I just got my new results back and would appreciate any advice before seeing my endo tomorrow afternoon. I have been on 125mg of Levothyroxine. Endo has switched me to taking levo at night, other then that there has been no change and I have been on this dose already with my March results. Endo wanted to see if taking the dose at night would make me feel better, and if not a) check nothing else is going on and b) start looking at options for addition T3 or taking NDT instead in our next session.
Not sure this is relevant BUT: They tested some general other blood tests, everything was normal except these two:
Serum bilirubin level 22 umol/L [0.0 - 21.0]
Lymphocyte count 3.7 10*9/L [1.1 - 3.6]
*I do have a current bulging disc in my lower back, so not sure if this is why this could be raised?
**Note: annoyingly they wouldn't test my vitamins again on the NHS as they said the levels were all normal last time! (Trust me, I tried!!) Annoying as I wanted to re-test folate after some of you said it wasn't good enough
LAST RESULTS: *this was done with medichecks, my newest results above are on the NHS
TSH: 0.57 mIU/L (Range: 0.27 - 4.2)
Free T3: 4.9 pmol/L (Range: 3.1 - 6.8)
Free Thyroxine (T4): 19.8 pmol/l (Range: 12 - 22)
PREVIOUS RESULTS FROM 1st of FEBRUARY: (When i was on 100mg)
TSH: 1.73 mIU/L (Range: 0.27 - 4.2)
Free T3: 4.2 pmol/L (Range: 3.1 - 6.8)
Free thyroxine: 18.2 pmol/l (Range: 12 - 22)
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thyroidqueen12
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From your prior posts it appears you're on the cusp of getting off straight levothyroxine and maybe trying NDT. I'd try asking for that if possible. The second choice, and probably the endocrinologist's choice, would be adding some liothyronine (T3) with your levothyroxine. That might help, unless you're genetically predisposed to not converting the levothyroxine well. Adding T3 mightn't help at all, but endocrinologists can be stubborn.
The elevated lymphocytes and bilirubin could be something that more complete blood cell examination would shed light on. A complete iron panel, a reticulocyte index and a peripheral blood smear might add further insight. You do need to know ferritin, iron, total iron binding capacity, and whether you produce a healthy complement of red cells. All this is necessary to carry oxygen to your brain and to fuel cellular energy.
I'd press for more tests to try to get to the bottom of what's happening with oxygen-carrying capacity. And change to NDT if you can.
That ( adding some T3) might help, unless you're genetically predisposed to not converting the levothyroxine well.
Please can you explain what you mean by this
You appear to be suggesting that the addition of T3 will not help if the Dio2 snp exists
Am I understanding your comment correctly?
If one has the Dio2 polymorphism then conversion is impaired
Heterozygous...not a lot
Homozygous ...more so
In either case the addition of T3 can help.
You appear to be suggesting the converse.
If T3 is low, health suffers...
So once levo and essential nutrients are optimised and symptoms still exist replacement T3 is required to provide the body with a T3 level adequate to maintain good health.
Peripheral tissue (all else outside the pituitary) rely on DIO1 enzymatic activity. A DIO1 polymorphism resulting in poor conversion will starve the tissues. Meanwhile the pituitary is happily steaming along on its well-functioning DIO2 enzymes.
In the pituitary, 80-90% of T4 is converted to T3 via DIO2. Only about 30-50% of T4 in the peripheral tissue is converted to active T3, due to the inefficiency of DIO1. The production of reverse T3 is poorly conceptualized, but some snps are known to boost conversion of T4 to reverse T3. When levels of rT3 becomes sufficiently high, there's nothing the liothyronine can do to overcome it, for the rT3 is bound to the sites that one would hope the T3 would glom onto.
D2 also has an opposite response from that of D1 to physiologic and emotional stress, depression, inflammation, and systemic illness. D2 is stimulated and there's increased activity in response to such conditions. DIO2 (intra-pituitary) T4 to T3 conversion goes up. But the rest of body suffers from diminished levels of active T3. This causes the TSH to remain normal, despite the presence of significant cellular hypothyroidism in the rest of the body.
Thyroidqueen might do fine on levothyroxine and some T3.
Or not.
The "or not" part can be drawn out, extremely trying, and fraught with physical exhaustion and despair.
On the other hand, the weeks I lay languishing on the bed unable to do anything were well spent going through my raw genetic data and identifying all of the DIO1 and DIO2 enzymes and their genetic markers and then researching clinical articles to find which ones were know sources of trouble when treating with levothyroxine. And which ones contribute to osteoarthritis.
I hope this explains some of where I'm coming from with my remark.
