So what do you think......

I have my results Tsh 0.23, T34.5, T4 15.5. I believe my GP is going to lower my thyroxine as the Tsh is low, but i still feel depressed fatigued and agitation. I am still waiting for private endo appointment due to covid. Any advice welcome as i am lost. Thanks

[SeasideSusie Remembering]

donnafackerell

Can you please add the reference ranges for your results so we can see exactly where all of them lie within the ranges, this will give us a better picture of your actual hormone levels rather than just seeing that the TSH is low. We can then work out the percentage through range your FT4 and FT3 are and this may help you to show your GP that a reduction in dose is not the way to go. FT3 is probably quite low but FT4 could be anywhere, we see many different FT4 ranges here - 7-17, 9-19, 11-23, 12-22 plus others, so you see your FT4 could be near the top of the range or quite near the bottom.

[Hidden in reply to SeasideSusie]

TSH. 0.23. 0.27-4.2. T3. 4.5. 3.1-6.8. T4. 15.5. 12-22. I have Hashimotos also.

[SeasideSusie Remembering in reply to Hidden]

donnafackerell

FT3: 4.5 (3.1-6.8) = 37.84% through range

FT4: 15.5 (12-22) = 35% through range

Your FT3 and FT4 are nicely balanced but far too low in their ranges.

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

Although your TSH is nice and low, your FT4 and FT3 show that you need an increase in your dose of Levo, 25mcg now and retest in 6-8 weeks. Possibly you may need further increases.

Your GP is dosing purely by the TSH result and that is not a thyroid hormone, it's a pituitary hormone. The thyroid hormones are FT4 and FT3 and they tell us what we need to know about our thyroid levels. If your GP reduces your dose of Levo then that will also reduce your FT4 and FT3 levels and you will become more hypothyroid.

Use the following to support your request for an increase in dose and refuse a reduction in dose:

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine (the professional magazine for doctors):

"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l. In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance. But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l. This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l).*"

*He recently confirmed, during a public meeting, that this applies to Free T3 as well as Total T3.

You can obtain a copy of the article by emailing Dionne at

[e-mail]

print it and highlight question 6 to show your doctor.

You mention below you're unsure how to do replies, you did this one perfectly, you click on the blue REPLY button immediately below the post you wish to respond to.

[SlowDragon Administrator]

Was test done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

Do you always get same brand levothyroxine at each prescription

Which brand

What vitamin supplements are you currently taking

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)

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/

NHS easy postal kit vitamin D test £29 via

vitamindtest.org.uk

[Hidden in reply to SlowDragon]

Yes I did all the rules for the blood test. I have Hashimotos do not eat gluten. And I used the private testing company. Waiting for private endo to return to work because of covid

[SlowDragon Administrator]

healthunlocked.com/thyroidu...

Previous post confirms autoimmune thyroid disease also called Hashimoto’s

Have you had coeliac blood test done

Are you now on strictly gluten free diet?

[Hidden]

THS. 0.27_4.2. T3. 3.1_6.8. T4. 12_22. Sorry I forgot to include the ranges I keep forgetting things. Previously I had antibodies and have Hashimotos. I have been waiting for private endo since last August. GP sticks to blood results only.

[SlowDragon Administrator in reply to Hidden]

So Ft4 is only 35% through range Ft3 only 16% through range

Helpful calculator for working out percentage through range

chorobytarczycy.eu/kalkulator

Most people when adequately treated will have Ft3 at least 50-60% through range

Low Ft4 shows your under medicated and/or poor absorption

Ft3 being much less than Ft4 shows poor conversion of Ft4 to ft3....extremely common when gluten intolerant

What vitamin supplements are you currently taking

When were vitamin levels last tested

Likely to need addition of T3 prescribed alongside levothyroxine

But need vitamins optimal before adding T3

[Hidden]

I am unsure how to use these replies properly. I just wanted to say I kept to all the rules for taking the. blood test.

[Bearo]

As you are waiting for your endo appointment I would ask GP not to change your dose before this or your levels will not be stable for a while. If the dose needs changing wait for the endo. At least this buys you time.