I am concerned about the GPs knowledge. Not only did she stop my thyroid meds but gave me iron supplement causing extreme diarrhoea and hospital emergency. I requested a thyroid test to include T3 as well as vitamin D and B12 but no mention of vitamin results.
This is the latest results she has sent to me saying they are all normal:
TSH - 3.71
T4 - 12.3
Free T3 - 4.5
There is no Free T4 and just Free T3
Should the T4 be over 10.9 and be ok
I would appreciate it anyone could help before I go back to the GP.
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Lynsie1
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Can you supply the ranges for your thyroid function test?
And if you give more details such how long you have been medicating, when you stopped, which medication you were taking & the amount, members will be able to comment.
If you had vitamins tested you are legally entitled to a copy of your results, so ask your doctors surgery to print one out for you. Do not accept written notes that risk omitting important information.
Hi Radd, the above info was a telephone message left. I will contact them on Monday and request a print out. I have been taking 100mcg for a number of years, many problems and self research have found I need lactose free tablets which I now have but the reluctance to check T3 was a concern as I had issues in the past and not sure it is being addressed.
" I requested a thyroid test to include T3... " They have checked fT3 (free T3), which is now pretty unusual to be allowed on NHS , very often even if GP requests fT3 /TT3 the lab won't run it unless the TSH is supressed, and the fT4 is over range , (to check for hyperthyroidism) .
fT3 is more useful than TT3 , so i don't understand why you would want both ? TotalT3 would not be very helpful anyway .....it is not used much in England , but for some odd reason it seems to be done more than freeT3 in Scotland at the moment.
That 'T4' result does actually look like it might be an fT4 result rather than a TT4. But we'll see when you get the ranges.
" Should the T4 be over 10.9 and be ok ?... "
Interpretation of fT4 test results depends on the lab reference range for the machine that was used.. there are several different machines in use with different ranges, and also there is a slight local population adjustment applied to the range, so for eg .
fT4 10.9 [12-22] would mean very low T4 but,
fT4 10.9 [7.9-14] would mean T4 was 33% through the range.
For this reason, it's impossible to say "T4 should be over X "
Hi tattybogle, thank you for your response, I am underactive, hypothydroidism, I should have mentioned. I live in Scotland and hope my request for full printout will help.
There also is a Reverse T3 test if you have Hashimotos you might have trouble converting. Look on here there’s a set of test your doctor should run, I know someone on here is very good. He always recommends what test to take, and other good information I just can’t remember his name or greygoose she’s excellent too! Best of luck
Obviously we need the ranges on results, before can comment
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
Was test done after minimum of 6-8 weeks on constant unchanging dose and brand of levothyroxine
The aim of levothyroxine is to increase dose upwards in 25mcg steps until TSH is ALWAYS under 2
When adequately treated, TSH will often be well below 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
GP Stopped prescription ? ... are these the results from when you were still taking Levo ?
If so, they look undermedicated ,as TSH should be below 2
If they are from after a period of taking no levo, then it may be too soon to tell what they will end up at as you'd need to be off Levo for many weeks to see what happened to natural thyroid levels without any exogenous T4
I think it probably is simply the doctor being sloppy by saying T4 instead of fT4 . T4 refers to the thyroid hormone our bodies produce but ft4 refers to a specific blood test measuring the level of T4 in the blood stream. Hope that helps.
TT4 ....Total T4 is how much T4 in total is in blood measuring both the 'unbound' form (floating around on it's own and thus available to go to cells) AND a 'bound' form , which is T4 attached to ...something , i've forgotten what , possibly Thyroid Binding Goblins ) and therefore not immediately available for cells.
fT4.......Free T4 measures just the unbound form.. which is why we prefer to see that one over TT4
Any deeper than that and i get a bit confused too.
fiftyone ....... it's the same for Free T3 (fT3 )and Total T3 (TT3) it's really 'thyroid binding globulins' (TBG) that stick to both T4 and T3 to transport them.
um... pass. TT4 will always include some 'bound' T4 .
I've always assumed that the TT4 would be 'higher' than the fT4, .....but i'm out of my depth
I don't know how /if it becomes 'unbound' or it of stays 'bound' forever and is then got rid of.
I just know that sometimes the body makes more TBG's and so that enables it to carry more T4 around.. it does this for example, in pregnancy , and i think estrogen levels have got something to do with it
Gosh, when you put that up the other day i scrolled on by, cos 'ratios' are a bit difficult for my brain.. but having looked carefully, i'm amazed how little free hormone there is compared to bound.
