Hi, I have just received the results of a private test and don't understand them, especially the relationship between the T3 and the Free T4. This is the first test for T3 that I have done. How can you tell if the ratio is good or if there are conversion problems?
I have been taking Levo since 19 March this year, starting on 50mg and going up to 75mg on 28 April.
At diagnosis on 18 March my TSH was 71, by 19 April it was 15. The new test from 11 May shows 12.6 (0.27-4.2) so disappointingly it has not gone down much.
At diagnosis on 18 March Free T4 was 3.9 (12.0 - 22.0) , on 19 April after a month on Levo 50mg was 15.6 and on 11 May after two weeks on 75mg it was 15 (12.0 - 22.0), so T4 has gone down a bit despite dose increase. Is that weird or normal fluctuation over a short time span?
For the first time I have a T3 result which is 4.0 (3.1 - 6.8). Is this okay?
When looking at T3 is the correct question whether it is okay relative to the Free T4 or is it okay to be within range regardless of the relationship to availableT4?
My antibodies remain >600 unfortunately. Possibly because the week that i did the tests I was eating gluten to prepare myself for a gluten sensitivity test. I've stopped gluten again now.
Very grateful for any help understanding these numbers.
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Pearlteapot
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At diagnosis on 18 March Free T4 was 3.9 (12.0 - 22.0) , on 19 April after a month on Levo 50mg was 15.6 and on 11 May after two weeks on 75mg it was 15 (12.0 - 22.0), so T4 has gone down a bit despite dose increase. Is that weird or normal fluctuation over a short time span?
The difference is so slight, it's negligeable. But, were both tests done under the same conditions, and at the same time of day? There is a slight difference in levels throughout the day.
For the first time I have a T3 result which is 4.0 (3.1 - 6.8). Is this okay?
So, when you got this T3 result, the FT4 was 15 (12.0 - 22.0)?
So, your FT4 is 30% through the range.
Your FR3 is 24.32%. (handy percentage calculatore: thyroid.dopiaza.org/ ) So, you are still very under-medicated and therefore too soon to know how well you convert.
But, the way to tell is to compare the percentages through the range. The percentage for the FT3 should be slightly lower than the FT4.
Did you have the TSH tested at the same time?
Ignore the antibodies. Once you know you have Hashi's there's absolutely no point in retesting them. The level of the antibodies does not indicate the gravity of the disease, it just indicates you have it. Antibodies fluctuate all the time, and tend to be highest just after an immune system attack on the thyroid, when they come along to clean up the blood.
How can you tell if the ratio is good or if there are conversion problems?
First of all you have to have TSH below 1 to give the highest possible FT4 level. Then you look at the FT4 and FT3 results. If they are reasonably well balanced conversion is good, if the FT4 is high and the FT3 is low then that generally shows poor conversion.
But for any thyroid hormone replacement to work properly we need optimal nutrient levels (Vit D, B12, Folate, Ferritin) so before we can judge conversion we need to address any low levels.
At the moment, you still have a long way to go. It's not quite two months since you started Levo and you probably need a few more increases in your dose before you start making real headway, so for now forget about conversion just concentrate on getting your TSH down to 1 or below and your FT4 in the upper part of it's range, plus testing nutrients (if not already done) and addressing any problems there.
At diagnosis on 18 March Free T4 was 3.9 (12.0 - 22.0) , on 19 April after a month on Levo 50mg was 15.6 and on 11 May after two weeks on 75mg it was 15 (12.0 - 22.0), so T4 has gone down a bit despite dose increase.
You are testing too soon after a dose change.
After starting Levo it's usual to wait 6 weeks to retest, then after the first and subsequent increases in dose you wait 6-8 weeks before retesting, this is because it needs that long for levels to stabilise.
18th March - 19th April was four and a half weeks.
Testing on 11th May after just 2 weeks on 75mcg was a total waste.
Are you doing private tests? If so don't waste your money, leave a good 6-8 weeks before retesting.
For the first time I have a T3 result which is 4.0 (3.1 - 6.8). Is this okay?
If you were further along your thyroid journey we'd say no, but at this stage it's pretty much irrelevant, as explained you need to get TSH down and FT4 up.
When looking at T3 is the correct question whether it is okay relative to the Free T4 or is it okay to be within range regardless of the relationship to availableT4?
You look at FT4 and FT3 and are aiming for them to be pretty much balanced once on your optimal dose of Levo.
Pearl to look at conversion you first need to be on an adequate dose of levo. This would be TSH down under 2 and ideally around 1.When TSH is 1ish you then need a blood draw that includes FT4 and ft3.
You then compare the percentage that each result is through their own range. An ft4 the is a high percentage through its range and an ft3 a low percentage through its range shows poor conversion.
If the percentages are similar or perhaps ft3 just dragging a little behind then conversion is ok.
You are not on a stable enough dose to worry about this at the mo. What you can do is track your results and ensure you get adequate dose Inc of levo. Ensure your vitamin levels are optimal so that your body can use the levo efficiently. And give your body time to adjust, readapt and heal.
So it is in range but not might not be high enough for you. Some don’t feel well unless it’s in top half at least.
What was your FT4 in same test? was is also similarly low in range. If it equal in % then conversion is not the issue. If the FT4 was eg 80% of range but FT4 under 25% the disparity of the the conversion can be seen.
