Its all starting to make sense now, I had thought i was a hypochondriac!
At the age of 17 I was diagnosed with rheumatoid arthritis and 20 years of spells of odd debilitating illnesses, with only 2 diagnosis of thyroid problems one hyper and one hypo. (the arthritis never materialised despite him telling me I would end up in a wheel chair)
The second diagnosis (hypo) was only 6 weeks ago and I have just sent for my own set of blood tests. They show deficient and low level vitamins, which I can now rectify.
What I don't understand is how to improve my free T4
results are
TSH 0.84
FreeT3 4.43
Free Thyrozine 11.50
I am on 50mg Levo
Written by
bluekitchen
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Your low Ft4 shows you are under medicated on just 50mcg levothyroxine
That’s hardly surprising as it’s only a starter dose
But (probably because of low vitamin levels) your TSH is currently low as well
You may struggle to get GP to agree to next dose increase in levothyroxine
Was this test done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test?
This gives highest TSH result
What are your vitamin results and ranges
The aim of levothyroxine is to increase dose upwards in 25mcg steps until TSH is under 2
When adequately treated, TSH will often be well under one.
Most important results are ALWAYS Ft3 followed by Ft4.
When adequately treated Ft4 is usually in top third of range and Ft3 at least 60% through range (regardless of how low TSH is)
Extremely important to have optimal vitamin levels too as this helps reduce symptoms and improve how levothyroxine works
Presumably you have also had thyroid antibodies tested?
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 (or even half tablet per day for first couple of weeks)
Or Thorne Basic B is another option that contain folate, but is large capsule
If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results
With B12 result below 500, recommended to be taking a B12 supplement as well as a B Complex (to balance all the B vitamins) initially for first 2-4 months, then once your serum B12 is over 500 (or Active B12 level has reached 70), stop the B12 and just carry on with the B Complex.
Bloods should be retested 6-8 weeks after EACH dose increase
For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also EXTREMELY important to test vitamin D, folate, ferritin and B12
Low vitamin levels are extremely common, especially if you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies
Ask GP to test vitamin levels
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)
Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins
Even if we don’t start on full replacement dose, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near full replacement dose
Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.
Traditionally we have tended to start patients on a low dose of levothyroxine and titrate it up over a period of months. RCT evidence suggests that for the majority of patients this is not necessary and may waste resources.
For patients aged >60y or with ischaemic heart disease, start levothyroxine at 25–50μg daily and titrate up every 3 to 6 weeks as tolerated.
For ALL other patients start at full replacement dose. For most this will equate to 1.6 μg/kg/day (approximately 100μg for a 60kg woman and 125μg for a 75kg man).
If you are starting treatment for subclinical hypothyroidism, this article advises starting at a dose close to the full treatment dose on the basis that it is difficult to assess symptom response unless a therapeutic dose has been trialled.
Which brand of levothyroxine are you currently taking?
Just to add to all the wise advice above, I can’t see the ranges for your tests but a combination of low TSH and low T4 is not typical. If T4 is under range your TSH would normally be high in typical hypothyroidism. Sometimes problems with the pituitary gland lead to a combination of low TSH and low T4. Perhaps you could follow up with your doctor to get a good explanation and if necessary further investigation. Good luck.
Hi, you are right that the T3 looks ok (especially compared to T4) but it's just odd for T3 to be in range but TSH and T4 to be below range unless you are taking T3 or there is something else going on. Could be a faulty test result. , I've only ever had results like that when I'm taking T3. Maybe an expert on here can help out?
I’ve been reading up on Central hypothyroidism as my blood results are very similar to OP. Regarding T3 being normal I found this:(skip to the last sentence)
“The hallmark of CH are low serum levels of circulating free thyroxine (FT4) into the hypothyroid range associated with low/normal serum TSH concentrations. Some patients with CH with a predominantly hypothalamic defect may have high serum TSH levels, a potentially misleading diagnosis which may be confused with subclinical primary hypothyroidism. Although serum TSH levels may be normal or high, the TSH is biologically inactive and cannot stimulate the thyroidal TSH receptor. The measurement of serum free triiodothyronine (FT3) levels is highly unreliable, as more than 30% of patients with CH have normal levels of this hormone.”
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