Advice re inconsistent and above range FT4 please.

[grumpyold]

Apologies in advance for long post.

GP made me have annual review blood test 21/12/21. Test was done at 8.20am, 24 hours after last dose of levo (150 mcg) and fasting apart from water.

Please note, my TSH always appears suppressed because I take Metformin.

TSH 0.01mu/L (0.35 - 4.94) See comment above re Metformin.

FT4 19.7 pmol/L (7.5 - 21.1)

FT3 4.6 pmol/L (3.8 - 6.0)

I was rather disappointed by the FT3 being only 36.6% ( if my maths is correct) because I have been converting well over the past 3 years.

Maybe my vits weren't optimal so after Christmas I ordered a Blue Horizon test. Test done at 7.40 am, 24 hours after last dose of levo and fasting apart from water.

10/1/22

TSH 0.005 mu/L (0.27 - 4.20) Always suppressed due to Metformin.

FT4 29.3 pmol/L (12.0 - 22.0) WTF??

FT3 5.65 pmol/L (3.1 - 6.8)

Thyroglobulin abs 304 IU/mL < 115 I know I have Hashis.

Thyroidperoxidase abs 21 IU/mL < 34

CRP 2.05 mg/L (<5.0)

Ferritin 175.0 ug/L (13 - 150) I have haemochromatosis so often a bit high.

Magnesium 0.90 mmol/L (0.66 - 0.99)

Cortisol (random) 458.0nmol/L (6 -10am 166-507, 4-8pm 73.8-291)

Vitamin D (25OH) 95 nmol/L (Optimal 75 - 200)

Vitamin B12 374 pmol/L (145 - 569)

Serum folate 43.70 nmol/L (8.83 - 60.8)

I think the vits and minerals look OK? But I was very surprised by the FT4 result being 10 pmols higher than my NHS blood test 3 weeks before.

I queried it with Blue Horizons and they said because my ferritin was above range, I must have some inflammation (even though my CRP was normal). I don't think this is likely to be the reason because my ferritin is usually above range because of the haemochromatosis.

So, to double check that above range FT4, I got a test from MMH. Test done according to previous protocol, 7.20 am 7/2/22.

TSH 0.01 mu/L (0.27 - 4.2) ( Always appears suppressed due to Metformin.)

FT4 27.2 pmol/L (12 - 22)

FT3 5.9 pmol/L (3.1 - 6.8)

So, now I am even more confused.

I only got the 2 private tests because my FT3 (on NHS test) was, for me, too low back in December. The NHS test at that time showed my FT4 was 89.71%. Not above range at all, yet the 2 subsequent (private) tests are both above range.

I know that it isn't wise to have FT4 too high. Should I think about self sourcing NDT or T3 and reducing my NHS levo? ( I always get the same brand. )

I would be so grateful for any advice. Thankyou.

[tattybogle]

if you feel ok on this dose , i'd leave it in the 'keep an eye on it' box rather than changing anything just yet. My fT4 has always gone up and down by quite significant amounts for no apparent reason.

a couple of years ago it went from top of range up to 200% (i felt perfectly fine) so GP reduced dose from 125 to 112.5 and fT4 went up even higher 240%. (?) So GP reduced dose to 100 , but i was really unwell on the lowest dose , so he reluctantly put it back up to 112.5. The fT4 came down again to about 140% despite the dose increase (?)

If you're concerned , maybe see where it is in a few months time ? You might find it was just having a little wander about and will go lower again by itself.

So if i was you i'd just keep an eye out for any changes in symptoms/function that might be overmedication., and wait and see what happens next.

When i have been actually overmedicated in the past , i was getting over frequent bowel movements and was really 'jumpy' and a bit more anxious but curiously my fT4 was only about 120% at that time, and at that time a reduction from 150 to 125 improved the symptoms of overmedication quite quickly .

But I had none of these overmedication symptoms when it was 240% and those dose reductions made me go down hill from a place of feeling quite well.

[grumpyold in reply to tattybogle]

Thank you so much for replying. I love that “going for a wander by itself”😂I’ll take your advice and monitor it. If I can avoid having to self source alternative it’s all to the good.

Take care and have a good weekend.

[tattybogle in reply to grumpyold]

[greygoose]

Your rise in the FT4 is probably due to your Hashi's. Do you know how Hashi's works?

[grumpyold in reply to greygoose]

I think I do. It was my disappointing FT3 result (36.36%) at the December NHS blood test which prompted me to get the 2 subsequent private tests which alerted me to the above range FT4 results. Prior to December test, my conversion has been much better than that.

Just concerned that my FT3 wasn't optimal for me, but that FT4 was well above reference interval without significant rise in FT3.

[greygoose in reply to grumpyold]

Yes, but if the excessive FT4 was due to an immune system attack on the thyroid, that has nothing to do with conversion. It's just the dying cells of the thyroid dumping their stock of T4 into the blood.

[grumpyold in reply to greygoose]

Yes, thank you.I’ll give it a few weeks and see what it’s doing then.

[greygoose in reply to grumpyold]

Good idea.

[Bearo]

I recently read something by Michael Mosely who said that the shop bought probiotics he got tested did not contain much of the live stuff they said they contained, whereas,in comparison, home made versions had loads of bacteria. I’m sorry I can’t cite that or even remember it properly.

[Bearo]

Sorry, I was replying to a different post, I’m not sure what happened!

[grumpyold in reply to Bearo]

No worries.

[Catseyes235]

As Tattybogle says be guided more by how you feel! We tie ourselves in knots trying to get within range/meet doctors expectations etc. Good luck!