New Blood results

[Baggieswidow]

Hi, I posted a while ago asking about my results as my TSH was suppressed but both my T3 and T4 were low. My Endo said I would end up with osteoarthritis and lowered my levothyroxine to 75 from 100 and my Liothyronine has remained at 20 per day. My blood results now indicate my T3 as normal, T4 as 10 and TSH as 10. I’m trying to get a print out but these last months I have felt exhausted and cannot control my temperature. Please can you tell me what this indicates as I now have to contact my Endo.

[greygoose]

Your endo is an idiot. Low TSH does not cause osteoporosis. I certainly don't think it causes osteoarthritis. And if you take T3, your TSH is going to be low. Did this endo prescribe it for you? He doesn't even seem to know what he's prescribing!

My blood results now indicate my T3 as normal, T4 as 10 and TSH as 10

First of all, there's no such thing as 'normal' where thyroid is concerned. When a doctor says 'normal', he just means 'in-range'. Which doesn't mean very much. Do you have the exact numbers? Or are you just taking your endo's word for it? Do you have a range for that FT4 because 10 appears very low, but we can't tell without the range because ranges vary from lab to lab.

As for that TSH, I find that very suspicious... Just reducing the levo by 25 mcg, whilst still taking T3, is unlikely to make the TSH jump from suppressed to 10. Do you have Hashi's? Or do you take biotin? In a B complex perhaps. Are your blood tests always done at the same lab?

I don't think this endo is doing you any good. Any chance you could see someone else?

[Baggieswidow in reply to greygoose]

Hi, I have now managed to get the results emailed to me, I did follow the instructions on the site prior to the blood test, see below19-Aug-2021

Serum free T3 level - (NEM) - Normal

4.4

pmol/L

4.00 - 6.80pmol/L

19-Aug-2021

! Serum free T4 level - (NEM) - TSH <0.05 & T4 = 10.0

10

pmol/L

12.00 - 22.00pmol/L

19-Aug-2021

! Serum TSH level - (NEM) - TSH <0.05 & T4 = 10.0

<0.05

miu/L

0.30 - 4.20miu/L

Request states: On thyroid replacement. Results

suggest patient may be over replaced. Thyroid

hormones take 6-8 weeks to reach steady-state

after a change in dose.

FT3 added

[greygoose in reply to Baggieswidow]

So it's your FT4 that is 10, not your TSH. Your TSH is 0.05, which is perfectly normal when taking 20 mcg T3.

But, if the bottom of the FT3 range is 4, then your FT3 at 4.4 is very far from 'normal' - which just means 'in-range', anyway - which is amazing on 20 mcg T3. Do you always take your T3 on an empty stomach, leaving at least one hour before eating, etc., just like you would with levo? If so, you would seem not to be absorbing it.

Although, I'm not sure I've got that right because your results are very difficult to read, the way you've written them.

[SlowDragon Administrator]

ALWAYS get printed copies of your blood test results

Sounds highly unlikely TSH is 10

Obviously need ranges on Ft4 and Ft3 results

And “normal “ is not a result

You are legally entitled to printed copies of your blood test results and ranges.

The best way to get access to current and historic blood test results is to register for online access to your medical record and blood test results

UK GP practices are supposed to offer everyone online access for blood test results. Ring and ask if this is available and apply to do so if possible, if it is you may need "enhanced access" to see blood results.

Link re access

healthunlocked.com/thyroidu...

In reality many GP surgeries do not have blood test results online yet

Alternatively ring receptionist and request printed copies of results. Allow couple of days and then go and pick up.

Important to see exactly what has been tested and equally important what hasn’t been tested yet

Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine

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

What vitamin supplements are you currently taking

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).

How much T3 are you currently taking

Do you normally split the dose

Day before test split dose of T3 into 3 smaller doses, taking at approx 8 hour intervals, with last dose 8-12 hours before test

Is this how you did your test?

[Baggieswidow in reply to SlowDragon]

Hi, I have now managed to get the results emailed to me, I did follow the instructions on the site prior to the blood test, see below19-Aug-2021

Serum free T3 level - (NEM) - Normal

4.4

pmol/L

4.00 - 6.80pmol/L

19-Aug-2021

! Serum free T4 level - (NEM) - TSH <0.05 & T4 = 10.0

10

pmol/L

12.00 - 22.00pmol/L

19-Aug-2021

! Serum TSH level - (NEM) - TSH <0.05 & T4 = 10.0

<0.05

miu/L

0.30 - 4.20miu/L

Request states: On thyroid replacement. Results

suggest patient may be over replaced. Thyroid

hormones take 6-8 weeks to reach steady-state

after a change in dose.

FT3 added

[SlowDragon Administrator in reply to Baggieswidow]

So you’re on levothyroxine plus T3 extremely common that TSH is suppressed

TSH <0.05

Ft4 10.0 (12.00 - 22.00)

FT3 4.4. (4.00 - 6.80)

Was this test done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

Do you normally split the T3 dose?

