I have been working at improving my vitamins. Last week my resting heart rate was 45 bpm and I have been cold and tired. These are my results from the blood test my doctor ordered.
TSH 0.17 (0.3-5.0)
T3 4.5 (3.1-6.8)
No T4
The doctor had asked me to reduce Levo and also spoken to the Endo who advised the same. I very politely refused and will now have a blood test in April which will include T4.
I have an ECG on Tuesday to look at my low resting heart rate, my BP is also high.
Any thoughts would be gratefully appreciated.
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Thicket
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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 and last dose levothyroxine 24 hours before test
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins
Your result is only 38% of the way through the range. Most of us on this forum with hypothyroidism would need Free T3 to be in the top third or the top quarter of the reference range, or around 60% - 80% of the way through the range.
Some people need their T3 to be over range if they are thyroid hormone resistant.
If your Free T4 was known then you could have a level which was under range, low in range, mid-range, in the upper part of the range, high in range or over the range.
Different combinations of TSH, Free T4 and Free T3 tell you different things about your health.
If you had very high in range or over the range Free T4 with your current level of Free T3 it would imply that you were a poor converter. In that case, optimising nutrients might help to improve your conversion.
If your Free T4 was around 40% of the way through the range or lower, it might mean that your TSH was rather low for your Free T4 and Free T3, suggesting that you might have central hypothyroidism.
There are many other possibilities, depending on what the full set (TSH, Free T4 and Free T3) of results are.
With only two out of three of the usual results required (you have TSH and Free T3, but Free T4 ought to have been done as well) the number of possibilities of how to improve your results and your health becomes quite large, making improving your situation difficult.
Also note that time of day of blood tests being done has an impact on results. It also makes a difference whether you've drunk coffee of eaten food beforehand. It also matters when your previous dose of thyroid hormones were taken.
I found the following results in your last post from 28th July this year.
Folate 4.4(3-18) 9% of the way through the range
Ferritin 57(20-350) 11% of the way through the range
B12 406(200-960) 27% of the way through the range
No vitamin D
None of those results are good, and depending on what you supplement with and how long you keep it up for it could take many months to raise your levels. I had very low in range ferritin and below range serum iron and it took me nearly two years to raise my ferritin to mid-range, by which time my serum iron was in range but low in range.
Regarding Vitamin D, once you have a result you can raise your level with vitamin D3 supplements at a dose you can calculate with this link :
Vitamin B12 - Personally, I always want my B12 at the top of the range up to about 1000, but others go for a level which is 500 (minimum) up to top of range.
Personally, I always use methylcobalamin or a combo supplement of methylcobalamin and adenosylcobalamin. Methylcobalamincan be found easily enough on sites like Amazon.
If fixing your nutrient levels doesn't help much then you will need to find a doctor to prescribe T3 or buy your own online. Please ask for advice on the forum on how to find a seller of T3 (if you go that route) because fake pills do get sold sometimes, and there is always the possibility of scammers who will take your money and send nothing.
I think I have done all I can with my vitamins. I'm hoping my doctor will come to the same conclusion. If not I'm planning to go private and book an appointment with Dr G (edited by admin) in Bristol. She is on the Thyroid UK list. Thank you for your advice. It really does mean a lot.
'Ferritin 57(20-350) 11% of the way through the range'
Bean, what do you mean by this? She's at 50% of where she ought to be.
Approximately. Perhaps target for ferritin is 25 to 30% of the range?
Or 'target: 90 to 120.
(350 for a woman is in danger zone. There would be something wrong at that level. After reading copious amounts of information on haemochromatosis, for a female, mid 200s can be harmful. Men's levels can be higher before it's harmful.)
TBH I can't even imagine how they come up with ranges. One lab here is 5 to 272.
We often get told that X needs to be mid-range or 60% - 80% of the way through the range or whatever. But mid-range and percentages vary according to the range supplied with the test.
If we are told that we need a fixed result for X of 100 then that is fine if the reference range never changes. But for many tests the ranges do change. Having one of the following results tells you different things.
1) Result = 100 Range = 0 - 200 i.e. mid-range
2) Result = 100 Range = 90 - 250 i.e. low in range
3) Result = 100 Range = 60 - 110 i.e. high in range
Clearly if the ranges change it alters the meaning of the actual results.
For vitamin D the range doesn't actually change very much, so saying the optimal result is 100 - 150 nmol/L or 125 nmol/L is fair enough.
For ferritin the general target is variously suggested to be mid-range or a little bit over. Those numbers will change according to the way that the ranges change - and for ferritin the ranges change a lot. Personally, I wouldn't want a ferritin result which was higher than about 75% of the way through the range.
But there are some research papers and websites I've seen that will say ferritin needs to be at least 70, for example, to get rid of restless legs. However, they don't tell you the range that recommendation is based on, so I find such pronouncements to be confusing and unhelpful.
Can’t add to the advice but just to let you know that my pulse is the first thing that tells me my dosage is wrong and needs raising. When my pulse is 69 to 72 I feel well and my blood pressure is perfect. When my pulse drops my blood pressure raises to high. It took me 45 years to find this as I worked with what doctors told me. Now I have private tests each year and keep a diary of how I am including daily blood pressure and pulse and when gp insists he does a blood test and wants to change everything I show him the evidence he is wrong. I only got brave to do this due to this page. Prior to this doctors yo yod with my dosage and I never felt well.
Yes that what the doctors said to me. When dose and cholesterol is correct my blood pressure is average 36 over 70. Brilliant for someone who is 70. When dose is wrong and pulse is down it goes to 158 over 80…….and yes the doctor tries to give blood pressure tablets and not re address the cause.
high blood pressure can ve as simple as low nitric oxide levels, i use L-Arginine to keep nitric oxide levels topped up... Nitric Oxide allows the veins n arteries to relax/become more flexible... hope that helps.
I worked hard increasing meds to get my T3 over six - and now have a body temperature that is around 36 (just over or just below) - before that my temp was 34 for years and pulse really slow.
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