Also ,never realised that a pmol was related to nmol like that... doh ! ( Thankyou , finally i can make sense of my TT4 results at diagnosis )
Brilliant ... why oh why did i not know that nmol and pmol are "nanomoles and picamoles" and that you could also have millimoles ........ I would have been able to understand much sooner if i'd been able to picture little mini moles running around, (or hanging on a fence in graduated sizes )
Doesn't help when they swap between per litre and per millilitre (seemingly randomly) and results therefore change by a factor of 1000 or switch units (e.g. nmol to pmol).
I know .. and what is it about medics that means they constantly play a game of "let's see how many different abbreviations can we use for the same antibody /measurement, at the same time ? "
Anybody would think they didn't want us to understand the results .. oh wait .... they don't .
....an don't get me started on why we still have to deal with different fT4 ranges that wander around at the whim of the manufacturers of machines.. imagine if the way you bought fruit and veg changed every time the shop bought some scales from a different manufacturer.. actually i can't imagine it ,but i bet it would get messy , with half tomatoes everywhere.
But so many people seem to love the idea of buying some things in pounds and ounces and some in kilograms and grams! Or petrol in litres and petrol consumption in miles per gallon.
And selling packets of coffee of 227 or 200 grams when the universal standard everywhere else is 250 grams. Switching units both confuses and provides a basis for manipulation/exploitation.
yes. thank heavens they have to write the actual £0.00p per / 100g (or variation thereof ! ) in the teeny-tiny small print on the shelf label, (as i get older i will become "that woman staring at Carrots with a magnifying glass in hand"
I still think of petrol in terms of a gallon , and compare prices to the time my Dad had a massive rant because it had gone up to 50p /gallon.
I was off levo for several weeks previously and from the result then I had to immediately take 50mcg for 2 weeks then onto 100mcg, and this was the test following that and was taken early without morning meds.
Goodness knows! She is new in the practice and word is she trying to save money by changing peoples meds (to cheaper options) or cutting them out, proving to be a false economy, an elderly neighbour was so confused they now have to send in nurses four times a day to medicate her.
Generally on levothyroxine only a TSH level of around 1 or less with ft4 over halfway through range is when you can begin to look at conversion problems . Otherwise it would just indicate that you need an increase in levo.Once TSH is around 1 you need to get blood tests that do TSH, ft4 and ft3. By comparing how far ft4 and ft3 are percentage wise through their ranges you can judge how well you are converting.
I am in Grampian and have been through the process and managed to get liothyronine T3 on the NHS. Any questions about the process just message me.
Hi Lalatoot, I am in Moray/(Grampian). I wonder why I did not receive T3 meds previously when there was apparently a conversion problem, instead just raised the thyroxine meds for me.
NHS don't go looking for conversion problems , they rarely look beyond TSH , they think it tells them all they need to know (it doesn't) you usually only get T3 if you fight tooth and nail for a trial of it.They usually won't even test for it, so they wouldn't even know if it was low or high.
most GP's usually never even mention T3 let alone 'offer' it to anyone.
Only Endo's can initiate a prescription for it anyway so a referral is needed first. And Endo's don't have to accept the referral if they look at your results and deem them to be 'normal'
Well , technically it is 'normal'..... 97.5% of healthy people have TSH somewhere with in the lab range . But.... see this graph of the most common healthy TSH levels healthunlocked.com/thyroidu... and you'll see that it's much ,much more 'normal ' for people without thyroid disease to have TSH around 1 or 2 than it is to have TSH of nearly 4.
In people who are treated with Levothyroxine , then the aim should be to get TSH under 2 at the most .
See this recommendation from GPOnline telling GP's to aim for between TSH 0.5 and 2 when treating hypothyroidism with Levo. healthunlocked.com/thyroidu....
however they would have to be interested enough to go looking for this information, as the main thyroid treatment guidelines just tell them to "get it into range" so according to that , your 3.71 is fine , but 'fine' is not the same as 'optimal'.
The real issue at the moment is that until you've been on 100mcg for about 6 weeks you don't know what any of your thyroid levels really are, so 3.71 might not even be what your TSH level end up at on that dose , TSH is slow to react , hence the 6 week wait .
