Advice please re comments from Blue Horizon

[Middleagedandtired]

Hello I post the lower post and picture some four months ago and got good advice but nothing from my Dr . What I failed to post here was this piece from Blue Horizon Dr commenting on my results .

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THE THYROID STIMULATING HORMONE (TSH) LEVEL IS LOW, WHICH IS NORMALLY SUGGESTIVE OF HYPERTHYROIDISM (OVERACTIVE THYROID GLAND). HOWEVER, THE FREE T4 AND T3 LEVELS ARE ALSO LOW, WHICH RAISES THE POSSIBILITY OF HYPOPITUITARISM (UNDERACTIVE PITUITARY GLAND, WHICH WOULD LEAD TO AN UNDERACTIVE THYROID GLAND INSTEAD) - FURTHER TESTING WOULD BE ADVISABLE IF THIS IS SUSPECTED. IN THOSE TAKING THE T3 FORM OF THYROXINE (LIOTHYRONINE), THYROID FUNCTION TESTS SOMETIMES YIELD CONFUSING RESULTS. IF THIS APPLIES TO YOU, IT IS FEASIBLE THAT YOU ARE TAKING INSUFFICIENT MEDICATION. WHATEVER THE SCENARIO, IT WOULD BE A GOOD IDEA TO DISCUSS THESE RESULTS WITH YOUR USUAL DOCTOR AT YOUR EARLIEST CONVENIENCE.

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I have been feeling unwell for years ( fatigued depressed overeating very bad brain fog on top of my Arthritis pains my usual sleep issues ) so decided to stop all the vitamins etc and have bloods checked . I stopped everything including self medicated T3(1/4 of 25ug tablet ) .Previous bloods were taken incorrectly by myself giving false readings as can be seen from my earlier posts .Blood was supplied 0950 hrs and 24 hrs after last Thyroxine .I take 75mg as was told to reduce from 100 as TSH high by Dr. I continued with my psoriatic arthritis meds of Secukinumab and Methotrexate.Also continued with Folate I purchase as stopped using the synthetic folic . I see B12 is high , I was supplementing with recommended dose hoping to help with the fatigue , but stopped that along with all the other stuff .

[SlowDragon Administrator]

I stopped everything including self medicated T3(1/4 of 25ug tablet ) .Previous bloods were taken incorrectly by myself giving false readings as can be seen from my earlier posts .Blood was supplied 0950 hrs and 24 hrs after last Thyroxine .I take 75mg as was told to reduce from 100 as TSH high by Dr.

Taking almost any dose of T3 will significantly reduce TSH

There’s no point stopping T3 before test…..unless it’s at least 8 weeks before test as TSH is very slow to change

Presumably you mean the TSH was too low (not too high) …..

Ft4 is too low, you probably need 25mcg dose increase in levothyroxine

Most people when adequately treated will have Ft4 and Ft3 at least 50% through range

Approx how much do you weigh in kilo

Guidelines on dose levothyroxine by weight (when JUST on levothyroxine) is 1.6mcg levothyroxine per kilo per day

What were TSH, Ft4 and Ft3 when on just levothyroxine

Cortisol is low …..probably because you are under medicated

[Middleagedandtired in reply to SlowDragon]

Thank you ...unable to comment on what TSH 4 and 3 were I look as been on 3 for a while

[SlowDragon Administrator]

If taking T3, this lowers TSH

It’s important to be taking high enough dose levothyroxine and T3 regardless of TSH

This is problem with self supplementing T3 ….GP almost always reduces levothyroxine because of low TSH

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

And day before test, splitting T3 into 2 smaller doses…..with last dose 8-12 hours before test

Typically when taking T3 it will be 1/4 tablet 2 or 3 times a day

If 2 per day at roughly 10-12 hours intervals

Or if need 3 doses per day, at equal 8 hour intervals

[Middleagedandtired]

Thank you have you any comments on the mention of Pituitary issues as mentioned by Blue Horizon Dr ?

[tattybogle in reply to Middleagedandtired]

The comment mentions pituitary issues (secondary hypothyroidism) because they saw the TSH was low as the same time as low ishT4/3. But we know your TSH was low because you'd been self supplementing T3.. which will lower TSH a lot..... The blue horizon doctor didn't know about your T3 use when writing those comments.

Even though you stopped taking the T3 before the test, i assume you only stopped for a day or so .. but it would take weeks /months off T3 to allow TSH to return to where it would be without taking T3.

So his comments are not really relevant to your test results.... the low TSH with low T4/3 that you have is easily explained by what you did , therefore no reason to suspect pituitary issues on the basis of these test results .

Edit .

TSH is much slower to respond to change of dose than fT4/3 are.

So in effect .. what you did means you have T4/3 results that show the dose taken for the previous few days ,but TSH results that still show the effect of the dose you were taking for the previous few weeks .. which is why they don't match .

This is why we need to be on a consistent dose for 6 weeks before blood tests can be interpreted correctly.

[Middleagedandtired]

Not wanting to be melodramatic but thats a relief ...Thank you

[SlowDragon Administrator in reply to Middleagedandtired]

Waste of time getting Dr comments from Blue horizon or Medichecks.

If taking T3 you would expect TSH to be very low or suppressed …..but when adequately treated Ft4 and Ft3 should be at least around 50% through range

Obviously as you stopped T3 the test is inaccurate anyway

[SlowDragon Administrator]

Reading old post from year ago

healthunlocked.com/thyroidu...

When you retest.

Testing thyroid levels.

Always test as early as possible in morning - at 9am

As currently on 6mcg (1/4 tablet) T3

Day before test

Splitting daily dose into 2 smaller doses (speck of dust)

Take last 3mcg (1/8th of T3 tablets) T3 9pm night before test

As you normally take levothyroxine at bedtime, adjust as follows

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 at 9am on Monday morning.

Take Monday evening dose levothyroxine as per normal

Remember

You only need to stop any vitamin supplements that contain biotin- eg vitamin B complex a week before any blood tests. If you take any iron supplements, stop these a week before blood test too