Following up to a previous post on 7.8.21 - I have just received a copy of my most recent blood test (3.8.21) which includes T3 if someone can advise (requested by me). I had been told by a sympathetic GP a couple of years ago that my T4 to T3 conversion is poor and I wanted to pursue this with my GP and get a referral. Do these blood tests show this? I am totally new to this so do not know how to interpret and feeling a bit nervous about it also.
3.8.21
Serum free T3 level 4.4. range 3.10-6.80pmol/L
Serum TSH level 2.8. range 0.30-4.20mu/L
Serum free T4 level 22.6 pmol/L range 12.00-22.00pmol/L (this is marked in red on the test)
My previous blood tests sent on request:
6.7.21
TSH level 11.7 range 0.30-4.20mu/L
Serum free T4 level 16.6 range 12.00-22.00
2.2.21
Serum TSH level 6.3. range 0.30-4.20
Free T4 17.5 range 12.00-22.00
15.1.21
Serum TSH 26.5 range 0.30-4.20
Serum Free T4 level 1 range 12.00-22.00
On this last blood test there is also something in red - GFR calculated abbreviated MDRD - (IH) - Abnormal - No action I have no idea what this is but may not be thyroid related. Any ideas.
83 range 90.00-9999.00ml/Lmin.
As a result of my tests (excluding the most recent one) - the GP has increased Levothyroxine to 100 and then to 150 mg most recently. I could not tolerate the latter and made me feel very ill and possibly hyperthyroid (extreme fatigue, brain fog, diarrhoea, hot sweats). Following my previous post I decreased this myself to now 100 and feel much better. (But note the most recent blood test was done while I was on 150mg)
Thanking everyone in advance for advice so that I am also in a better position to argue my case with GP and get any necessary referrals and also try to start to take control over my own health if possible.
Written by
pebblesh
To view profiles and participate in discussions please or .
GP should have only increased levothyroxine by MAXIMUM of 25mcg ….but you might need even less than that …perhaps an extra 12.5mcg
Test results are pretty meaningless unless done after 6-8 weeks on constant unchanging dose and brand of levothyroxine
Request GP test TPo and TG thyroid antibodies if not been tested
This is to confirm autoimmune thyroid disease also called Hashimoto’s diagnosed by high thyroid antibodies. About 90% of primary hypothyroidism is autoimmune thyroid disease
Also request/insist on testing vitamin D, folate, ferritin and B12
For good conversion of Ft4 to Ft3 we need GOOD vitamin levels
What’s your diet like
Are you vegetarian or vegan
Always test as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test
Aiming for both Ft4 and Ft3 approx 60% through range
Currently Ft3 only 35% through range
Ft4 over range
Helpful calculator for working out percentage through range
You need FULL thyroid and vitamin testing done 6-8 weeks after constant unchanging dose and brand of levothyroxine
Likely to need to test privately to make progress
For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested.
Also EXTREMELY important to test vitamin D, folate, ferritin and B12
Low vitamin levels are extremely common, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)
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 .
Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
Is this how you do your tests?
Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins
If TPO or TG thyroid antibodies are high this is usually due to Hashimoto’s (commonly known in UK as autoimmune thyroid disease).
About 90% of all primary hypothyroidism in Uk is due to Hashimoto’s. Low vitamin levels are particularly common with Hashimoto’s. Gluten intolerance is often a hidden issue to.
I requested the new test to include Ft3 on 3.8.21 as I was feeling so poorly since the increased dose and they had not tested before. I had been on 150 mg since 16th July.
14 January 2021 - 100 mg
Increased to 125 mg on 2nd February
NHS - Endocrinologist advised on 24.2.21 following their separate blood test to decrease to 100 mg
GP increased this to 125 mg 24.5.21 after blood test ? (this blood test does not seem to be on the list I have been given)
GP increased again to 150 mg on 6.7.21 after blood test
I think mostly blood tests were done after 6-8 weeks - except for most recent one.
I am not vegan or vegetarian - but would not say that my diet is optimal. I am trying to find out more about what I should be eating on this forum and others.
I will ask for antibodies test and vitamins etc - I think perhaps my best option may be to get a private test done at this stage. (I notice that a TPO antibodies test in Jan 2019 - only time this was done was abrnomal - thyroid peroxidase antibodies lev - 458 range 0.00-34. Also at same time Vit D abnormal 23 - range 50-250)
If my T3 is only 35% and T4 too high - does this not indicate that there may be a conversion issue that will need to be investigated further. This is the first T3 test I have had done.
TPO antibodies test in Jan 2019 only time this was done was abrnomal
thyroid peroxidase antibodies lev - 458 range 0.00-34.
