I am due to see my NHS endocrinologist on 26th. I’ve had my blood results and the ranges have changed on TFT’s and a couple of other tests. I’m taking 10mcg Liothyronine (split) and 62mcg Levothyroxine per day. This has confused me and probably will confuse Endo. I am also experiencing more migraines and gastro issues which I am struggling with. I have been gluten free for 4 years. Any help would be very much appreciated.
Thank you
mcdermott
Changes in reference ranges isn't a problem. It's just a matter of maths. You work out what percentage through the range the result is to compare them when the ranges change.
Here is the calculator:
The result goes in the first box, the low end of range goes in the second box, the upper end of range goes in the third box, press OBLICZ to calculate the percentage.
With your current results this works out as follows:
FT4: 11.7 (9-19.1) = 26.73% through range
FT3: 4.7 (2.4-6) = 63.89% through range
Thank you I will compare.Is it possible my worsening migraines could be down to T3? I’ve been on combo since December. They have been more regular in the last few months.
Thank you
Sorry, I don't know about your migraines. T3 has never had that sort of effect on me, but of course we are all different.
Thanks.Do my results look OK?
I’ve read about Hashimoto’s encephalopathy and it seems to fit with me, it’s rare, but wondering if that could be what I have.
Your results are fairly typical of someone on combination hormone replacement; however, it's how you feel that is important. I am combo meds and that level of FT4 would be dreadful for me and I'd be quite unwell, I'm one of those who need both FT4 and FT3 fairly well balanced in the upper part of their ranges.
Have you heard of Hashimoto’s encephalopathy? Thank you
No I haven't, I don't have Hashi's so haven't studied it.
Thanks.
yes . i have read of it , it's encephalitis , but from an autoimmune cause that responds to steroids to fix it... also known as SREAAT (Steroid-Responsive Encephalopathy Associated with Autoimmune Thyroiditis ) ncbi.nlm.nih.gov/pmc/articl...
"Introduction .
Clinical profiles of acute or subacute encephalopathies are variable with diverse etiologies. Most often, the clinical features, laboratory investigations, electroencephalography (EEG), cerebrospinal fluid (CSF) and neuroimaging studies reveal an underlying cause for the encephalopathy. Once the infectious and metabolic causes for encephalopathy are ruled out, an inflammatory or autoimmune cause should be considered. Autoimmune encephalopathy has various forms including that against known pathogenic antigens (e.g.: Voltage-gated potassium channel (VGKC)-complex, N-methy D-aspartate receptor [NMDAR] etc.) and also idiopathic autoimmune encephalopathy responding to steroids termed as Hashimoto encephalopathy (HE) or steroid responsive encephalopathy associated with autoimmune thyroiditis. HE is a rare, autoimmune disease characterized by encephalopathy and elevated antithyroid antibodies in the absence of a central nervous system (CNS) infection, tumor or stroke.[1] HE was postulated to be a distinct disease entity by Brain et al. in 1966.[2] It is a disease of the CNS having a good prognosis if diagnosed and treated early.[3] The clinical symptoms are nonspecific, the onset being acute, subacute or chronic with a variable disease course-self-limiting, progressive or relapsing–remitting.[4] The symptoms can remit spontaneously or after corticosteroids. There are frequently reported misdiagnoses of this disease in the literature.[5] Clinical presentations of HE ranges from amnestic syndrome,[6] seizures including status epilepticus,[7] ataxia,[8] myoclonus[9] and psychiatric manifestations including depression,[10] mania,[11] psychosis and hallucinations.[12,13] This entity has attracted growing attention because it is included in the group of treatable dementias.[14] There are case reports, small series and literature reviews that have made an attempt to characterize further this entity.[15,16,17] Nevertheless, there are many uncertainties that still remain about this condition including its clinical spectrum, laboratory and radiological findings and the significance of quantitative levels of thyroid peroxidase (TPO) antibody. The present study is an attempt to analyse data on a series of patients in whom the diagnosis of HE was made during a 3½ years period.