Day before blood test split dose of T3 into 3 smaller doses, taking at approx 8 hour intervals, with last 5mcg T3 dose 8-12 hours before test

Most people when adequately treated on levothyroxine plus T3 will have Ft4 and Ft3 roughly 50-60% through range

Your Ft4 is below range, suggesting you need dose increase in levothyroxine

[Baggieswidow in reply to SlowDragon]

Hi, yes my test was early and I did what is suggested. I was on 100 Levothyroxine but the Endo reduced it to 75 at the beginning of June because of my suppressed TSH. My Liothyronine stayed the same at 20 which is split into 10 in the morning and 10 at night. My previous results showed an iron deficiency and low Vitamin D so I have been taking a good quality vitamin tablet. I’m just fed up of feeling so tired, I have put on weight and I sweat uncontrollably when it’s hot, it’s so embarrassing. Surely I can get back to normality, I sometimes wish they had never removed my thyroid ☹️

[SlowDragon Administrator in reply to Baggieswidow]

So many endocrinologist freak out at low TSH

Dose levothyroxine was reduced incorrectly

You’re under medicated and need 25mcg dose increase in levothyroxine

[pennyannie]

Hello again :

I seriously don't know what to say as I can't quite believe what you have written !

The TSH is shouting out for more medication - though in all honesty after a thyroidectomy this is the least important of the 3 blood tests.

Your T4 is likely under range :

The most important result is that of T3 and I don't have a number and I have no idea what constitutes " normal " ?

We tend to feel at our best when both the T3 and T4 are in range and since you are on a T3/T4 combo both these vital hormones needing to be up around 50% through their ranges.

Have you managed to start supplementing your core strength vitamins and minerals ?

I read that ferritin needs to be at least 70 for optimum thyroid hormone conversion.

I know I feel at my best with a ferritin at around 100 : folate 20 : active B12 70 + ( serum B12 500 + ) and vitamin D at around 100 and from memory I think you had at least ferritin and vitamin D under range when I last replied to you.

Is there an option to see a different endocrinologist though I know s/he has supported your T3 prescription and that you have had upset with your surgery maintaining your medication.

You have a clinical need for T3 - Liothyronine and am sure another endocrinologists will concur and maybe even reinstate your original level if that is where you felt better.

[Baggieswidow in reply to pennyannie]

Hi, I have now managed to get the results emailed to me, I did follow the instructions on the site prior to the blood test, see below19-Aug-2021

Serum free T3 level - (NEM) - Normal

4.4

pmol/L

4.00 - 6.80pmol/L

19-Aug-2021

! Serum free T4 level - (NEM) - TSH <0.05 & T4 = 10.0

10

pmol/L

12.00 - 22.00pmol/L

19-Aug-2021

! Serum TSH level - (NEM) - TSH <0.05 & T4 = 10.0

<0.05

miu/L

0.30 - 4.20miu/L

Request states: On thyroid replacement. Results

suggest patient may be over replaced. Thyroid

hormones take 6-8 weeks to reach steady-state

after a change in dose.

FT3 added

[pennyannie in reply to Baggieswidow]

Hey there :

So, anyway, this gives you a T3 of 4.4 in a range of 4-6.80 - so it is said to be normal as it is

in the range - BUT - it is just 4 points and just 14% through the range not high enough :

Your T4 is 10 in a range of 12-22 - so under the range and NOT normal :

Your TSH is 0.05 and UNDER the range and the LEAST important result as previously

explained BUT the only one being looked at and which these stupid comments refer to :

So your TSH is not 10 -but suppressed and low in range and that is OK and being on T3 tends to lower the TSH anyway and the TSH is not as important as the T3 and T4 levels.

As previously explained you must be dosed and monitored on your T3 and T4 blood test results which need increasing as we generally feel better when both T3 and T4 are both in the ranges and towards middle / top quadrant.

Can you see different doctor, or your doctor, and ask him/her to fully explain this blood test to you and do you feel better able to understand this content and that you need both T3 and T4 in the ranges, balanced at around 50% through :

I'm afraid this endocrinologist hasn't looked at the detail and simply read this stupid dogma about the TSH level which is based on the assumption that there has been no medical intervention and you still have a fully functioning working thyroid :

These comments are totally irrelevant in your case, you have had your thyroid surgically removed and your HPT axis can't be relied on and neither can the TSH or these ill thought out and limited comments.

[Baggieswidow in reply to pennyannie]

Thank you for explaining, I’ve asked for the Endo to call me but I’m going to call again Tuesday and keep on at them until they sort it out, I’m fed up of feeling rubbish and just having to put up with it.

[Baggiesfan]

Hi Baggieswidow, your name caught my attention when I was looking for suppressed tsh, low T3 and T4, maybe we're from same area. How are you getting on? My numbers are similar and my private endo has stopped my T3 as I'm struggling with ectopic beats. Levo now back to same as it was before I started T3 six months ago. Interested to hear what you're taking now as I feel rubbish too and tired of getting nowhere. Hope you're feeling better x

[Baggieswidow]

Hi, my Endo said to try stopping the T3 and increase my levothyroxine from 100 to 150. My results came back with my T3 just in range and my T4 at 16 however my TSH was even more suppressed. Also I started to get palpitations and my blood pressure went up and I put on weight again, I generally felt worse. I am now back on my T3, I feel better already but in 6 months time, I am going to try removing the T3 again and take 125 of levothyroxine. My Endo is just concerned that constantly having a suppressed TSH will result in osteoporosis. I think if this doesn’t work he may do more tests, I’ve already had the pituitary gland tests which didn’t reveal much. I think I am lucky to have an Endo that supports the use of T3 because when my doctors wanted to stop it he challenged it for me and it was reinstated.