FT3 results

[melross]

Hi Hope someone can shine some light. I've been taking a low dose of Carbimazole for Hyerthryroidism for a couple of years now and have regular blood tests. I have recently been recalled for a repeat blood test. I notice that for the first time, at the last last blood appointment, I had my FT3 tested and the results were 5.7pmol/L. I suspect this is why I am being recalled. Can anyone shine some light on what FT3 is? What my results might mean? and whether my results are normal or not? I'd like to understand a bit more, if someone can kindly assist. Thanks in advance.

[PurpleNails Administrator]

The thyroid produces T4 and is has to be converted to T3, the active useable hormone.

Do you have your TSH and FT4 result with reference range?

Previously your results (where these when you were diagnosed?)

Serum free T3 level High 8.7 pmol/L (3.1 - 6.8)

Serum free T4 level High 22.8 pmol/L (12.0 - 22.0)

Serum TSH level Low <0.01 mu/L (0.30 - 4.20)

So a FT3 of 5.7 in the same lab range would be good.

[melross in reply to PurpleNails]

Hi Thanks for your reply. I think the earliest results I could find are as follows:

T3 6 pmol/L (3.10-6.80pmol/L)

T4 18.2 pmol/L (12.00-22.00 pmol/L)

TSH <0.01 mu/L (0.30-4.20mul/L)

Above before treatment started.

Latest results:

TSH <0.01mU/L (0.4-4.9mU/L)

ft4 13,3pmol/L (9-19pmol/L)

ft3 5.7pmol/L (2.6-5.7pmol/L)

Just wondered if there was anything in my latest results which could be cause for concern.

Thanks M

[PurpleNails Administrator in reply to melross]

Your FT3 is top of range, (100% of range) most doctors would want that lower. Usually they like to see us at bottom of the range so if you experience a sudden rise there’s lots of opportunity to spot it. Patients feel better when it’s higher in range. How often are you tested? Initially I was tested 6 weekly.

Doctors may suggest you increase your carbimazole dose to lower the level. What are your currently taking? I’d increase by a fraction, eg 5mg 3 days a week.

Your FT4 is 43% through range so much lower, a dose increase will lower this too. How do you currently feel?

Has TSH remained suppressed through treatment? This can happen especially if suppressed for a long time, Doctors focus on getting this to work. Mine only rose fractionally when frees were low for several months. It’s never been in range despite taking carbimazole for 2 years.

You have negative antibodies? Which were tested TSI, TRAB, TGAB? Your TPO was negative. You have had an ultrasound scan confirming nodules? I have a large solitary nodule which was confirmed by negative TSI and nuclear uptake scan.

Do you take any supplements? Other medication?

Was treatment commenced based on TSH as FT4 & FT3 were in range at that stage? Looks like your hyperthyroidism was persistent given that you continued taking care for 2 years and frees still within range. Did you ever have a hypothyroid result (under-range FT4 & FT3?)

Have you had nutrients tested? Vitamin D, folate, ferritin, B12? these are often affected when thyroid dysfunctional and will compound any symptoms.

[melross in reply to PurpleNails]

Hi I'm being tested every 12 weeks. I'm currently taking 5mg of carbimazole each morning.

My TSH has remained surpressed throughout.

I do not think my antibobies have been tested. How would I know? What results would I be looking for? I think I did ask the Consultant and my GP when we first chatted but I've scanned all my letters I can not see any TSI, TRAB or TGAB results. Do you think I should be pushing for this. Following a scan, I have been told my Hyperthyroidism is caused by multiple nodules, although the scan was carried out by another hospital. I've since changed hospitals and now have a different Endocrinologist.

I currently dont take supplements but I do take combination blood pressure meds for essential hypertension, in addition I take Propranolol for headaches/this also helps lower my BP in combination with other BP meds. I don't like taking Propranolol as I think it really does affect my energy levels, however if I do stop (and I have tried), my headaches return with a vengeance.

My nutrients have not been tested.

[PurpleNails Administrator in reply to melross]

12 weeks if you are stable should be ok. You began on 20mg? So it’s been reduced to 5mg which is a low dose a slight increase would help bring your FT3 into range.

These are the types of thyroid antibodies :

Thyroid Stimulating Immunoglobulin (TSI)

TSH receptor antibodies (TRAb) (your prior post said letter said it had been requested)

Thyroid Peroxidase (TPO) (prev. post <15 iu/mL (0 - 34), so negative level, not all hashimoto patient have TPO also need test for TGab)

Thyroglobulin (Tg, or TGab)

They have a (0-XX) range or <XX level. Above the range or limit would be positive. below the level would be considered negative.

TSI and TRab associated with Graves. TPO & TGab associated with hashimotos.

You can obtain copies of blood test results directly from the hospital department secretary or surgery reception. (Don’t approach with doctor, they don’t like it!) Don’t accept verbal or hand scribbled notes you need a printed copy with ranges (ranges vary between labs so essential). They shouldn’t ask why but if they do try to resist just say for your records. You are legally entitled to your records.