As ever, appreciative of everyone's keen interest to helping each other.
"for the rT3 is bound to the sites that one would hope the T3 would glom onto."
Is it ? ...... i thought i had understood that ReverseT3 can't fit onto the T3 receptors in the cell nucleus....... have i misunderstood which receptors/sites you mean .. or have i missed bit in my logic ?
Yes, I confess I haven’t actually been inside my cells to watch what’s happening. I’ve only this, from numerous laboratory blood tests for rT3, and correlation with profound physical exhaustion when its proportion to FT3/4 was high:
Reverse T3 does something awful, when there’s too much of it. It can be a monster.
She certainly shows logic and reasoning to the best extent.
I'm neither a thyroid scientistist nor a medic so, like you, have had to attempt to learn from the learned.
In my case, in order to recover from RTH/ cellular hypothyroidism.
I have recovered from very poor health thanks to support from experienced and knowledgeable members here.
I cannot claim to be an expert in this field so appreciate the greater knowledge of others.
Like tattybogle -whose knowledge is invaluable on this forum - I wonder if I too have missed something here
for the rT3 is bound to the sites that one would hope the T3 would glom onto."
thyroidqueen12 asked members of the forum for their experiences/opinions on the various treatment options presented to her by her endo.
I agree with her decision to choose T3 over NDT....just my opinion!
It really is a rediculous situation that as lay people we thyroid patients have to find the solutions to resolve our (often desperately) ill health because the experts failed.
I hope, following you challenging time, that you are now keeping well.
Like you I hugely appreciate the amazing help and support offered here
Thanks for your reply. All of my other Liver function tests were normal. I also had a full blood count report, where everything was also normal apart from the Lymphocyte count.
Re-Thyroid treatment: I am not leaning towards NDT over adding T3. My last post was wondering what others found worked best for them. My endo has said that either T3 or NDT are my next options if I'm still not feeling better & he doesn't find anything else going on which might cause this. Although now that there is a raised cortisol results (on a day where I felt the best in a while), I assume he will try something to treat this first. We'll see this afternoon...
Oh, also: I've never had one of those gene tests done as my endo said he doesn't think they work well. If he will consider giving me T3 with just showing poor conversion, then I'm fine with that.
Was latest test done early morning, ideally before 9am and last dose levothyroxine 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
Yes early morning before 9am. I posted on here in regards to my 24hr issue: i was not told about procedure if taking levo at night, as my endo said to just take it normally since it's far enough away from testing. So i took my normal dose at night, and got the blood taken at 8.45am.
I have not taken any supplements. I am trying to change one thing at a time so that I know what is working. I was hoping to get my vitamins tested again to know how this has developed. Annoyingly, the NHS would not test my vitamins again as they said they were in range last time I got tested 😱
Thorne Basic B or Jarrow B Right are recommended options that contains folate, but both are large capsules. (You can tip powder out if can’t swallow capsule)
IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results
Thanks for your message. Yes this is now the 3rd example of low conversion, and I will make sure to point this out to endo.
My endo said he would be reluctant to raise my levo again due to my weight. I am leaning towards having T3 added to my T4, rather than NDT because it is a smaller change. I'm worried that changing completely to NDT might make me feel worse again.
I am not currently GF, I have not found any issue with gluten. However, I am getting a coeliac blood test this week to check. (I saw on NICE guidelines that you can get this if you have hypothyroidism, so I thought it would be good to make sure!)
Your weight gain is possibly exacerbated by low T3.
I lost about 2 stone when I changed to T3-only....but with RTH/high T3 dose I may be a bit of an exception!
If your endo doesn't want to increase your levo/T4 for whatever his reason may be, then why is he considering NDT (T4 + T3) which will also raise T4 level.
His joined up thinking is questionable!
It's not so much to do with degree of change as about getting the correct dose of the correct hormone.
Hashi patients don't necessarily have to be coeliac to find gluten a problem....but wise to check anyway.....your antibodies are high.
The immune system attacks the thyroid gland which becomes inflamed then cannot produce adequate hormones, resulting in hypothyroidism.
Gluten can trigger symptoms.
Avoid soya.
You can now present your case for T3 to your endo!!
DippyDame sound advice. I added 10 mcg T3 to my 125 mcg T4 and the T3 raised my T4 high. Yet my FT3 was on the lower end. Very interesting. I was surprised to see it.
DippyDame sorry if I wasn't clear- I didn't mean that I am overweight. I am a normal weight. I meant that he is looking at your body weight when dosing levo
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Opinion on latest results please.
Interpret resukts
Am I going in the right direction ? 
Help with test results please
Thyroid Monitoring Results
