Since I posted my last blood results here ( T4 was 23.5, T3 4.45 and TSH 0.01 on 12th March) I’ve seen an endocrinologist. He thought I might need some T3 but in the first instance suggested I reduce my Levothyroxine.
I’ve been taking 125mcg for about 3 years.
So for the last 7 weeks I’ve taken 125mcg and 100mcg on alternate days.
My latest results show my T3 is 4.4, TSH 0.02 but my T4 is 25.5
I expected my T3 to go down and my TSH to rise but don’t understand why my T4 is higher.
I’d be very grateful if someone could offer some sort of explanation, I’ve got another consultation tomorrow.
Thanks in advance.
( My iPad isn’t working very well so I can’t edit this, so sorry if it’s a bit muddled)
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Supernovae
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When did you take your last dose of Levo before the test?
Always advised here, when having thyroid tests:
* 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.
I am just v puzzled as to why decreasing my dose has caused my T4 to rise.
Was previous test done at the same time/under the same conditions?
The dose reduction was small at 12.5mcg and looking at your results your TSH and FT3 are minimally different - 0.01 and 0.05 respectively, I'd say there was no difference there at all allowing for the fact that natural fluctuations happen with hormone levels, you could retest 10 minutes after your first test and there will be a slight difference in levels. So with a wider range for FT4 the 2 points difference is extremely small and I'd say that it's possible the 12.5mcg reduction isn't enough to make an impact on the results in your case.
Well the change in dose was minimal as is the change in blood test results :
Except that it proves you need T3 - Liothyronine - so let's hope it happens -
though I was refused a trial of T3 because my TSH was suppressed/ low at 0.01 but interestingly your TSH has moved up a little with this T4 adjustment.
So, let's look at your conversion ratios above :
The accepted conversion ratio when on T4 only is 1 / 3.50 - 4.50 with most people feeling better at around 4 or under - so if I divide your T3 into your T4 I'm getting the following :
In the first set of results your conversion ratio is coming in at 5.28 :
In the second set with the dose adjustment your conversion is even wider out at 5.79 :
This shows that reducing your levothyroxine has raised your TSH but raised T4 and not T3 as your conversion is now even more compromised than before.
I would hope it's not suggested that you reduce your T4 medication again, unless it's to accommodate an additional prescription for T3 - Liothyronine.
No thyroid hormone replacement works well until ferritin, folate, B12 and vitamin D are at good optimal levels and your core strength strong and solid as T3 is much more powerful than T4 :
We don't know what criteria this endo is using but fingers crossed for you for tomorrow :
Please check my maths, before you quote them, as I think we maybe both a bit muddled today:
I was on lactose free levothyroxine, Teva, but the chemist couldn’t always get it so in the end I accepted anything.
The endocrinologist in his letter to the GP last time said I should be on lactose free levothyroxine, I’ll make sure I order it early enough for the chemist to get some in.
I’ve had a coeliac blood test which was negative, so haven’t gone gluten free.
Only 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
Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse
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
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
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.
I read ferritin needs to be over 70 for Levothyroxine to work :
I feel at my best when my ferritin is around 100 : I aim for active B12 at 70 + with folate at around 20 and vitamin D at around 100 :
As you are not a big meat eater you might like to consider buying Asda Frozen chickens livers ?
They are very clean and mild to taste and once defrosted I flash fry one tub down a week, in a little olive oil - it doesn't take 10 minutes and I then whizz down into a pate type mixture which I keep in the fridge in an jam jar.
I take a spoonful a day and with a dollop of Hellmans this helps this medicine go down and keep my ferritin optimal.
I only suggested it as it's my own medicine - I find liver hard to eat in a lump or pieces for various reasons - this pasty pate is just some mush on a spoon and an excuse for a dollop of Hellmans!!!!
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