range , it's the fT4 that's over .

[glowing_cat in reply to tattybogle]

And the TT4 and TPOAb, but I agree with retesting in 6-8 weeks.

[tattybogle]

Latest results on 75mcg for 2+ weeks only;

TSH: 0.17 [0.27 -4.7] -------- FT3: 5.9 [3.1-6.8] ----------- FT4: 25.1 [12-22]

Dec on 50 mcg ;

TSH: 1.93 (0.35 - 4.94) ----------------------------------------- FT4: 14.6 (9.0 - 22.0)

"Arguably, my latest results seem to indicate I have thyrotoxicosis/hyperthyroidism but I have none of the symptoms, having been there before"

Arguably if you only look at TSH and fT4 , you could say they show 'overtreatment' however as fT3 is comfortably in range, not everyone would agree. But most Doctors and Endo's will see these latest results as overtreated, based on the fT4 being over range combined with the TSH being lower than they like.

Overtreatment and hyperthyroidism are two different things... one is too high a dose of replacement thyroid hormone, and is easily and quickly rectified by reducing dose, the other is a continuous over production of thyroid hormones by the thyroid gland and is not so easily dealt with.

You could ask to try a lower dose of levo with small addition of T3, but they might not be forthcoming since fT3 is not too bad.

It's a shame 75mcg has taken fT4 over range, it means we can't tell yet how much fT3 you get out of it if it's kept in range.

But you can try saying you don't want to have fT4 over range to get enough fT3 ( there have recently been shown to be some increased risks with over range fT4)

Do bear in mind that since this test was done when you've only been on 75mcg for 2 weeks/5 days that the TSH may still move further and that a different TSH result will probably result in a different amount of conversion from T4 to T3 so ft4/3 could still change too in theory,( and also that how you really feel on this dose will not be apparent for several more weeks at least)

[glowing_cat in reply to tattybogle]

The Thriva doctor seems to think I have hyperthyroidism and suggested reaching out to a GP to reduce my dose if I have such symptoms (but I don't). And to be honest, I'd rather not reduce my levo dose, since I'm generally doing well on it and it took me years to get medication in the first place.

To be clear, I know the difference between hyperthyroidism and overtreatment. But as you say, our esteemed medical professionals certainly do not seem to be aware of the difference... nor how to treat it. I'll be sure to refer to your explanation to the endo on Monday 😉

Do bear in mind that since this test was done when you've only been on 75mcg for 2 weeks/5 days that the TSH may still move further and that a different TSH result will probably result in a different amount of conversion from T4 to T3...

Certainly, I'll ask to retest in 6-8 weeks. I wanted to see where my levels were sitting, since I'm soon running out of my 75mcg supply because I was only meant to trial it for 1 month with the previous endo, but will now see another one. On the whole, the symptoms have improved, but as you say, I'll find out how I'm faring in a few more weeks.

But you can try saying you don't want to have fT4 over range to get enough fT3 ( there have recently been shown to be some increased risks with over range fT4)..

Do you have any examples of that? It would be good to read up on the possible effects of high FT4.

[tattybogle in reply to glowing_cat]

This post, (and the 2 following it up) are what i was thinking of;

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...