I used to be good with figures..

[chubi52]

Hi all,

Is there anyone that can help me figure out what's going on with my thyroid. As with all of us trying to sort a problem through covid has been a challenge ( doctors not being willing to see a patient has not helped)

I'm going to write my test results over a period of 25 months, not every test was the same I don't know why I always asked for the same.. Is probably why I can't get my head around the inconsistent figures..

Sept 20

Tsh 5.02 (0.35_3.5)

Ft4 10.4 (7.5-21.1)

No ft3

Nov 20

Tsh 1.13 (0.35-3.5)

No Ft4 or ft3 tested although requested but got a full blood count done and vit b12, 358 (187-88.3) folate 5.2(2.7-15.0) vit d 106 (50-120)

May 21

Tsh 0.73 (0.35-3.5)

Ft4 14.9 (7.5-21.1)

Ft3 5.4(3.8-6.0)

July 21

Tsh 0.37 (0.35-3.5)

Ft4 12.5 (7.5-21.1)

Nov 21

Tsh 0.59 (0.35-4.94)

Ft4 14.2 (7.5-21.1)

Ft3 3.9 (3.8-6.0)

Vit d 68 (50-120)

ferritin 59 (23.0-300)

Folate 13.9 (2.7-15.0)

B12 508 (187-883)

Feb 22

Tsh 1.09 (0.35-4.94)

Ft3 4.4(3.8-60)

Ft4 again requested but not done

I'm so sorry for this long post as I just can't get my head around on what's going on as its been such a long journey and have not felt right since end of 2019...

I'm getting worn out now my brain aches.. Will add as from December 24th last year I was put on liquid levothyroxine 5mls which is 125 mcg as its thought I wasn't absorbing the tablets.. My doctor has said will be tested in 3 months now as I'm in range.. But I don't feel normal but definitely feel better than I did..

I guess what I need to know what does Tsh need to be to know I'm converting the t4 and t3

Many thanks if you are able to help

[Lalatoot]

TSH around 1 or lower is what you need. However you also need FT4 and FT3 from the same blood draw.

[chubi52 in reply to Lalatoot]

Thank you for your replySo 1.09 could that indicate over medicated? As that's my first result from changing from tablets to liquid... I'm being retested in 3 months, but feel it could be before as not feeling good on 5mls of 125 mcg bottle.. I do request tsh, ft4, ft3 but seems to be hit or miss what the doctor puts on the test sheet

Thanks again

[Lalatoot in reply to chubi52]

No. TSH 1.09 is a good result. Overmedicated would be a result where Ft4 or FT3 is over range.

[SlowDragon Administrator]

Obviously you need TSH, Ft4 and Ft3 tested together

Always test thyroid early morning, ideally before 9am and last dose levothyroxine 24 hours before test

List of private testing options and money off codes

thyroiduk.org/getting-a-dia...

cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code

thyroiduk.org/getting-a-dia...

monitormyhealth.org.uk/

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 on Monday morning. Take Monday evening dose levothyroxine as per normal

What vitamin supplements are you currently taking

REMEMBER.....very important....stop taking any supplements that contain biotin a week before ALL BLOOD TESTS as biotin can falsely affect test results - eg vitamin B complex

Vit d 68 (50-120)

ferritin 59 (23.0-300)

Look at increasing iron rich foods in diet to improve ferritin

How much vitamin D are you currently taking

Aiming for vitamin D at least around 80nmol and around 100nmol maybe better

Have you had thyroid antibodies tested yet for autoimmune thyroid disease

About 90% of primary hypothyroidism is autoimmune thyroid disease

[chubi52 in reply to SlowDragon]

Hi thanks for the replyYes I take bloods first thing.. I take my medication at night so that doesn't interfere with anything as for vitamin d I take d3 2.200 iu but not every day as when I was my symptoms were worse and my doctor said I was over medicating on vitamin d as you can see from my results they are never consistent on what's being tested although I request the same tbh its crap when I ask for tsh, ft4, ft4, vitd, b12, foliate, ferritin, when I complain its not what I asked for I get told they are not allowed to keep testing when results say normal... I get so angry as I tell them I don't feel normal..