Basically , you don't need to worry about the fT3 result until you are taking enough levo to get your TSH to go down to about 1 or 2, (and it stay's there ..on a stable dose) ...then you can look at your fT4 and fT3 results together , to see how much fT3 you are converting out of the T4 you take .At the moment (while your dose of levo is being built up to the right dose) fT3 doesn't really tell you much.
The difference in fT4 15 / 15.6 is not really any difference at all , you would expect larger fluctuations than that in fT4 over the normal course of the day anyway.
If you only went up to 75mcg on 28th April.. then testing on 11th may ( 2 weeks ) is too soon to see what the effect will be on TSH, (or on fT4 either, really ) ....both these things take time to settle and then react to increase of dose .
It can take TSH quite a long while to settle down after a dose change , you need to leave at least 6 weeks really .
If you test at even 4 weeks, you might still expect the fT4 result and TSH result to be quite different in another few weeks as the body adjusts what it's getting and what it's doing with it .
The (TPOab?)_ antibodies will probably go down by themselves over time anyway , and they may also go up again ... and down again ~ each time the thyroid is attacked and damaged by the immune system , some more TPOab antibodies will show up to help clear up the mess. Then they'll go away when they are finished doing it .
Mine used to be >3000 when i was diagnosed in 2003 , now they are 195 .. despite eating gluten by the truck load for 20 years .
Ah okay, well I've learned something about T4/T3 for when TSH does eventually get below 1.
The reason I did the test so early was because my NHS tests had not done T3 and I wanted to know what that was, not realising that it doesn't matter at this stage. I had just seen a lot of posts saying 'key thing is T3' so thought I'd run off and get my t3 tested.
The other reason is obviously anxiety!
Thanks so much for all the answers. I appreciate it so much and appreciate being able to ask what turn out to be irrelevant questions. A few less things to worry about for now (I'll find others)
tattybogle "Mine used to be >3000 when i was diagnosed in 2003 , now they are 195 .. despite eating gluten by the truck load for 20 years ."
Wow really. So it you've been munching away on pizza for 20 yr what do you think you did that reduced your inflammation? (This is actually one of the most cheerful things I've read in weeks!)
well i assume over the last 15 /20 yrs most of my thyroid tissue has a now been 'nobbled' ..., so there is less functioning thyroid tissue there for the immune system to attack .. .. so therefore less thyroid peroxidase (from inside the thyroid ) can get spilled into my blood stream .. so therefore , even if thyroid does still get attacked , i get less thyroid peroxidase antibodies showing up ...because there is less thyroid peroxidase for them to fasten onto ( they are like labels saying "clean this up"). That's my current understanding anyway .. but of course nobody really knows .... they don't completely understand how the autoimmune part of the problem works yet.
eg ...... in the same way that if you let teenagers have a party in your house , there is Sh** loads of cleaning up to do the next day ... but if you let some 50 yr olds have a party , there's usually much less carnage to deal with the next day.
The thing is though ( sorry, going to pop your happy smile now ) ... i've not exactly been very well for those 20 yrs .. who knows if i'd have been able to function better if i'd totally removed the gluten and/ or followed an Autoimmune protocol diet and /or taken supplements to improved my nutrient levels ?
Once it became apparent that levo didn't fix me 100% ,i tried loads of dietary improvements , cut out the sugar, and the bread ,and the after dinner smoke....but it never really improved any of the issues i had , so eventually i went back to my 'bad habits' and ate what i wanted and just tried tobe moderate and abstemious.. but not too pedantic about banning any one thing or another totally .
There was nowhere like this forum back then to talk to other people and learn anything, so i didn't know there was much else to be done really apart from take the levo and wonder why (according to the GP) i was 'treated '...... but my body refused to work very well any more .. .. and wonder if it was 'just me' ..... or did i have M.E. now as well .
So my tale is perhaps a warning ...... rather than an advert for carrying on eating pizza .... sorry
Tattybogle. Since I first saw your tag I thought you must be Scottish. Sweet memories. The above contribution is trying to confirm that for me. Please don’t take offence. It’s a Scottish thing. No matter what, I love your honesty and humour about your journey.
thankyou arTistapple.... nope, not Scottish , but apparently i was a very 'funny looking' newborn baby with sticky-up hair..,, some Scottish friend of my Dad's said "Och ..., she looks like a wee tattybogle" ... and it stuck .....so i've been one ever since.
Brands - I'm taking 50mg MercuryPharma and 25mg Wockhart. when the GP agreed that I could go up to 100mg the pharmacy issued new tablets made by Aristo but I'm going to go back to the Pharmacy and ask him to issue Mercury as I don't want to change brands while I'm still titrating to the right dose. I'm also going to try and hold out longer on 75mg so that I'm on it at least 4 weeks, as some here advised. Will see how terrible i continue to feel on 75mg
D3 will be re-tested next week. The prescription has ended and I'm now taking Arctic D cod liver oil/D3 supplement of 1000iu.
I'm a bit charry of taking vitB at the moment as my transferrin saturation level is >47 and my mother has haemachromatosis. I don't understand what high transferrin saturation combined with low folate means, could I be iron overloaded even though Folate is low? hence I am not taking B supps until I work out the answer to this question. Have also asked GP if I can be tested for Haemachromatosis. I have a bottle of Folate supp ready and waiting if it's okay to take it!
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