Subjects and Methods.
This is a retrospective, hospital-based study. The study was approved by the institutional scientific committee and ethics review board. The hospital registry was screened to identify records with a diagnosis of encephalopathy from January 2010 to June 2013. 675 patient records were identified.
The following criteria was used for the diagnosis of HE: (a) Acute or subacute onset of altered mental status (AMS), (b) elevated antithyroid antibodies (c) rapid response in mental status with corticosteroids and (d) absence of structural, infectious or other metabolic factors which could explain the AMS and its response to steroids.[18] The exclusion criteria for the study were (a) Illness attributable to infective/metabolic/toxic/vascular etiology, (b) Illness attributable to structural lesion/traumatic brain injury, (c) postoperative encephalopathy and (d) age of patients <18 years. Out of the 675 patients screened, 29 fulfilled the diagnosis of encephalopathy with high TPO antibody levels (>60 IU/mL). 16 patients were excluded as per the exclusion criteria. 13 patients were found to meet the defined criteria for HE. The case records of the included patients were reviewed in detail. Data on age, gender, clinical presentation, past medical history, medications, antithyroid antibodies levels, brain magnetic resonance imaging (MRI), EEG, CSF analysis, treatment, and outcome were collected ..... cont.."
nhs.uk/conditions/encephali... nhs.uk/conditions/encephalitis/symptoms/
nhs.uk/conditions/encephali... nhs.uk/conditions/encephalitis/causes/
SeasideSusie
Thank you so much for this information!😊
Presumably testing was done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test
Day before test did you split T3 into 3 doses
5mcg waking, 2.5mcg mid afternoon and 2.5mcg approx 8-12 hours before test
Do you always get same brand levothyroxine at each prescription ……which brand
Results suggest you perhaps need dose increase in levothyroxine to improve low Ft4
Suggest you try increasing to 75mcg daily
Retest in 6-8 weeks
Headaches and gastro issues (low stomach acid) both suggests under medicated
Calcium is on low side ….frequently due to low vitamin D
What vitamin supplements are you currently taking
When were vitamin D, folate, ferritin and and B12 last tested
Yes to first 4 questions.I was on 75mcg but results were high so came down to 62mcg.
I can’t take any more of either, I have tried and palps are worse with chest pain sometimes, especially with worsening migraines. I take vitamin D with K all through winter and spring but ease of in summer as results are all good.
Thank you
What were Ft4 and Ft3 results when on 75mcg
When were vitamin levels last tested
FT4 18.8 pmol/L (10.0 - 20.0)FT3 5.5 pmol/L (3.5 -6.5)
Vitamin D tested December 107 nmol/L (50 - 200.0)
Others were April last year.
B12 887 ng/L (190.0 - 800.0)
Ferritin 205ug/L (12.0 - 300.0)
Folate 17.6 ug/L (3.0 - 17.0)
Cholesterol has been high long time between 7.2 and 8.1
Thank you
So Ft4 has dropped considerably, suggest you retry increasing levothyroxine
Personally I find it better to split levothyroxine into 2 doses …..
Perhaps trying 50mcg at bedtime and 25mcg early waking
My T4 went up to 21.7 (10 - 20) on 75 though. Over range.
But Ft4 might not go high this time …..things change over time
Possibly your metabolism is picking up …..a little
I have Hashimoto’s though, so it’s difficult with fluctuations. Slightest increase can mean out of range.Thank you
Are you still on strictly gluten free diet
Have you tried dairy/lactose free diet
Yes GF for 4 years but it’s never made any difference. I have lacto free milk but I do have yoghurts. I really would find it difficult excluding all dairy.
I agree dairy free is harder …I tried it….made no apparent difference.
But gluten free was/continues to be a revelation
GF has made no difference for me.
Blood results with ranges
Help interpreting blood results (With Ranges this time!)
Results with ranges
b12 ranges
Help with understanding results and ranges please 
