Can I have some help with test results please

[Piglet1956]

I have Hashis and I've just received blood results from GP following an increase in Levothyroxine from 75 to 100 just 8 weeks ago. Despite being told I could only have TSH and T4 measured the results have come back with T3 as follows -

TSH 0.10 (Range 0.35-5.00)

FreeT4 16.3 (Range 9-21) 60.83% through range

Free T3 3.8 (Range 3.0-6.0) 26.67% through range

Tests were taken at 8:53am and 24 hours after last Levo dose.

Despite TSH being low, T3 is not great and T4 could also be better - am I understanding that correctly?

I have a private blood test organised for Monday morning and I should get vitamin and minerals results in it.

Thanks everyone in advance.

[SlowDragon Administrator]

Which brand of levothyroxine are you currently taking

Do you always get same brand

Previous post showed good vitamin D and ferritin

But you need B12 and folate tested.

What vitamin supplements are you currently taking

[Piglet1956 in reply to SlowDragon]

I’m currently taking two 50 tabs of TEVA and have been since increased two months ago. Before that, 75 was a mix of Mercury (25) and ALMUS (50). I was supplementing B12, Iron and Vitamin D but stopped B12 and Iron 12 days before the test.

[SlowDragon Administrator in reply to Piglet1956]

Teva upsets many, many people

Many patients do NOT get on well with Teva brand of Levothyroxine. Teva contains mannitol as a filler, which seems to be possible cause of problems.

Teva is the only brand that makes 75mcg tablet. So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half

But for some people (usually if lactose intolerant, Teva is by far the best option)

Teva or Aristo are the only lactose free tablets

Most easily available (and often most easily tolerated) are Mercury Pharma or Accord

Accord is also boxed as Almus via Boots, and Northstar 50mcg and 100mcg via Lloyds ....but doesn’t make 25mcg tablets

beware 25mcg Northstar is Teva

List of different brands available in U.K.

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

Teva poll

healthunlocked.com/thyroidu...

Once you find a brand that suits you, best to make sure to only get that one at each prescription.

Watch out for brand change when dose is increased or at repeat prescription.

New guidelines for GP if you find it difficult/impossible to change brands

healthunlocked.com/thyroidu...

academic.oup.com/jcem/artic...

Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).

Levothyroxine is an extremely fussy hormone and should always be taken on an empty stomach and then nothing apart from water for at least an hour after

Many people take Levothyroxine soon after waking, but it may be more convenient and perhaps more effective taken at bedtime

verywellhealth.com/best-tim...

No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.

Some like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away

(Time gap doesn't apply to Vitamin D mouth spray)

If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test

If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal

REMEMBER.....very important....stop taking any supplements that contain biotin a week before ALL BLOOD TESTS as biotin can falsely affect test results - eg vitamin B complex

[SlowDragon Administrator]

Are you still on keto diet. This can lower conversion of Ft4 to ft3

Are you gluten free?

[Piglet1956 in reply to SlowDragon]

I’ve been on holiday for the past fortnight so didn’t do Keto as it’s just too hard when away from home. However I am alway gluten free. I am back on the keto wagon today

[Piglet1956 in reply to SlowDragon]

Thank you SlowDragonThat’s interesting that keto can lower conversion rates. I will investigate further.

[fuchsia-pink]

Despite TSH being low, T3 is not great and T4 could also be better - am I understanding that correctly?

Yes!

How do you feel? If not tip-top, ideally you'd get a levo increase of 25 mcg a day to boost both. Your GP may hesitate, on the basis of the low TSH - but you really need free T3 to be higher than this. You aren't converting brilliantly well, so if you're nutrients are good, I suspect you will also need to start discussing a referral to an endo and a trial of T3 meds, unless a levo boost and any imrpovements to nutrients gets you to where you need to be ...

It can take a while to get a referral so may be worth getting your ducks in a row, starting with the list of T3-friendly endos from Dionne at Thyroid UK - [e-mail] - and a new post asking for recommendations near-ish to you. You don't need to see the nearest person but must obv be reasonably convenient. Good luck x

[Piglet1956 in reply to fuchsia-pink]

Thank you fuchsia pink. I think I will wait till I get results for the private test before knocking on my GPs door for an endo referral.

[fuchsia-pink in reply to Piglet1956]

Absolutely

And best not to start talking about endo referrals until you've done your research and know who you want to see - it doesn't have to be the nearest person, and you want someone who's going to be helpful!

[pennyannie]

Hello Piglet :

The accepted conversion ratio when on T4 - Levothyroine only medication is 1 / 3.50 - 4.50 with most people preferring to come in at around 4 or under.

To find your conversion ratio you simply divide your T3 into your T4 and I'm getting 4.29 showing your convesion slightly outside where you'll likely feel better.

Your conversion can be compromised by low vitamins and minerals so it might be worth knowing where your ferritin, folate, B12 and vitamin D are, as these need to be maintained at optimal levels for optimal use of T4 - Levothyroxine thyroid hormone replacement.

Obviously having Hashimoto's throws a spanner or two in the works, and read many people following the work of Dr Izabella Wentz as healing the gut seems a first step, along with looking at food intolerances, so to help reduce inflammation, which again can compromise conversion of T4 into T3.

With Hashimoto's, over time, from further autoimmune attacks, your thyroid hormone production becomes even more reduced as the gland is further damaged and you may well then need to consider full thyroid hormone replacement to replace the dying glands function.

Since your T4 is only around 60% through the range there is room for a dose increase and this should convert proportionately to a higher T3 but considering your TSH is under the range you may have trouble obtaining an increase in T4 medication.

The TSH was originally introduced as a diagnostic tool to help confirm a diagnosis of hypothyroidism. It was never intended to be used once the patient was on any form of thyroid hormone replacement, but sadly, we seem to find more and more medics dosing and monitoring on just a TSH blood test result which is a totally unreliable measure of anything once on medication.

Ideally you should be dosed and monitored on your T3 and T4 blood test results and most people feel at their best when their T4 is up in the top quadrant of the range at around 75% with a T3 coming in at around 60% and with optimal vitamins and minerals supporting body conversion of the medication.

[Piglet1956]

Thank you for your reply Pennyannie. I will know more about the vitamin and mineral levels when I get the results of the private test, hopefully towards the end of this coming week.