Thsnk you

[greygoose]

A TSH test cannot tell you how well you convert. To know that, you need the FT4 and the FT3 tested at the same time and compare them. As you have here, in November 21:

Ft4 14.2 (7.5-21.1) 49.26%

Ft3 3.9 (3.8-6.0) 4.55%

By looking at the percentages, you get a good idea of how well you convert. A euthyroid (no thyroid problems) person would have an FT4 around mid-range, as yours is, with an FT3 slightly lower - say around 46%. The gap between your FT4 and FT3 is much wider, indicating poor conversion.

How much levo were you on at that time? Because you also look a little under-medicated - a hypo usually needs levels higher than euthyroid. Have you had an increase in dose since then?

Handly percentage converter:

thyroid.dopiaza.org/

[chubi52 in reply to greygoose]

Thanks for the replyUnfortunately this doctor doesn't seem to write all the test I'm asking for, there seems to always be one missing when asking for tsh, ft4, ft3, I thinks it why I cant get to grips with it, I'm not giving enough information to work on...

I take 5ml of liquid levorhyroxine, as I felt with tablets I was always under medicated due to not absorbing them...

I was upped to 150mcg middle of last year on tablets.. Got a call in October to say I was now over medicated and to take 125mcg daily, anyway got to beginning of December and I started feeling bad again, hence I was put on liquid 24th Dec.. 5 mls of a 125 mcg bottle... Next bloods taken feb 2022 and was told I'm in range and now to be tested in 12 weeks.. I take my meds at night and always have bloods done in the morning before I eat or drink... The last 2 weeks I've been feeling awful again so I think 5 ml too much, but going by what you are saying maybe I'm not converting so would I be correct in needing a t3 as well as levo sorry name escapes me of the medication... No fun when brain won't work.. Once again thanks...

[SlowDragon Administrator in reply to chubi52]

I take my meds at night and always have bloods done in the morning before I eat or drink...

Last dose levothyroxine should be 24 hours before test

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 on Monday morning. Take Monday evening dose levothyroxine as per normal

REMEMBER.....very important....stop taking any supplements that contain biotin a week before ALL BLOOD TESTS as biotin can falsely affect test results - eg vitamin B complex

[SlowDragon Administrator in reply to chubi52]

I was upped to 150mcg middle of last year on tablets.. Got a call in October to say I was now over medicated and to take 125mcg daily,

None of these results below show over medicated…..they mainly show you are UNDER medicated/poor conversion

Especially if you typically took last dose levothyroxine the night before test (12 hour gap) ….not the recommended 24 hours gap

May 21

Tsh 0.73 (0.35-3.5)

Ft4 14.9 (7.5-21.1)

Ft3 5.4(3.8-6.0)

FT4: 14.9 pmol/l (Range 7.5 - 21.1) 54.41%

FT3: 5.4 pmol/l (Range 3.8 - 6) 72.73%

Good conversion, probably near correct dose …..might need very small dose increase in levothyroxine

And/or optimal vitamin levels

July 21

Tsh 0.37 (0.35-3.5)

Ft4 12.5 (7.5-21.1)

FT4: 12.5 pmol/l (Range 7.5 - 21.1) 36.76%

Likely under medicated if test was 12 hours after last dose levothyroxine

No Ft3

Nov 21

Tsh 0.59 (0.35-4.94)

Ft4 14.2 (7.5-21.1)

Ft3 3.9 (3.8-6.0)

FT4: 14.2 pmol/l (Range 7.5 - 21.1) 49.26%

FT3: 3.9 pmol/l (Range 3.8 - 6) 4.55%

Terrible conversion and under medicated

Helpful calculator for working out percentage through range

thyroid.dopiaza.org

[chubi52 in reply to SlowDragon]

Thank you for the reply am seeing my doctor tomorrow and will be bringing this up with them, as I haven't seen a doctor in 2 years over this condition so maybe face to face I may get answers