So high thyroid antibodies confirms autoimmune thyroid disease also called Hashimoto’s diagnosed by high thyroid antibodies
No need to retest
About 90% of primary hypothyroidism is autoimmune thyroid disease
Technically it’s Hashimoto's (with goitre) or Ord’s thyroiditis (no goitre). Both variants are autoimmune and more commonly just called Hashimoto’s
Hashimoto's frequently affects the gut and leads to low stomach acid and then low vitamin levels
Low vitamin levels affect Thyroid hormone working
Essential to maintain OPTIMAL vitamin levels
Poor gut function with Hashimoto’s can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common.
According to Izabella Wentz the Thyroid Pharmacist approx 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
Before considering trial on gluten free diet get coeliac blood test done FIRST just to rule it out
If you test positive for coeliac, will need to remain on gluten rich diet until endoscopy (officially 6 weeks wait)
If result is negative can consider trialing strictly gluten free diet for 3-6 months. Likely to see benefits. Can take many months for brain fog to lift.
If no obvious improvement, reintroduce gluten 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.
Eliminate Gluten. Even if you don’t have Hashimoto’s. Even if you have “no adverse reactions”. Eliminate gluten. There are no universal rules except this one.
I am trying to find out more about what I should be eating on this forum and others.
There's nothing that you SHOULD be eating, apart from a balanced diet including plenty of protein and fresh fruit and veg; good fats; some carbs; not too much fibre, and adequate salt.
What you SHOULD NOT eat is all forms of unfermented soy (soy flour, soy oil, soy protein, etc.); processed seed oils; artificial sweeteners. And processed foods because they contain all of those things!
If my T3 is only 35% and T4 too high - does this not indicate that there may be a conversion issue that will need to be investigated further. This is the first T3 test I have had done.
Things that help improve poor conversion
Optimal vitamin levels
So it’s essential to test vitamin D twice year when supplementing
Test folate, ferritin and B12 at least annually
Same brand levothyroxine at each prescription often necessary
Thank you for your replies - a lot to take in. Seems that the indication is from what you say I have Hashimotos. I was on D Hux D3 500 mcg for some months after those test results - but I am not now and have not had follow up test on this.
Just to add the accepted conversion ratio when taking T4 - Levothyroxine only is said to be :-
1 / 3.50 - 4.50 - T3/T4 and most of us feel at or best when our conversion is around 4 or under:
So to find your conversion ratio you simply divide your T3 into your T4 and I'm getting your at 5.10 so wide from the centre and going out showing impaired conversion of the T4 :
T4 is a storage hormone and needs to be converted by your body into T3 the active hormone that runs the body and is said to be around 4 times more powerful than T4.
Your own ability to convert the T4 into T3 can be be compromised by low vitamins and minerals and it is essential that ferritin, folate, B12 and vitamin D are maintained t optimal levels. These core strength vitamins and mineral may well be in the NHS ranges but not high enough to help you convert the Levothyroxine and you may well find you will need to supplement these yourself.
Have you had your thyroid antibodies tested, as it's important to if the cause of your hypothyroidism is auto immune as then other factors need to be considered.
Thank you for your reply and advice re conversion ratio. It gives me an indication when speaking to my Doctor I saw on my history of blood tests that TPO antibodies test in Jan 2019 says it was abnormal - thyroid peroxidase antibodies lev - 458 range 0.00-34. Slow dragon in their reply indicates that this points towards Hashimotos.
So with Hashimoto's it's quite likely that you will need to look at repairing your gut as there's a tendency to have food intolerance to such things as gluten, dairy, wheat, etc.
You might like read up on the work of Dr Izabella Wentz who has this auto immune disease and found once she identified her " food triggers " and " healed her gut " the thyroid hormone replacement worked more effectively.
The mainstream medical do not really have any answers regarding AI thyroid diseases so you will need to become your own best advocate and learn what you can do to help yourself regarding life style choices.
"On this last blood test there is also something in red - GFR calculated abbreviated MDRD - (IH) - Abnormal - No action I have no idea what this is but may not be thyroid related. Any ideas.
83 range 90.00-9999.00ml/Lmin."
This is a kidney function test. A 30-40yr old is likely to have a GFR of 107 mL/min, a 60-70yr old around 85.
A single test of 83 is not usually of any concern, and could be as simple as that you were a bit dehydrated when having the test. Some meds can cause a drop in GFR/low blood pressure/strenuous exercise the day before/eating lots of protein.
I think that the suggestion would be to ask your GP to re-test in a couple of months, and certainly keep an eye on it, because your GP may not. I've seen lots of posts on the kidney forum where people haven't been told until their GFR drops below 60 (and often lower than that), then they've obtained past results, realised that there had been a downward trend and felt that if they had been informed they would have been able to slow the descent (which a lot of people do very effectively).
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
Blood test interpretation help
Help to interpret bloods please?
Could somebody help me to interpret my blood test results?
Glucose and Cortisol Blood test interpretation help needed please!
