How do I get my t4 up?

[gigitheweegie]

So my tsh is finally optimal (in my uneducated opinion!) at 0.67

But here’s the thing, t4 is still low in the range.

When I’ve had this before, an increase in dose was suggested on here which did help get it up a bit but I’m sure as hell not going to get prescribed an increase in Levo now with those tsh results so does anyone have an idea what I can do?

These results were just basic bloods from my doctors surgery.

T4 has been higher in the past

I have ordered private bloods this afternoon and will follow up my doctors surgery results with a telephone consultation but mean time, any pointers would be useful.

Could it a pituitary issue rather than a thyroid issue?

[SeasideSusie Remembering]

gigitheweegie

Did you do the test as we always advise here:

* 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.

Does the private blood test you've ordered also include vitamins? These need to be optimal for thyroid hormone to work properly - Vit D, B12, Folate, Ferritin.

[SlowDragon Administrator]

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

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?

How much levothyroxine are you currently taking

Do you always get same brand of levothyroxine

What vitamin supplements are you currently taking

Do you have Hashimoto’s

Are you on strictly gluten free diet

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

Strictly gluten free diet often helps or is essential

[gigitheweegie]

Yes all test protocol followed and also, vitamin tests included in my order! Thanks

[gigitheweegie]

I’m taking vitamin d and k spray - I’ve just moved on to this as I have recently had kidney stones. Previously just vitamin d spray.

Vitamin a about 3 days per week

Vitamin c

Vitamin e liquid roughly about 2 days a week

selenium

Magnesium citrate

Zinc

And the odd b12 spray when I remember 🤪

I’ve changed levo brands since covid as I’ve been forced to collect my prescription from a local pharmacy which is linked to the surgery.

I’m taking 150ug levo a day which I take when I wake in the middle of the night with water.

I’m gluten free but not dairy free.

I don’t have thyroid antibodies but do have thyroid swelling on one side which was noted on ultrasound so I guess could be hashimotos.

I’m probably best to just wait till I get my results and post again but I’m just emotional with the whole process and disappointed with my results! Thanks

[Jazzw]

It won’t be a pituitary issue—it’s just what happens to many of us once we start thyroid hormone treatment. Unfortunately, many doctors seem oblivious and spend their time needlessly raising and lowering doses to make the TSH dance to the tune in their heads!

How much levothyroxine are you currently on?

[gigitheweegie in reply to Jazzw]

Currently 150 a day jazzw

I was on 125 until 2 months ago tsh was over 3 and t4 was 11 so with an increase of 25 my tsh has gone down a good amount but t4 hasn’t improved much

[Jazzw in reply to gigitheweegie]

Argh, so often the case. You’d probably benefit from another raise in dose but as you already know, you may struggle to get it.

I don’t suppose your doctor tests FT3? The lowish FT4 won’t matter as much if your body is managing to convert a decent amount of T4 to T3.

[gigitheweegie in reply to Jazzw]

I’m not sure if they do or not but I’ll get a private test done anyway. Always good to see vitamin levels etc.

Thanks for your help