Advise please on latest blood test.

[PottyDotty]

Following my latest blood tests after further decrease of Levothyoxine from 150mcg to 125mcg.

T3. - 3.2 (range 3.1 - 6.8)

T4 - 19.4. ( range 12.0 - 22.0 )

TSH. - 0.56 ( range 0.3 - 5.0 )

B12. - 641 ( range 200.0 - 960.0 )

Ferritin - 193 ( range 20.0 - 350.0 )

Folate - 10.4 ( range 3.0 - 18.0 )

Vit D not tested but I do take daily Vit D supplements.

GP doesn’t want to see me again until next year, in fact although I tried to get an appointment, there was nothing available for the foreseeable future unless an emergency.

I would appreciate your advise, do I add a tiny amount of T3 or simply take Zinc and Selenium in the hope that it helps conversion from T4 to T3 please?

Very many thanks

Dot

[pennyannie]

Hello PottyDotty :

The accepted conversion ratio of T4 - Levothyroxine is said to be 1 / 3.50 - 4.50 T3/T4 with most people feeling at their best when their conversion ratio comes in at around 1/4 - T3/T4.

To find your conversion ratio you simply divide your T3 into your T4 and I'm getting yours coming in at around 6.10 so very wide from centre and showing that you aren't converting T4 into T3 at all well and you must be feeling quite unwell.

No thyroid hormone replacement works well until your core strength vitamins and minerals are maintained at optimal levels and I try to aim for a ferritin at around 100 : folate at around 20 : active B12 75 ++ ( serum B12 500 ++ ) and vitamin D around 100 :

Are you supplementing ferritin, it looks a little high, do you have an inflammation marker as this can influence ferritin results, and conversion ?

I think adding in a little T3 is likely the next step :

P.S. Looking back i see you were self medicating 4 years ago with T3 - have you stopped taking the Tiromel ?

[PottyDotty in reply to pennyannie]

Thank you pennyannie. Yes, I only took Tiromel for a couple of weeks, then went back to solely Levothyoxine. I do take one gentle iron tablet every other day, mainly because it helps reduce my restless leg at night. I still have plenty of Tiromel left, so thought about just a quarter of a 25mcg tablet a day. I also saw a post that said Zinc and Selenium could help with poor conversion, but no idea if that’s true. Xx

[pennyannie in reply to PottyDotty]

Ah, I spotted another post 4 years ago " thanking everyone " and jumped to the conclusion ( a fault of mine ) that you had continued and been successful with your self medication.

Well, in a perfect world we would test for everything before supplementing anything.

It does seem that living with a slower than normal metabolism, extracting essential key nutrients from food is a challenge and since vitamins and minerals are needed to be maintained at optimal levels for the thyroid hormone replacement to work well, we need to supplement.

Selenium is generally suggested when patients have eye issues and a dose of 200 mcg a week - though if you do not know your levels maybe go with 100 mcg :

I think your conversion too wide of centre to resolve without the introduction of some T3 - Liothyronine - such as Tiromel and since you still some, I'd be tempted to give it another go.

Your doctor doesn't want to see you for another year so you have time to try again and just see how if you can feel a bit better.

Has iron deficiency anemia been ruled out ?

RLS is found in both hyper and hypo patients and there doesn't appear to be any definitive solutions and though I understand your using Gentle Iron as an insurance policy - do not think it is necessary.

[PottyDotty in reply to pennyannie]

Thank you so much for your helpful response. Yes, iron deficiency has been ruled out , but GP is quite content for me to continue with the gentle iron every other day. I will start on a quarter of a T3 tablet and see how I get on. Once again, thank you very much. Xx

[DippyDame]

Why was levo reduced to 125mcg from 150 mcg?

Your T4 to T3 conversion is poor ( high FT4 with low FT3)

Your FT4 is 74% through the ref range but some patients need to go higher to try to raise FT3.

I suspect your GP looked at your TSH and decided" overmedicated"....' reduce levo "

They don't know much about thyroid hormones!

Ignoring the fact that FT3 is the most important lab....and yours is abysmally low!

How do you feel on 125mcg levo ( c/f 150mcg)?

More symptomatic?

Then you need to raise your levo again and optimise the essential nutrients

No improvement...request an appointment with an endo with a view to having a trial of T3 on the grounds of poor conversion

Hmmm! Your GP may not want to see you for a year but he may need to!!

I wonder if they do early morning Triage calls....I only discovered lately that my surgery do this.

Call in, then GP on duty will advise....I managed to speak to a GP last week within 20 mins via Triage.

Don't suffer in silence, they are there to look after you if you feel unwell!

[PottyDotty in reply to DippyDame]

Thank you DippyDame. He actually reduced it from 175mcg to 150mcg to 125mcg since January because T4 was over range. I did try explaining that I needed the T3 to be higher to feel well, but he poo pooed that. Since reducing I do get a lot more symptoms, including carpal tunnel like symptoms at night, really bad constipation, freezing cold even in the sunshine and mood swings! I even printed out a list of my symptoms and gave it to him, all to no avail.

[Sparklingsunshine in reply to PottyDotty]

I don't know if your surgery uses Livi, but a number do, it's free for many NHS surgeries, basically you sign up through the app, go through the personal details and verification procedures and then you can use it to make video calls to NHS GP's who can prescribe and advise. Not your own GP, but another qualified doctor.

You need to be able to take a selfie, had a right laugh when I did mine as I've honestly never taken one before. Its to do with making sure your medical record is actually yours. It must have facial recognition software in it.

You can make appointments, cancel etc through the app. It's free, if your surgery uses it. I think they allow you to make on the day video appointments or a few days in advance. I assume its to try and relieve some of the pressures on surgeries. Just a thought.

[PottyDotty in reply to Sparklingsunshine]

Thank you Sparlingsunshine. No, unfortunately our surgery does not have anything like that and have even stopped patients from emailing the GP or contacting the triage either. I used to have MJog messenging app too, but that’s been discontinued. We have a satellite surgery in the village, but even that’s been shut for a few months too. They are saying it’s due to lack of Doctors!

[Sparklingsunshine in reply to PottyDotty]

Hi

I'm sorry, the state of the NHS is truly shocking. Without wishing to get political, its years of empty promises and under investment in staff and resources. I honestly fear for patient safety.

[PottyDotty in reply to Sparklingsunshine]

Absolutely. I know of many old folk in their late 80s, that still can’t get help from the NHS and some are in real pain. Such a shame. Xx