Please can you advise me on my recent test results.

[Pink-mist]

Medichecks:

TSH 0.+16 mlu/L. Range: 0.27 - 4.2

Free T3 3.76 pmol/L. R: 3.1 - 6.8

Free Thyroxine. 20.900. R:12- 22

Thyroglobulin. 457.000. R: 115

Peroxidase. 104.00. R: under 34

Ferritin 102.00 ug. R: 13-150

Folate. 16.19 ug. R: 3.89

B12. 150 pmo. R: 37.5

Vit D. 118.00 nmo.

CRP. 0.89 mg

A test from the Gp was:

Serum free T4. 19.3 pmo. R: 11.0- 22.6

TSH. 0.10 mu. R: 0.2 - 4.00

The Gp asked me to reduce the level of Thyroxine from 75 mg plus 12.5 every other day as I’ve had 3 low results over the last 2 years.

I am now taking 75 mg. I did take my medication before the test but the Gp said it made no difference.

I would appreciate your thoughts as I am not feeling too well at the moment.

Also experiencing unpleasant symptoms during the night, intense changes in body temperature, and I am well past the menopause, it starts from my feet , like a surge going up my body with a sensation like restless legs, I then feel it in my chest, my breathing quickens and heart rate feels to be banging in my chest. I then feel like I’m in an oven. It is very uncomfortable, nothing like a usual hot flush.

Just wondered if anyone else had experienced anything like it. I know it sounds strange but it makes me feel unwell the day after. I feel weak with no energy, shortness of breath, feeling my heartbeat, shaky, with feelings of anxiety. I suppose you could say symptoms of a flare up.

Thank you for your help.

[SeasideSusie Remembering]

Pink-mist

I did take my medication before the test but the Gp said it made no difference.

Well that's unfortunate because it does make a difference, see below:

Always advised here, when having thyroid tests:

* Blood draw no later than 9am. This is because TSH is highest early morning and lowers throughout the day. If looking for a diagnosis of hypothyroidism, an increase in dose of Levo or to avoid a reduction then we need the highest possible TSH

* Nothing to eat or drink except water before the blood draw. This is because eating can lower TSH and coffee can affect TSH.

* If taking thyroid hormone replacement, last dose of Levo should be 24 hours before blood draw, if taking NDT or T3 then last dose should be 8-12 hours before blood draw. Adjust timing the day before if necessary. This avoids measuring hormone levels at their peak after ingestion of hormone replacement. Take your thyroid meds after the blood draw. Taking your dose too close to the blood draw will give false high results, leaving any longer gap will give false low results.

* If you take Biotin or a B Complex containing Biotin (B7), leave this off for 7 days before any blood test. This is because if Biotin is used in the testing procedure it can give false results (most labs use biotin).

These are patient to patient tips which we don't discuss with phlebotomists or doctors.

So what we can gather from your results is that you have a false high FT4, your normal amount of circulating hormone would show a lower result if you had taken your Levo at the suggested time and would be a more accurate result.

The Gp asked me to reduce the level of Thyroxine from 75 mg plus 12.5 every other day as I’ve had 3 low results over the last 2 years.

Which result is he referring to? The TSH? Well that's likely to be low anyway. TSH is not a thyroid hormone, it's a pituitary hormone and it's a signal from the pituitary that tells the thyroid to make hormone when it detects there's not enough. If it thinks there is enough hormone it doesn't send the signal so TSH remains low. These results show a high FT4 - no need for the TSH signal to be sent so the TSH result is low. When on enough thyroid hormone replacement, i.e. optimally medicated, TSH will often be very low in range or even suppressed, that's just how the feedback mechanism works.

Your FT3 is very low in range potentially indicating poor conversion, but you can't know that for sure unless you do the test under the right conditions as outlined above. Poor conversion is suggested by high FT4 and low FT3 so you definitely need an accurate FT4/FT3 result first.

However, it was suggested 4 years ago that you would benefit from T3 and you asked for details of a supplier. Did you ever start taking it because your current FT3 result doesn't suggest that you do. Low T3 causes symptoms.

You already know that you have Hashimoto's.

B12, Folate and Ferritin are fine.

Vit D is OK as the recommended level is 100-150nmol/L, it's up to you if you want to get it higher in the range.

[Pink-mist in reply to SeasideSusie]

Thank you for your reply. The test from Medichecks should be more accurate as I did not take medication before I took the bloods . I have not taken T3 as I’ve been reasonably well. What level do you think the T3 should be and where is it available without a prescription?

[Pink-mist in reply to Pink-mist]

I forgot to say that the Gp is referring to the TSH.

[SeasideSusie Remembering in reply to Pink-mist]

Pink-mist

Free T3 3.76 pmol/L. R: 3.1 - 6.8

Free Thyroxine. 20.900. R:12- 22

OK, so we'll take these results from you Medichecks test.

The aim of a treated Hypo patient on Levo only, generally, is for TSH to be 1 or below with FT4 and FT3 in the upper part of their reference ranges, if that is where you feel well.

Your FT4 is 89% through range and your FT3 is just 17.84% through it's range. So your T4 to T3 conversion is very poor. Good conversion needs optimal nutrient levels and you have no problems there, so it would seem that if you are experiencing symptoms then it's due to the low FT3 and you may wish to add some T3 to your Levo.

When on combination hormone replacement (Levo and T3) one usually sees FT4 go lower in range and FT3 in the upper part of it's range. There is no set level for them to be, we each have to find the levels that suit us best by trial and error, gradually tweaking doses until we find our sweet spot.

The Admin team don't keep a list of suppliers, nor can we recommend any, but we do sometimes receive feedback from members about suppliers they use. You will need to make a new post asking members to recommend reliable suppliers of T3 to you by private message. You can then check with myself, or another member of the Admin team, to see if we have received any feedback on any supplier that you have been given details of.

[Pink-mist in reply to SeasideSusie]

Thank you SeasideSusie for your reply, it has been very helpful.

[SlowDragon Administrator]

Your high thyroid antibodies confirms autoimmune thyroid disease also called Hashimoto’s

Thyroglobulin. 457.000. R: 115

Peroxidase. 104.00. R: under 34

As you have Hashimoto’s you on strictly gluten free diet?

[Pink-mist in reply to SlowDragon]

Hello SlowDragon,Yes, I have been gluten free for 3 years.