And T4 in levo has a 'half life' of around 7 days , so again that takes at least a couple of weeks to really show what your fT4 will stabilise to after a change in dose, and this in turn will be affected by any change in TSH level because that will affect how much T4 your own thyroid put out. So even though you can measure fT4 properly before 6 weeks , the result as 2/3 weeks still might not be where it stabilises on that dose after 6 weeks.
OK , so GP's next step should be to increase levo in response to this latest TSH result. ( probably by 25mcg , but to some extent that depends on knowing the lab range for that fT4 test. if something like 12.3 [12-22] then definitely 25mcg increase because T4 is so low in range, but if something like 12.3 [7.9-14] then possibly just 12.5mcg increase might be better , because T4 is getting towards top of range.
She should do this now .....and then retest in 6 weeks increasing further if needed until your TSH is around 1 , then once T4 is in top part of range and TSH is 1 or lower , you can get fT4 and fT3 tested together , and see how much T3 you are getting out of the T4.
that's the theory .. in practice it's never quite that simple
Sometimes it's worth waiting a bit longer than 6 weeks on a new dose before deciding how you actually feel on it.. i have found sometimes the first 5/6 weeks on a new dose are a bit up and down, but between 5-10 weeks it settles and slow improvement continue to build.
When T4 /T3 levels go higher (in the blood) the hypothalamus 'notices' and tells the pituitary to reduce it's output of TSH (thyroid Stimulating Hormone). So, adding Levo (synthetic T4) will lower TSH.
(NHS just ignore T3 and try to do it all with Levo, because T4 converts to T3, (but, unlike them, we are interested in how well it converts to T3)
When T4/3 levels go too low in the blood the pituitary increases TSH , and TSH goes to the thyroid 'ask' it to make more T4/3..... if your own thyroid is unable to make enough, the pituitary keeps putting out more TSH which is how come we get diagnosed as Hypothyroid ... high TSH with low fT4.
In a healthy thyroid the increase in TSH would be met with sufficient increased T4/3 production, and so TSH would then respond by going down again.. it does this all the time to a degree, to keep a balance and meet changing needs for hormone.
The high TSH can be an indication that your dose of levo is too low and that you need an increase. This is confirmed by looking at where your Ft4 level is within its range. So you need to find out where your 12.3 is in the range. Each lab has a different range. If you happen to be in NHS Grampian and bloods were done at ARI the range for ft4 is 9 - 19. So your FT4 result is roughly a third of the way through the range. This indicates that you need to try a higher dose of levo.
What Tattybogle says is correct. GPs cannot and do not know about T3.
Away to have breakfast now but will send a private message later to tell you the route I went down to get better treatment.
This response of the doctor shows just what is wrong with GP diagnosis. They trust the numbers, not the patient'symptoms. We get the ridiculous thinking, widespread through thyroid medicine, that on the one hand, the patient IS supposed to be treated as an individual but on the other is treated as a statistical number which is deemed to be satisfactory anywhere in range. In health we all have our unique FT4 and FT3 which don't vary by much (but they are never measured in health). From your data, it would look as if you might have some working thyroid left, which is trying but not succeeding in giving a healthy result. As regards conversion efficiency: if no thyroid working at all then the ratio FT4/FT3 of > 4.5 with FT3 low in range would indicate poor conversion. Normally in health the range is about 3 to 3.5. So anything between this and 4.5 with lowish FT3 should be looked at more closely as to whether you are taking too much T4 to get the FT3. Ironically if this is your only health problem, then the unused rT3 test might indicate if you have reached the limit of T4 therapy, and the excess is being diverted to this inactive form of T3 (to get rid of it harmlessly). Only 1 situation I think where rT3 might be useful.
When you pose this question, we can't help you unless you tell us what the units are for your FT3 test, and what the normal range your lab uses. My personal point of view is: you should have an FT3 result which is somewhere between the middle and top of normal range.
Yes your results look normal while you are STILL ON 100 mcg thyroxine! So you should stay on that or add in a bit more but you should NOT stop taking thyroxine. Get another doctor to confirm this. She sounds supremely ignorant of all matters thyroid related.
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) and therefore not immediately available for cells. 
it's really 'thyroid binding globulins' (TBG) that stick to both T4 and T3 to transport them.
How should I phase out T4 to T3 only?!
How slowly should I come off T3 to see if I can actually cope on my own now?
How can I have so many hypo symptoms when my TSH, T4 and T3 are all within 'normal' range!
How can I get my t3 and t4 levels up
How can I find a GP surgery that tests T3?
