Help (request No.2)! Blood results give unexpected drop in % through range of Free T4, Free T3 and quite an increase in TSH

[Levo50]

Apologies - although my previous post gives an overview unfortunately my blood results are unreadable, so I felt easer to repost to try and simplify below…

08.04.2021 GP

Levo (Accord) 75mcg

TSH = 2.0 (0.27-4.2) = % through range 31.03%

Free T4 = 15.4 (10-20) = % through range 54%

Free T3 = not provided

NO HRT

28.05.2021 GP

Levo (Accord) 100mcg

TSH = 0.1 (0.27-4.2) = % through range -1.72%

Free T4 = 17.7 (10-20) = % through range 77%

Free T3 = not provided

NO HRT

19.07.2021 MEDICHECKS

Levo (Accord) 75mcg (Although Endo recommended 100/75 alternate)

TSH = 0.08 (0.27-4.2) = % through range -4.83%

Free T4 = 17.3 (12-22) = % through range 53%

Free T3 = 4.7 (3.1-6.8) = % through range 43%

NO HRT – Mood very low

TPA 128

26.01.2022 MEDICHECKS

Levo (Accord) Going to try 100/75 (can’t think of any other option (100 didn’t suit)

TSH = 3.02 (0.27-4.2) = % through range 70%

Free T4 = 14.4 (12-22) = % through range 24%

Free T3 = 3.48 (3.1-6.8) = % through range 10%

HRT – Mood improved, gained weight, other symptoms

Vitamins all good

Ferritin stabilised

TPA 110

Any thoughts / suggestions most welcomed, no idea why my Free T4 and T3 have halved % through range!?

So frustrating (seems impossible) trying to get the balance right, so wish I was normal ‘sad face emoji’

[Lalatoot]

Why did 100mcg levo not suit?

[Levo50 in reply to Lalatoot]

At the time I remember my mood was really very low, I felt depressed, was crying most of the time, I believe I was swinging between hypo and hyper and maybe that's becuase my TSH was so low, I think it is a fine balance and I will titrate up very slowly and repeat bloods. I wonder now whether I have become a poor converter.

[Lalatoot in reply to Levo50]

You can't consider conversion until you are on an adequate dose of levo. Your TSH should be under 2 and more likely nearer 1 with ft4 over 50% through range. Then you can see where date is and if it is lagging behind. At the moment you are undermedicated on levo.Please be aware that the symptoms of under and over medication can be the same. It is certainly not like the clearly defined lists you read on the internet for hypo and hyper. I know that from experience!

[pomeranion in reply to Lalatoot]

Can you clarify conversion. My TSH is .934 and FT4 1.75. Only tests taken by. Endocrinologist

[Lalatoot in reply to pomeranion]

No you can only look at conversion if you have ft4 and ft3 results. This is because you are looking at how t4 converts to t3.

My TSH was 0.19 (0.55 - 4.78)

My ft4 was 19 (10 - 25)

My ft3 was 4.5 (4.0 -7.0)

Ft4 is 60% through its range

Ft3 is 16.67% through its range

This shows bad conversion. If conversion was good then ft3 would somewhere towards the 60% just a little bit behind ft4.

Many on here find it hard to get ft4 and ft3 tested and resort to private testing. I was lucky because my TSH had been 32 and was now under range they had been testing TSH, ft4 and ft3 regularly on the NHS to monitor me.

[pomeranion in reply to Lalatoot]

Thank you for the quick reply. I will try to get updated testing and especially the FT3.Can you enlighten me as to hypothyroid or hyperthyroid symptoms. I am really suffering since Levothyroxine supplementation. My Endocrinologist is reducing to 75mcg. from 88mcg. I have terrible symptoms indicative of hyperthyroidism. I stopped taking the Levo. about 2 weeks ago because of the Endo. not taking my concerns under consideration. The side effects of hyperthyroidism are terrible because of my osteoporosis and previous fractures. I am considering changing Drs.

I have researched all of the lists of differences between hypo and hyper. I have never experienced any of the new symptoms before. What is your opinion?

[Lalatoot in reply to pomeranion]

I was hyperthyroid and had treatment to kill off my thyroid so I then became hypothyroid. I can say from experience that I had many of the same symptoms hyper as I did hypo. I think that the clearcut lists they give for hyper and hypo can mislead. I even have weight loss when I am hypo!I felt that levo was the devil's brew for many years. I had to split my daily dose as I found it hard to take. In the end I decided that the levo was the cause of my symptoms and I cut down until I was on 25mcg per day. Felt great for 3 months and then was very ill. The problem had not been the levo. The problem was that I had never been on a high enough dose. I had been undermedicated.

If you get tests done post the results and we will try to help.

[radd]

Levo50,

Although a 100mcg Levo dropped to 75mcg is only a difference of 25mcg a day, over a week this totals 175 mcg which is quite a big reduction. Therefore, it is usual to alternate daily doses to titivate dose more easily.

However, the difference between July 2021 and January 2022 results is you have started HRT. I presume you switched to patch/gel which bypasses the liver and theoretically shouldn’t raise extra protein carriers that risk binding Levothyroxine. Except it can, as evidenced by some forum members who have needed to increase their Levo dose several weeks after starting HRT. I assume its the small amount that gets recycled.

You are quite under medicated now so if this were me I would raise to 100/75mcg daily, and retest after six weeks but be expecting possibly another raise to 100mcg daily now taking HRT

[Levo50 in reply to radd]

Thank you this is so helpful an informative, it has given me confidence to try 100 daily to see how I go, I’ve done this for a few days and felt ok, do you think this is wise? Just with your comments around HRT it gives me confidence TSH shouldn’t plummet as low as 0.1 again!

[radd in reply to Levo50]

Levo50,

Your TSH is dictated by the total amount of thyroid hormone in your blood stream, which includes the bound & unbound, and will not be directly influenced by the HRT.

Some people need a lower (under-range) TSH in order to be able to gain enough thyroid hormone.

[Levo50 in reply to radd]

Thank you so much 😀

[JAmanda]

I know you said 100 didn’t suit but I’d try that again - it could have been it was too little not too much.

[Levo50 in reply to JAmanda]

Really good point, I am gaining confidence to go for this! Thank you!