Recent results

[Holiday12345]

Hi just got my recent results Tsh 2.13, T4 14.8 and T3 1.4.... I don’t have ranges yet. I was trying to work out what the T4 and t3 mean (To find your conversion ratio when on T4 only you simply divide your T3 into your T4, that gives me 11.38 I think but it wants to be less than 5?)

[shaws Administrator]

The aim is a TSH of 1 or lower and both FT4 and FT3 in the upper part of the ranges. We should have small increases in dose to reach TSH of 1.

T4 is inactive and has to convert to T3 and it is T3 that is the 'engine' that enables our body to function from head to toe - brain and heart have the most T3 receptor cells.

[Holiday12345 in reply to shaws]

Is FT4 and FT3 the same as T4 and T3? I asked for all the thyroid bloods my gP could do. Or are they completely separate things

[fuchsia-pink in reply to Holiday12345]

They might be ... Total T4 and total T3 are the total amounts of each hormone your body produces - but it can only use the "free" bits - hence why we try and get free T4 and free T3 tested (as the "total" numbers are somewhat irrelevant).

They seem to test "totals" pretty routinely in Scotland, but in England and Wales I think it's usually "frees" - if that helps

So your T4 could be free T4 or total T4 ... (we can probably work it out when you get the ranges .. the T4 number looks like free T4 to me given the usual ranges we see in the UK ...)

[Holiday12345 in reply to fuchsia-pink]

Ah ok, I’m in Scotland, I’ll get ranges this afternoon and update my post many thanks

[SlowDragon Administrator in reply to Holiday12345]

In Scotland they tend to test total T3

[tattybogle in reply to Holiday12345]

There are two different tests for the T4 hormone, one is called TT4 (total T4) and one is called FT4 (free T4)... the 'total' one measures it all including the bits that are bound to ( something ) and therefore not available. the free one just measure the bits that are available.

Same with fT3 an TT3.

So we usually prefer to see fT4 and fT3 results, as they are more true to what's really available.

[SlowDragon Administrator]

How much levothyroxine are you currently taking

Essential to regularly retest vitamin D, folate, ferritin and B12

Previous post from few months ago shows low vitamin levels and only on 50mcg levothyroxine.

guidelines on dose levothyroxine by weight

Approx how much do you weigh

Even if we frequently 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

NICE guidelines on full replacement dose

nice.org.uk/guidance/ng145/...

1.3.6

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.

Also here

cks.nice.org.uk/topics/hypo...

gp-update.co.uk/Latest-Upda...

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.

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...

[Holiday12345 in reply to SlowDragon]

Hi, I take 50/75 levo alternate days think I probably need to go up to 75 each day. So difficult to get GP interested in thyroid. (My cholesterol is high 6.2 and need to get it down (had 2 tias at Xmas, haven’t got on well with statins so far) but thyroid affects cholesterol and blood pressure?). I’m about 9 stone 5, and have autoimmune thyroid high antibodies. Doc not interested in antibodies. Wouldn’t test vitamins but my ferritin last time was up to 59. I keep getting confused when folk speak about the T4 T 3 and the FT4 and FT3 are they the same things ?

[SlowDragon Administrator in reply to Holiday12345]

Print out guidelines on dose by weight and request dose increase to 75mcg levothyroxine every day

Retest in 6-8 weeks. All thyroid tests should be done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

Which brand of levothyroxine are you currently taking

Always get same brand at each prescription

Many thousands of U.K. thyroid patients forced to test thyroid and vitamin levels privately to make progress

Suggest you test vitamin D now

NHS easy postal kit vitamin D test £29 via

vitamindtest.org.uk

High cholesterol is likely linked to being under medicated and still hypothyroid

nhs.uk/conditions/statins/c...

If you have an underactive thyroid (hypothyroidism), treatment may be delayed until this problem is treated. This is because having an underactive thyroid can lead to an increased cholesterol level, and treating hypothyroidism may cause your cholesterol level to decrease, without the need for statins. Statins are also more likely to cause muscle damage in people with an underactive thyroid.

[Holiday12345 in reply to SlowDragon]

I use the Mercury Pharma brand. I’ll request an increase and retest in 2 months, Many thanks

[SlowDragon Administrator in reply to Holiday12345]

About 90% of primary hypothyroidism is autoimmune thyroid disease also called Hashimoto’s diagnosed by high thyroid antibodies

There’s much you can do yourself to improve symptoms

Regularly retest vitamin levels and maintain at OPTIMAL levels

Strictly gluten free diet often helps or is essential

Hashimoto's frequently affects the gut and leads to low stomach acid and then low vitamin levels

Low vitamin levels affect Thyroid hormone working

Poor gut function with Hashimoto’s can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common.

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps, sometimes significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

While still eating high gluten diet ask GP for coeliac blood test first or buy test online for under £20, just to rule it out first

healthcheckshop.co.uk/store...?

Assuming coeliac test is negative you can immediately go on strictly gluten free diet

(If test is positive you will need to remain on high gluten diet until endoscopy, maximum 6 weeks wait officially)

Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse

chriskresser.com/the-gluten...

amymyersmd.com/2018/04/3-re...

thyroidpharmacist.com/artic...

drknews.com/changing-your-d...

restartmed.com/hashimotos-g...

Non Coeliac Gluten sensitivity (NCGS) and autoimmune disease

ncbi.nlm.nih.gov/pubmed/296...

The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported

ncbi.nlm.nih.gov/pubmed/300...

The obtained results suggest that the gluten-free diet may bring clinical benefits to women with autoimmune thyroid disease

nuclmed.gr/wp/wp-content/up...

In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned

restartmed.com/hashimotos-g...

Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.

[pennyannie]

Hey there Your T3 looks very strange if this result is a a free T3 and free T4 result :

Please supply ranges and that both T3 an T4 underwent the same testing method :

[Holiday12345 in reply to pennyannie]

I’ll try get hold of the ranges this afternoon , thanks for your reply

[JAmanda]

I'd be looking for a dose increase of Levo but you're right it does look like you don't convert to T3 well. Ask for 25 mcg more Levo now then rested in 6 weeks. How are you feeling? (Advice assumes these are Ft4 and 3 results.)