Newbie needing help to understand blood results.

[Jacarilla]

I had the remaining half of my thyroid removed at the end of august last year due to a non malignant tumour. (First half 10 years ago for same reason) I live in Spain and am under the care of a private endocrinologist.

I was immediately started on 100mg of levothyroxine (brand Eutirox) and calcium tablets . 3 weeks after my surgery I was reviewed and these were the results (apologies for it being in Spanish but I think it makes sense)

21 sept 21

PTH intacta suero 19.99 pg/ml

TSH suero 4.07 UI/ml (0.35 - 5.50)

T4 libre suero 1.92 ng/dl (0.78 - 1.80)

Calcio suero 9.4 mg/dl (8.7 - 10.4)

I suffered some anxiety and sleep issues as well as feeling hot but couldn’t say if this was down to thyroxine as I had some of these symptoms beforehand due to menopause (I take estradiol and progesterone HRT)

My next review :

Revision 1.12.2021

calcio 9.

glu 92.

Hb1ac 7,29%.

PTH 27.

TSH 0,88. (0.35 - 5.50)

T4L 1,79. (0.78 - 1.80)

Vit D 39

At this point my endocrinologist decided my symptoms were because of over medication and reduced it by a very small amount so that on just one day a week I took 50mg instead of 100mg. So I was taking 650mg a week.

A couple of weeks later I had a review with my gynaecologist as my endocrinologist does not deal with HRT (this seems crazy!) my blood results from that were

revision 17.12.2021

TSH 0,74, (0.35 - 5.50)

T4L 1,57. (0.78 - 1.80)

FSH 38.

LH 22,4.

prolactina 19.

estradiol 34.

The endocrinologist had requested she should not change anything with my HRT until my thyroxine was sorted so she doesn’t want to see me again until then.

So back to the endocrinologist with the above results and he decided my thyroxine meds are still too much and reduced them more dramatically this time to 75mg a day. And reduced my calcium from 3 x 500mg a day to 1 a day.

So I have just had another blood test but a limited one this time (as he requested) and these are my results. Although my knowledge is very limited these results have completely foxed me! I think I understand why my TSH would be raised as my thyroxine was reduced quite sharply but my T4 is up rather than down??

It might be worth mentioning I was diagnosed prediabetic a year ago and manage this quite well with diet although my endocrinologist is keen to put me on meds for it. I also take magnesium biglycinate for constipation 250mg a day.

30/1/22.

T4 libre suero. 1.68 ng/dl (0.35 - 5.50)

TSH. 4.53 μUI/ml (0.78 - 1.80)

I am due to see my endocrinologist next week but would love to be more informed about what’s happening and what I should expect next.

Thank you in advance for your help. Having spent the past 2 years extensively researching menopause and HRT so that I can make informed decisions and understand the issues I now find myself totally in the dark with regards to my thyroxine and loss of my thyroid. As for the prediabetes, which has also reared its head in the same time period, I am starting to understand that too. I am 59 years old and been healthy all my life so it’s all been quite a shock to be grappling with 3 issues all at once!

[pennyannie]

Hello Jacarilla and welcome to the forum :

A fully functioning working thyroid would be supporting you daily with trace elements of T1. T2 and calcitonin plus a measure of T3 at around 10 mcg plus a measure of T4 at around 100mcg.

T4 is a storage hormone that needs to be converted by your body into T3 the active hormone that the body runs on which i said to be around 4 times more powerful than T4 :

Your own ability to convert the T4 into T3 can be compromised by low vitamins and minerals, ( especially those of ferritin, folate, B12 and vitamin D ) inflammation, dieting, any physiological stress ( physical or emotional ) depression and ageing .

So, in the first instance we need to see your blood test results and ranges for a TSH, T3, T4, thyroid antibodies, inflammation, plus the vitamins and minerals as detailed above

It is essential that you are dosed and monitored on your T3 and T4 blood levels and both these vital hormones need to be in balance at around a 1/4 ratio and high enough in the range to be acceptable to the patient and to relieve symptoms being experienced.

