I've just had the results of my first Medichecks tests - see below. I was diagnosed with Hashimotos five years and am on 75 micrograms Levothyroxine. Have also been taking B12, Super B complex and Vitamin D supplements for the past few months. (Did not take these in the ten days before the tests though). Tests were done early morning before I took my levo.
My GP is quite good at doing TSH and vitamin tests when I've been symptomatic, but not the other tests except for antibodies at the outset. I'm learning as I go along but always keen to feel healthier and minimise the periods of feeling unwell.
It looks to me as if my T3 is too low. Also, does such a low TSH mean an increased risk of osteoporosis?
Very grateful for any guidance - thanks
TSH (0.27 - 4.2) 0.26 mlU/L
Free T3 (3.1-6.8) 3.3 pmol/L
Free Thyroxine (12-22) 19.1 pmol/l
Folate serum (>2.9) 11.5ug/L
Ferritin (13-150) 61ug/L
Vit B12 - active (25.1-165) 186 pmol/L
Vit D (50-200) 94 nmol/L
CRP HS (0-5) 3.5 mg/L
Thyroglobulin antibodies (0-115) 30.2 IU/mL
Thyroid Peroxidase Antibodies (0-34) 189.0 IU/mL
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Zadock
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Have also been taking B12, Super B complex and Vitamin D supplements for the past few months. (Did not take these in the ten days before the tests though).
You really only need to stop Biotin or B Complex containing Biotin before a blood test, and the maximum time would be 7 days.
Vit B12 - active (25.1-165) 186 pmol/L
Folate serum (>2.9) 11.5ug/L
You are wasting your money on taking a separate B12, you don't need it. Our B12 store is good for about 2 years, if you continue taking B12 all you are doing is making expensive urine as excess is excreted.
As your folate is also good (the range is 2.9-14.5) then all you need is a B Complex now which will maintain both B12 and folate levels.
Vit D (50-200) 94 nmol/L
This is pretty good and almost at the level recommended by the Vit D Society and Grassroots Health, which is 100-150nmol/L.
Are you also taking D3's important cofactors - magnesium and Vit K2-MK7? Magnesium is needed so that the body can convert D3 into it's usable form. D3 aids the absorption of calcium from food and Vit K2-MK7 directs the calcium to bones and teeth and away from arteries and soft tissues where it can cause problems such as calcification of arteries and kidney stones, etc.
Ferritin (13-150) 61ug/L
This is a bit low, ferritin is recommended to be half way through range (82 with that range) and some experts say the optimal level for thyroid function is 90-110. You can help raise your level by eating liver regularly, maximum 200g per week due to it's high Vit A content, also liver pate, black pudding, and including lots of iron rich foods in your diet
The aim of a treated Hypo patient on Levo only, generally, is for TSH to be 1 or below with FT4 and FT3 in the upper part of their reference ranges. Your TSH is nice and low and FT4 is 71% through range which is pretty good, but your FT3 is a miserable 5.4% through it's range. This shows very poor conversion of T4 to T3. Good conversion requires optimal nutrient levels and even though Ferritin isn't quite optimal the rest are good.
Supplementing with selenium can help conversion, if you decide to do this then make sure it's selenium l-selenomethionine and not the selenite or selenate forms, and no more than 200mcg daily.
My opinion (and I am not medically qualified, just a patient with experience of poor conversion) is that you need some T3 added to your Levo.
Thank you so much. Poor conversion is what I suspected.... In answer to your questions, I'm not taking Magnesium, Vit K2-MK7 or selenium, so will start to do so (and stop the extra B12). So, what next? Should I see a thyroid experienced private endo to discuss trying T3? I'd be nervous about trying it alone and assume my GP would not be amenable to this.Thanks again - your advice is so helpful.
Don't start all supplements at once. Start with one, give it a week or two and if no adverse reaction then add the next one. Again, wait a week or two and if no adverse reaction add the next one. Continue like this. If you do have any adverse reaction then you will know what caused it.
So, what next? Should I see a thyroid experienced private endo to discuss trying T3?
Maybe discuss your Medichecks results with your GP, point out your good level of FT4 and extremely poor level of FT3. If your GP is bamboozled by the "percentage through range" of the result (yes, some of them are, it makes you wonder if they didn't need Maths to get into Uni) then just make a big noise about how low in it's range it is and if it was 0.3 points less it would be below range.
Here is the calculator that works out the percentages:
Also, your GP might be interested in what Dr Toft, leading endocrinologist and past president of the British Thyroid Association, has recently written in an article "Counterblast to Guidelines", which says that T3 may be helpful for many patients:
….It is instructive to consider the history of thyroid hormone replacement in order to appreciate that many of our policies have, to some extent, been accidental rather than planned.
Thyroid extract was first used some 125 years ago with good effect and remained in widespread use until the 1950s when a suitable synthetic LT4 preparation gradually supplanted it. The doses employed were 200–400 μg daily.
Although T3 was discovered as the second thyroid hormone in 1952 it was not used to any extent therapeutically as patients seemed content with LT4 alone, long before the demonstration that circulating T3 was largely derived from deiodination of extrathyroidal T4.
The seismic shift in the treatment of hypothyroidism, however, was the result of the development of sensitive assays for TSH which showed that, in order to restore serum TSH to normal, the dose of LT4 required was of the order of 75–150 μg daily. Higher doses caused suppression of TSH consistent with hyperthyroidism. The resultant dose reductions were tolerated by the majority of patients but this was the beginning of significant dissatisfaction with adequacy of the recommended treatment of primary hypothyroidism which remains problematic today. The previously high doses of LT4 would, by the law of mass action, have overcome any impaired D2 activity in affected patients.
Little attention has been given to a study, important in retrospect, which showed that it was difficult to increase serum T3 into the hyperthyroid range with LT4 unless serum free T4 concentrations were markedly elevated at around 35–40 pmol/l. This was an elegant demonstration that exogenous subclinical hyperthyroidism was a different entity from endogenous subclinical hyperthyroidism, even although serum TSH was suppressed in both conditions. In other words, a low serum TSH concentration in patients taking LT4 did not necessarily indicate overtreatment.
In short, what he is saying is that for Levothyroxine to be effective, the patient needs a dosage between 200 and 400 mcg daily. But since the focus of the medical profession had shifted to the TSH, the medical profession has erroneously decided that the TSH has priority over the wellbeing of the patient.....
If your GP agrees that your FT3 is low - and maybe remind your GP that T4 is a pro hormone which has to convert to T3 which is the active hormone which every cell in our bodies need - then ask if he will refer you to an NHS endocrinologist. However, you will need to choose carefully, most endos are diabetes specialists with little to no understanding of thyroid disease and how to treat it.
You can send for the list of thyroid friendly endos - private and NHS - from Dionne at ThyroidUK:
tukadmin@thyroiduk.org
See who you can travel to, ask on the forum if anyone has any experience - good or bad - on Dr So and So - you can name doctors when asking for feedback but all replies must be by private message as we can't discuss individual doctors on the forum.
I'd be nervous about trying it alone and assume my GP would not be amenable to this.
Believe it or not, some endos actually tell their patients to buy T3 on the internet!
Thank you so much. I’ll try that and yes, I already have your list. I saw an endo when first diagnosed but he was little help. I’ve had one recommendation by pm through this site. It’s such a help - thank you.
I am on a gluten free diet but haven't always been very strict about sticking to it. I recently tested negative for coeliac but of course I hadn't been eating gluten so it may be inaccurate.I'm in Ilkley, West Yorkshire. Thanks for your advice.
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