Tests

[AustinHealeySprite]

I’ve had hypothyroidism for a quite a few years but recently something is not quite right. In the last 12 months after my yearly test my doctor has changed my thyroxine 4 times .my latest results are

TSH 0.02. 0.55-4.78

Free T3 4.8 3.50-6.50

Free T4 22.6. 11.50-22.70

Tests done at 9 and last dose of 200mcgs of Thyroxine taken at 8 the day before on a empty stomach.

I feel quite good at moment but felt “wrecked” and extremely tired when my doctor reduced my dose earlier in the year due to results

I just want to be ready with answers if he wants to reduce my dose again

Thanks for any help

My first post 😳

[SeasideSusie Remembering]

AustinHealeySprite

TSH 0.02. 0.55-4.78

Free T3 4.8 3.50-6.50

Free T4 22.6. 11.50-22.70

The aim of a hypo patient on Levo only, generally, is for TSH to be 1 or below with FT4 and FT3 balanced in the upper parts of their reference ranges.

It looks like you need a top of range FT4 (99% through range) to produce FT3 at a lowly 43% through range.

Calculator here: thyroid.dopiaza.org/

This shows poor conversion of T4 to T3. T4 is a storage hormone that converts to T3 which is the active hormone that every cell in our bodies need.

Low nutrient levels can affect conversion so it's essential to test

Vit D

B12

Folate

Ferritin

and if there are any low levels or deficiencies these need to be addressed.

Optimal levels we advise here are:

Vit D - 100-125nmol/L (according to the Vit D Society and Grassroots Health

B12 - top of range for Total B12, if testing Active B12 then a minimum of 70 and 100 plus is better

Folate - at least half way through it's range

Ferritin - half way through range although some experts say that the optimal ferritin level for thyroid function is 90-110ug/L.

If all nutrients are optimal and still poor conversion then this points to the possibility of adding some T3 to your Levo but this has to be initiated by an endocrinologist.

but felt “wrecked” and extremely tired when my doctor reduced my dose earlier in the year due to results

If your GP is adjusting your dose just by looking at the TSH, or even both TSH and FT4, then this is wrong. It's actually the FT3 level that tells us if we are optimally medicated - over range FT3 = overmedicated. Low TSH and high FT4 do not mean overmedicated. Unfortunately FT3 is rarely tested at primary level and most doctors just don't understand how important this test is. I would refuse any further reduction unless FT3 is measured.

[AustinHealeySprite in reply to SeasideSusie]

Thank you 🙂

[SlowDragon Administrator]

Do you always get same brand levothyroxine at each prescription

Many people find different brands are not interchangeable

Teva brand upsets many people

Vitamin levels tend to drop if dose levothyroxine is reduced

Lower vitamin levels also more common as we age

What vitamin supplements are you currently taking

We need GOOD vitamin levels for good conversion of Ft4 to Ft3

What’s the cause of your hypothyroidism

Have you had thyroidectomy, or RAI or autoimmune hypothyroid?

[AustinHealeySprite in reply to SlowDragon]

It all started with an overactive thyroid resulting in RAI a long time ago Brand of thyroxine is usually the same

Don’t take any vitamins 🤭

I’ve been very stable for years then with yearly test in May my thyroxine was dropped and it’s been changed 4 times since

I’m now back on 200 mcgs but I’m afraid because of my TSH result the doctor will lower the thyroxine again

[SlowDragon Administrator in reply to AustinHealeySprite]

Recommend getting FULL thyroid and vitamin testing done yourself

These days NHS only tests TSH ……completely inadequate

Ask your GP to test vitamin D, folate, ferritin and B12

Optimal vitamin levels are

Vitamin D at least around 80nmol and around 100nmol maybe better

Serum B12 at least over 500

Folate and ferritin at least half way through range

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

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins

List of private testing options and money off codes

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

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins …..then 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/

GP’s often extremely reluctant to test vitamin D

You can test here ….if not doing full thyroid and vitamin testing

NHS easy postal kit vitamin D test £29 via

vitamindtest.org.uk

[AustinHealeySprite in reply to SlowDragon]

If I feel “ok” at the moment what is the effect of long term low TSH

[SlowDragon Administrator in reply to AustinHealeySprite]

Ideally we would aim for Ft4 and FT3 roughly 60-70% through range

Optimal vitamin levels can help improve conversion of Levothyroxine (Ft4) to active hormone (FT3)

So testing vitamin levels next step

If, once vitamin levels are optimal FT3 remains much lower than Ft4

Two options

1) have high Ft4 in order to get FT3 high enough

Some people are fine with over range Ft4

2) get small dose T3 prescribed alongside (slightly reduced) Levothyroxine

Either option tends to lower TSH

[AustinHealeySprite in reply to SlowDragon]

Thank you

[SlowDragon Administrator in reply to AustinHealeySprite]

Endocrinologist has to prescribe T3 initially via hospital pharmacy for first 3-6 months trial

If going to just take higher dose Levothyroxine may still need to get endocrinologist approval to run with suppressed TSH

GP’s (and most endocrinologists) don’t like/try to prevent patients having below range TSH

TSH is just the message from pituitary, it’s not a thyroid hormone. TSH is the message to tell thyroid to work

Most important results are always FT3 followed by Ft4

As long as FT3 is within range you’re not over medicated

When adequately treated many many people end up with below range TSH