If in England,Surgeries are contractually obliged to provide GP records via online access. Other practices vary.

What sort of scan did you have? ultrasound scans can confirm presence on nodule but not function. A radioactive uptake scan only way to conclusively confirm if the are hyper-functioning. Obtain a copy of the scan report, is should comment on the appearance of thyroid.

Doctors are treating hyper, assuming the nodules are causing elevation. Further antibody testing should be done.

I am exactly the same with Propranolol. I had tachycardia at diagnosis, so GP gave it to me, after 2 month specialist told me to abruptly stop taking. It triggered migraines and I I’ve slowly lowered the dose but still take 30mg per day to stop the headaches returning.

I have a nurse specialise teleclinic me with results & advise on dose adjustments. Hospital cancelled all appointment last year but I am expected to attend in August. I think they like to see us to discuss RAI. I believe this has been suggested for you but like me you are not keen.

If doctor refuses to test nutrients consider using private option as detailed in slowdragons post.

[SlowDragon Administrator]

T3 6 pmol/L (3.10-6.80pmol/L)

T4 18.2 pmol/L (12.00-22.00 pmol/L)

TSH <0.01 mu/L (0.30-4.20mul/L)

Above before treatment started.

These results don’t really suggest Hyperthyroid (Graves Disease)

.....looks more like early stage Hashimoto’s (autoimmune hypothyroid) Hashimoto’s frequently starts with transient hyperthyroid results and symptoms before becoming increasingly hypothyroid as thyroid is destroyed

We see many early stage Hashimoto’s patients misdiagnosed as Graves patients if thyroid antibodies aren’t tested

How do you feel?

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested (high with Hashimoto’s, can be slightly high with Grave disease)

. Also EXTREMELY important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, with BOTH Graves And Hashimoto’s

Ask GP to test vitamin levels and 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 .

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

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

Graves’ disease must be confirmed by testing TSI or Trab antibodies

Graves Disease antibodies test

medichecks.com/products/tsh...

Good info on Graves’ disease

ncbi.nlm.nih.gov/pmc/articl...

healthunlocked.com/thyroidu...

If TPO or TG thyroid antibodies are high this is usually due to Hashimoto’s (commonly known in UK as autoimmune thyroid disease). But you can have high TPO or TG with Graves’ disease too

Link about thyroid blood tests

thyroiduk.org/getting-a-dia...

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

Link about Graves’ disease

thyroiduk.org/hyperthyroid-...

List of hypothyroid symptoms

thyroiduk.org/if-you-are-un...

[melross in reply to SlowDragon]

Hi Thanks for your reply and helpful info. I haven't been diagnosed with Graves, following a scan, I was diagnosed with Hyperthyroidism due to multiple nodules on my thyroid.

I don't think I have had any tests for antibobies.

I have low energy levels and frequent headaches.

My vitamins have not been tested.

Thanks

[SlowDragon Administrator in reply to melross]

Nodules suggests Hashimoto’s

Carbimazole is not correct treatment for Hashimoto’s

Headache is extremely common hypothyroid symptom

Recommend getting full thyroid and vitamin testing done including antibodies

What vitamin supplements are you currently taking, if any

[Marz]

10 months ago greygoose gave good advice with the suggestion you may have Hashimotos. I would have another read through that earlier post and test the anti-bodies that were suggested at that time.

Hashimotos leads to an underactive thyroid so you could be on the wrong treatment ...

[pennyannie]

Hey there again Meloss ;

Well your T3 and T4 are now in range and in all honesty have never been that high to think this could be Graves Disease.

It's quite likely your levels have become a little erratic and causing you symptoms because of the nodule issues and believe if you can stay on the AT medication this has to be the best long term option for you.

I think I saw that you had antibody analysis for Hashimoto's and it was negative - though understand a scan needs to done to defintely rule out Hashimoto's AI disease.

If this is Hashmoto's AI disease it is not treated with anti thyroid medication, like Carbimazole. This AI disease can cause symptoms of both hyperthyroid and hypothyroidism and the disease systematically destroys your own gland ultimately rendering you hypothyroid and requiring thyroid hormone replacement for hypothyroidism.

Obviously taking the AT medication will be clouding your erratic thyroid hormone production which can be because of either nodules or Hashimoto's AI disease.

[melross]

Thanks everyone for your helpful advice and suggestions. I really do appreciate it. I know to some, it doesn’t look like Ive taken on board advice and suggestions from previous posts last year but my records show I did request antibodies test last year. I think my request hasn’t, for whatever reason been acted upon and due to the obvious over the past 12 months I’m guilty of letting things slide. I have however send another request to the consultants secretary now so hopefully I’ll get a reply soon.

Once again all, your support is invaluable, so a big thank you!