The thyroid is a major gland, the body's engine, and responsible for full body synchronisation including your physical, mental, emotional, psychological and spiritual well being, your inner central heating system and your metabolism.

Loosing your thyroid, either in part or fully, puts an enormous strain on the rest of your body and you can't simply surmise that bit left will compensate for the loss - it may well not.

If you go into the Thyroid UK website, just scroll up here to see how many members are currently registered, you will find a list of hypothyroid symptoms and this might help you focus on where you are in all this.

Thyroid UK are the charity who support this forum and the goal is simply to improve thyroid health by this patient to patient forum.

Is your TSH really 4.53 and your T4 1.68 - as the ranges, I think, are on the wrong details :

On thyroid hormone replacement your TSH should be down towards the bottom of the range and at least down to at least under 2 and probably more likely much lower : and your T4 looks very low or if the ranges are incorrect at around 88% but we do need to see a T3 drawn from the same sample to take this further.

Did you take your T4 before this blood test ?

We generally suggest an early as possible blood draw fasting overnight and just taking on water and take your T4 after the blood draw - it's a storage hormone - it doesn't matter - : also stop all vitamins and minerals and supplements a week beforehand so we can see exactly what you body is holding onto:

Hope this makes some sense - and start reading up on other posts as although it all reads as gobble gook it does actually make sense and once we have some corner pieces your thyroid jigsaw puzzle will take form and you too can improve much of this yourself with a little knowledge and support from other thyroid forum members, as we've all been there, in one shape or another.

[Jacarilla in reply to pennyannie]

Thank you pennyannie that’s a lot to take in but I will try to digest the info you have given.No those last results are not the wrong way round which is wholly why I posted this morning. Those results completely confused me!

The blood was taken early morning after fasting but after taking my morning dose of thyroxine. This is the same as all previous blood tests as I have never been told not to take my meds (or to leave off supplements for a week) before testing.

[pennyannie in reply to Jacarilla]

OK - well it's a patient to patient tip as this way you should achieve the higher TSH and a lower T4 which should better able you to get an increase in T4 as historically we seem to be under medicated rather than over medicated.

[SlowDragon Administrator]

Looking at previous posts

You had hemi thyroidectomy?

Have you ever had thyroid antibodies tested for autoimmune thyroid disease (Hashimoto’s)

If dairy intolerant, you may need to try avoid as much dairy as possible

Gluten intolerance is slightly more common than dairy intolerance with autoimmune thyroid disease

Many of us find it better (or essential) to be gluten and dairy

[Jacarilla in reply to SlowDragon]

I had a full thyroidectomy in august 2021 as I’d already had half removed in 2010… both surgeries were as a result of adenoma.

I’ve never had an antibodies test as far as I know. Is this a test I can ask my GP for?

[SlowDragon Administrator in reply to Jacarilla]

if you have no thyroid left not a lot of point testing antibodies now

Would be interesting if had had antibodies tested in past

[Litatamon]

Hi,

Do you have a range for the PTH intact? I want to make sure I am not working with different values.

[Jacarilla in reply to Litatamon]

a month after my surgery it was 19.99 range 18.5-88. It hasn’t been tested since .. not sure what this is…? Parathyroid?

[Litatamon in reply to Jacarilla]

You do have different values and measurements there, so disregard me. You do not have raised values.

Mine were raised for a bit after surgery, just wanted to make sure that was not the cause of some of your symptoms..

Yes it measures the parathyroid hormone released and usually has a correlation to calcium levels in the blood. And sometimes it can be raised due to the parathyroid being injured during surgery.

[Jacarilla in reply to Litatamon]

ahh yes… I see your point… mine was ok but I was on calcium tablets for 3 months. Still struggle with calcium levels…