GP will say I'm hyperthyroid and reduce my T4. According to these blood tests, would she be right?!

[Abi-Abster]

I am taking T4 Levothyroxine 125mcg x1 with self-prescribed T3 25mcg x twice daily. I’ve been taking T3 for 5 years, and I feel I’ve hit the right spot with my current thyroid regime.

However, my bloods appear to read otherwise. Indeed, as far as I can see, they combine to form the picture of hyperthyroidism.

I don’t feel hyperthyroid (I have before, so I hope I would recognise the symptoms) and - other chronic conditions aside - I actually feel fine thyroid-wise. Plus my nails still peel apart rather than grow strong.

However, I have been bleeding on and off for a few months now, and I can’t tell if that’s due to 5 months of magic HRT (I started bleeding from month 3-5 inclusive) or a symptom of hyperthyroidism.

Before HRT I also bled frequently and irregularly, which I put down to perimenopause, but a couple of years ago the Endocrinologist told me it was due to an overactive thyroid.

I love how I feel on HRT and don’t want to stop - I’d keep bleeding if I had to! But I'd rather not bleed if I could at all avoid it, and again, I need to be sure it's not due to hyperthyroidism.

Apart from the obvious TSH, the bloods that the lab has Flagged could also pertain to hyperthyroidism, and potentially reinforce the hyperthyroid diagnosis from additional angles.

In anticipation of my GP calling to reduce my 125mcg T4 (which feels better than the 100mcg I was prescribed for years), please explain and help me make sense of the the following results.

I need to be able to plead my case, but I'd also prefer not to be bleeding all the time!

Each result will have the following layout:

Test: My result (Ranges Given & Measurement)

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C-Reactive Protein: <1 (0 - 5mg/L)

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Coag Screen

APPT ratio: 0.9 (0.8-1.2)

INR: 1 (0.8-1.2)

APTT: 28.9 seconds

Prothrombin Time: 10.5 seconds

---

Ferritin: 72 (15-200ug/L)

(no other Iron, B12 or Vit D, unfortunately)

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Free T4: 13.4 (9-19 pmol/L)

TSH: < 0.03 (0.35 – 4.94 mu/L) Lab Flagged Low

^ I know I need a full panel of T3, FT3 tests etc, but the GP didn’t organise that for me. So for now, FT4 and TSH are all I have to go on in terms of direct thyroid tests. Apologies!

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Blood Count

Haemoglobin: 132 (120 – 150 g/L)

White Cell Count: 4.8 (4 – 10 10*9/L)

Platelets: 234 (150 – 410 10*9/L)

RBC: 4.2 (3.8 – 4.8 10*12/L)

HCT: 0.37 (0.36 – 0.46 L/L) Low

MCV: 87 (83 – 101fl) Low

MCH: 31.1 (27 – 32pg)

MCHC: 357 (315 – 345g/L) Lab Flagged High

RDW 11.3 (11.6 – 14 %CV) Lab Flagged Low

Neutrophils: 2.6 (2 – 710*/L) Low

Lymphocytes: 1.5 (1 – 3 10*9/L)

Monocytes: 0.4 (0.2 – 1 10*9L)

Eosinophils: 0.2 (0.02 – 0.5 10*9L)

Basophils: 0.1 (0 – 0.1 10*9L)

Absolute NRBC: 0 (0 – 0.09 10*9L)

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Liver Function

Albumin: 42 (35-50 g/L)

Globulin: 33 (20 – 35g/L )

Total Bilirubin: 6 (2 – 21mol/L)

Total Protein: 75 (60-80g/L)

ALP: 54 (20-150 u/L)

ALT: 22 (5 – 40 u/L)

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Haemoglobin A1C Diagnostic (IFCC): 31.1 (20-41mmol/mol)

HbA1c% (DCCT): 5 % (no range given)

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I'm aware there are additional blood tests that I could have taken to better read my the health of my thyroid, but the above is what my GP organised.

I have been coeliac and avoiding gluten for approx 25 years now

Many thanks for your time

[greygoose]

Sorry, how do your results combine to form a picture of hyperthyroidism? I can't see it. Your TSH is low, but that doesn't mean anything. Your FT4 is also low, so you can't possibly be over-medicated on levo. (You can't be hyper, anyway, because you're hypo and the thyroid cannot switch from one to the other.)

It's taking T3 that has caused your TSH to drop. That's what T3 does. It suppresses the TSH. But, that - on its own - doesn't mean you're over-medicated. You'd have have the FT3 tested to know that. Does your GP know you take T3? If not, I think you're going to have to tell her, in order to explain the suppressed TSH. Reducing your levo won't have the slightest effect on it.

[Abi-Abster in reply to greygoose]

Thank you greygoose I'm relieved the FT4 isn't showing I'm hyperthyroid. The GPs know I take T3.

The bits that come together to show potential hyperthyroidism are the flagged blood tests, so:

MCHC: 357 (315 – 345g/L) Lab Flagged High

Amongst other reasons (Liver disease, Lupus, hemolytic and macrocytic anaemia - but I've been taking liquid iron and B12), Dr Google says that a high MCHC can be due to an "Overactive thyroid: Thyroid problems frequently lead to changes in a person's red blood cells."

....and some other results above which I looked up but can't remember now!

But if the main FT4 results don't show I'm hyperthyroid, hopefully the doc will be OK with my thyroid meds

[greygoose in reply to Abi-Abster]

Do you take a B complex with your B12? The Bs all work together and need to be kept balanced. How much B12 are you taking?

In any case, you are not hyper, that's for sure.

[SeasideSusie Remembering]

Abi-Abster

I am taking T4 Levothyroxine 125mcg x1 with self-prescribed T3 25mcg x twice daily.

please explain and help me make sense of the the following results.

As you're taking T3 it's essential that you test TSH, FT4 and FT3 all together from the same blood draw. We can't possibly tell you anything about your thyroid tests without an FT3 result when taking T3. This means that if your GP can't get FT3 tested as well then you will need to do your own thyroid panel which includes this. MonitorMyHealth is cheapest at £26.10 using discount code here:

thyroiduk.org/help-and-supp...

[SlowDragon Administrator]

First step is to get FULL thyroid and vitamin testing done yourself

Medichecks or Blue horizon

What vitamin supplements are you currently taking ?

Likely iron/ferritin are dropping with continued blood loss

thyroid blood tests early morning, ideally before 9am last dose levothyroxine 24 hours before test

On T3 - day before test split daily dose into 3 smaller doses, spread through the day at approx 8 hour intervals, taking last 1/3rd of daily dose 8-12 hours before test

As you are coeliac it’s almost inevitable you were going to need addition of T3

Email Thyroid U.K. for list of recommended thyroid specialist endocrinologist and doctors who will prescribe T3

[e-mail]

Roughly where in U.K. are you

Suggest you inform GP that you are taking T3 and you want a referral to endocrinologist of your choice

Over 57,000 prescriptions for T3 in England last year

Searchable by CCG area

That’s typically 6 prescriptions per person per year

openprescribing.net/analyse/

[Astro16]

I am nowhere near as knowledgeable as folk like greygoose, on this site. I too come here for help. I would love to help more but i still havent got my health right with this thyroid problem too. I WISH YOU ALL THE BEST X SORRY I CANT HELP MORE ! Astro16