My blood test, please comment

[Windsinger]

Hi fellow thyroid warriors!

Another year, another test... It's been a while... After a bit of trial and error, I have settled with NDT 1.5 grains. I feel good , but recently started feeling a bit under the weather, bit low, unmotivated... You know... Nothing, comparing with what it was pre medication... So just received my blood test results from Medichecks. Blood drawn in the morning, before breakfast or medication, last dose of NDT taken day before in the morning...

TSH 0.01 ( 0.27-4.2)

T4 10.7 ( 12-22 )

T3 4.41 ( 3.1-6.8)

So, TSH almost non existent, which I understand is not a problem if on NDT... But what about this T4? Should I push it up? T3 is not in the best place either, but it's been 24 hours since last dose, so may be in reality it is a bit higher than that...

As I said I think I am feeling OK, a bit tired lately... and my NDT is at the end of its use by date, may be the potency is down? Should I increase and how much?

I don't understand why T4 is so low... It's been like that in previous tests too...

Thank you all. looking forward to hearing your take on it

[greygoose]

Two possible reasons your FT4 is too low: a) because FT4 always drops when taking T3; b) because you're probably under-medicated.

But, the FT4 is correct, it's just the FT3 that is a false low, because you should only leave a gap of 8 to 12 hours for T3.

Doesn't matter if the NDT is at the end of its use-by date - isn't that a sell-by date, though? If it's in its original packaging and kept in good conditions, it will keep it's potency for a long.

Do you take your NDT on an empty stomach and wait an hour before eating, etc. just like levo?

I think you do need an increase in dose, but only ever increase by 1/4 grain at a time.

[Windsinger in reply to greygoose]

Thank you. I take NDT in the morning as i wake up and then wait for 30 min to an hour to have coffee... Will try and increase by 1/4 although it is hard to split precisely... this little pink round pill...

[greygoose in reply to Windsinger]

It would probably be much better if you could wait an hour before coffee. Coffee will affect absorption of thyroid hormones.

[Jazzw]

We’re all different but one and a half grains a day certainly wouldn’t be enough for me.

And it doesn’t look like it’s enough for you, even taking into account the longer than recommended gap between taking your last dose of NDT and taking the test.

I existed quite happily on 2 grains for quite a while (I’m now on 3 grains).

I’ll be honest and admit I’m a bit more gung ho than greygoose—I probably would raise by half a grain to see what that did. Though I completely agree that you absolutely need to go slower once you’re taking more than 2 grains a day. I get very frustrated fiddling with fractions of pills.

[Windsinger in reply to Jazzw]

Thank you for your reply. Much appreciated!

[SlowDragon Administrator]

Important to test vitamin D, folate, ferritin and B12 once year as well…

What vitamin supplements are you currently taking

[Windsinger]

Thank you for the reminder. My B12 is above the range ( I had some B complex injections recently), folate and ferritin in the range and D is very low. But when I supplement with D I develop condition called Granuloma Annulare... Its the whole different topic... Its like a red bumpy rush on the skin and it is told to be connected with some Vit D receptor dysfunction... So stuck there... Is it bad to have B12 over the range? It is quite often over in my case...

[pennyannie]

Hello Windsinger :

Ideally you should have left around a 10/12 hour window between last dose and blood draw .

I think you can afford to up your dose in 1/4 grain increments :

Do you check your temperature, blood pressure or pulse at all ?

No thyroid hormone replacement works well until vitamins and minerals are maintained at optimal levels and since you struggle with the vitamin D you may just need that additional 1/4 grain to compensate.

[Windsinger in reply to pennyannie]

Thanks for that... It is so helpful! So how do I time my test? If I take NDT in the morning, then do I take the test in the evening? or do I skip morning meds, take it in the evening and test next morning... I did not think about it... How do people do it normally? It does not have to be fasting, does it, but I hear morning tests are preferable...

[pennyannie in reply to Windsinger]

I think if self medicating just be consistent with blood draw timings etc - as then you have like for like conditions and something to compare to :

You can then track your progress and see any differences in levels but to be honest with NDT it's more about how you feel and dosing to the relief of symptoms.

If having to please a NHS doctor with limited knowledge that's likely mission impossible :

Irrespective of the timings your TSH will be low suppressed and your T4 lower and your T3 higher than when on T4 monotherapy so if your doctor is not aware of NDT and how it presents in a blood test you'll need to explain.

A morning test is meant to show as high a TSH as is possible as if that's is all being tested on the NHS system this may work in the patient's best interests if wanting a dose increase in T4 :

I always take my NDT 1 + 1/2 grains at around 3 in the morning so arrange a private blood draw yearly to include the vitamins and minerals for around 11.00am :

My TSH is 0.01 : my T4 around 13/15 ( range 12-22 ) and my T3 around 6/7 ( range 3.10 - 6.80 ) T3 in the middle 7s if I've not eaten and fasted - and if I have eaten breakfast I generally come in the range at around mid 6's.

I wouldn't change my routine if I felt well and to be honest I just do a yearly full thyroid blood draw more for the vitamin and mineral levels than where my T3 or T4 are sitting.

P.S. I think that fact that you not too worried about anything and " just surprised " by these low results indicative of someone who is probably on around the right dose !!

I'm with Graves Disease post RAI thyroid ablation 2005 :