No T4 given ???

[spinela7]

I have Hashimoto but I went Hyper it has taken me ages to get it lowered slowly.The blood test 2 days ago was 8weeks last test. On this occasion only TSH was taken ??? . The result was 0.91 is this still hyper I know my body likes a much lower level.I am having problems with my BP had a monitor on for 72 hours came off 2 days ago.I have put being Hyper to have caused my BP problems my GP said thyroid has nothing to do with your BP. I was talking to nurse on the 111 and she felt my thyroid was probably the cause.Can anyone enlighten me on the results please. Thank you.

[SeasideSusie Remembering]

spinela7

The result was 0.91 is this still hyper

Hopefully you have the reference range that goes with this result. TSH ranges are often something like 0.27-4.2 or 0.35-5.5 or something very similar. Whatever your range is I believe you are within the range, not below it.

However, testing TSH on it's own is inadequate, it's not a thyroid hormone, it's a pituitary hormone. The thyroid hormones are FT4 and FT3 and it's essential to get the full picture by also doing these tests and it's the FT3 in particular which tells you if you are "hyper".

With Hashi's it's a "false" hyper anyway, swings from hypo to false hyper are normal with Hashi's. When the immune system attacks the thyroid, it releases a lot of hormone into the blood stream and this increases the FT4 and FT3 to way over range and the TSH lowers, often goes suppressed. So it's the FT4/FT3 that you need to know to see if you are still in a false hyper stage.

[spinela7 in reply to SeasideSusie]

Thank you for replying. My T4 months ago when this started was 22.6 (12.00-22.00)pmol my TSH was 0.25 (0.27- 4.20) I have not seen T4 again being taken. So my 0.91 TSH (0.27-4.20). The T3 was not there.

[SeasideSusie Remembering in reply to spinela7]

spinela7

My T4 months ago when this started was 22.6 (12.00-22.00)pmol my TSH was 0.25 (0.27- 4.20)

Those are not the results of a false hyper swing. Who said you were "hyper"?

If anything they suggest maybe:

1) You took your Levo too close to the blood test or

2) You take a biotin supplement or a B Complex and didn't leave this off for a few days before the test (biotin can give false results) or

3) You may be a smidge over medicated but that would depend on where your FT3 lies within or out of it's range. You may need an over range FT4 to achieve a reasonable FT3 level. It's so important to test all three to assess thyroid status.

Testing TSH alone doesn't tell us anything. If GP wont test all 3 then this is why many members resort to private tests, the cheapest of which for the basic 3 tests is MonitorMyHealth which is an NHS lab which offers the test to the general public (home fingerprick test) for £26.10 with discount code here:

thyroiduk.org/help-and-supp...

How much Levo do you take?

Do you always do your test as we advise:

* Blood draw no later than 9am. This is because TSH is highest early morning and lowers throughout the day. If looking for a diagnosis of hypothyroidism, an increase in dose of Levo or to avoid a reduction then we need the highest possible TSH

* Nothing to eat or drink except water before the blood draw. This is because eating can lower TSH and coffee can affect TSH.

* If taking thyroid hormone replacement, last dose of Levo should be 24 hours before blood draw, if taking NDT or T3 then last dose should be 8-12 hours before blood draw. Adjust timing the day before if necessary. This avoids measuring hormone levels at their peak after ingestion of hormone replacement. Take your thyroid meds after the blood draw. Taking your dose too close to the blood draw will give false high results, leaving any longer gap will give false low results.

* If you take Biotin or a B Complex containing Biotin (B7), leave this off for 7 days before any blood test. This is because if Biotin is used in the testing procedure it can give false results (most labs use biotin).

These are patient to patient tips which we don't discuss with phlebotomists or doctors.

[spinela7 in reply to SeasideSusie]

Hi SeasideSusie I have to say everything you have mentioned I already comply to. I take my thyroxin at night which my Endo agreed with. Thank you for replying

[SeasideSusie Remembering in reply to spinela7]

spinela7

Taking Levo at night is fine, it suits many members. But did you adjust the timing the day before the test so that last dose was 24 hours before blood draw? If not then this explains the slightly over range FT4.

When Levo is taken at night, we advise the following, using a Monday blood test as an example:

1) Delay Saturday night's Levo dose until Sunday morning, timing it to be 24 hours before the time of the test on Monday.

2) Do test Monday morning.

3) Take Levo immediately after test (this will be Sunday night's dose).

4) Take Monday night's dose as normal.

Just adjusting timing for the one day gives an accurate measure of the normal circulating hormone. Most endos wont know and wont necessarily agree, some endos advise this as well as we members here.

But who said you were hyper originally?

Your new TSH of 0.91 definitely doesn't suggest hyper but as I said it's the FT3 which is the most important result.

[spinela7 in reply to SeasideSusie]

I had talked to my Endo via phone call I don’t know what my FT4 was then but he said to reduce slowly which I did. The FT4 I gave you was one of the early tests at 6weeks. I didn’t get to see results only told still a bit high by text message. My FT3 never see it really but when I have seen the result is always above half way I think it’s where it should be. I am happy to see the TSH down as the last one was 2.90. The results are normal they say but for me I feel more comfortable a lot lower than 0.91.Many thanks for all the information you are a wealth of knowledge much appreciated.

[spinela7 in reply to spinela7]

I did not realise about B Complex or about NHS lab thanking you again.

[spinela7 in reply to SeasideSusie]

I did not realise about B complex or NHS Lab thanking you.

[SlowDragon Administrator in reply to spinela7]

These results did not suggest hyperthyroid at all Very possibly a tiny bit over medicated….but ONLY if Ft3 was over range

Never agree to dose reduction based on just testing TSH and Ft4

Bloods should be retested 24 hours after last dose levothyroxine

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

How much has levothyroxine been reduced since then ?

When were vitamin levels last tested

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.

Very 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)

Low vitamin levels common as we get older too

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

List of private testing options

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code

thyroiduk.org/getting-a-dia...

monitormyhealth.org.uk/

NHS easy postal kit vitamin D test £29 via

vitamindtest.org.uk

[spinela7 in reply to SlowDragon]

Thank you for replying really nice of you also.You can ask but rare indeed to get FT4 and even rarer to see FT3 done. I will take your advice and do the NHS blood test. So far instead of 100mg then 125mg alternate days I now choose four odd days for 75mg.So its 100mg daily 3 days and 4 days will be 75mg. Thanking you for your help and all the information .Take care

[tattybogle]

" my GP said thyroid has nothing to do with your BP."

.. your GP obviously need to do some more reading ... he could start with this (article in GPOnline from 2010 , written by specialist registrar's in Cardiology and Endocrinology)

healthunlocked.com/thyroidu....

[spinela7 in reply to tattybogle]

Thank you for replying. He is not my GP but was the one I was given that day. Scary really.

[tattybogle in reply to spinela7]

Further evidence to contradict that GP's comment "thyroid has nothing to do with your BP"onlinelibrary.wiley.com/doi...

"Thyroid hormones regulate both cardiovascular and renal mechanisms underlying hypertension"

Stanislovas S. Jankauskas PhD,Marco B. Morelli PhD,Jessica Gambardella PhD,Angela Lombardi PhD,Gaetano Santulli MD, PhD,

First published: 29 December 2020

"3.4 Clinical evidence

Hypothyroidism is widely recognized as a cause of secondary hypertension. In 1878, Ord described .......... "

goes on to discuss hyper /hypo/ BP in great detail.

Study Posted by Helvella here : healthunlocked.com/thyroidu...