Test Results show over-replacement but

[Carlax]

Dear All,

I went to the Specialist and he agreed to prescribe T3 until my next review in September. He was quite pleasant and understood some of my points. Unfortunately not all points but nevertheless I believe it was a fruitful appointment.

I got the result of the blood test done on the day. Mind due, one caveat, the T3 gap was 24 hours but the T4 was only 10 hours (not 24hrs). I stopped all supplements ( Iron, Magnesium, Vit C, Bit complex B) a week before the test.

These are the results:

TSH : 0.08 (0.3-4.2)

Free T4 : 14.9 (9.0-19.0)

Free T3: 4.3 (3.0-5.4)

The TSH suggests over-replacement but the other two markers are within range.

The test results are based on 112.5mcgrs of T4 and 10mcgrs of T3.

The suggestion is to go to 75mcgrs of T4 and 20mcgrs of T3 - What do you think?

This is 25mcgrs lower in T4 that the private doctor suggested. I am happy to go to the 75mcgrs suggested by the NHS doctor but should I do it gradually? Just mindful of the fact that I am very reactive to sudden changes in the medication ( whether real ones of placebo, I dont know).

Thanking you in advance

Carla

[SeasideSusie Remembering]

Carlax

Due to the erroneous timing of your thyroid hormones before the test, you have a false low FT3 result and possibly a higher than normal FT4 result.

If that was me I'd prefer to retest with the correct timings the day before the test before making any decision on how to adjust dose(s).

Last dose of Levo - 24 hours before test

Last dose of T3 - 8-12 hours before test, splitting dose into 2 or 3 and taking last part of dose 8-12 hours before time of test.

T3 dose adjustments should be 5mcg at a time, not 10mcg as proposed.

Levo dose adjustments should be 25mcg or less, never more.

Never adjust both at the same time because you need to know how each dose adjustment has changed levels/symptoms.

[Carlax in reply to SeasideSusie]

Hi SeasideSusie,

I will repeat the test then. It makes sense. Thanks for the prompt response. it is very much appreciated. I will see which company I can use for the tests. Thanks

Carla

[SeasideSusie Remembering in reply to Carlax]

If you just want to test TSH, FT4 and FT3 then Monitor My Health (an NHS lab at

Exeter hospital) is cheapest if you're happy to do a fingerprick test. Cost is £26.10 with discount code, details here:

thyroiduk.org/help-and-supp...

The only supplement you need to stop before any blood test, including thyroid test, is any one containing biotin, this is what affects the results when biotin is used in the testing procedure. Your B Complex will contain biotin so stop that 3-7 days before the test but the others you can continue up to and including the day before and take after the test on the day.

[radd]

Carlax,

Your results are good and low TSH level as expected when medicating T3.

How are you feeling? If you are still symptomatic it is too early in this regime to make start radical dose changes.

You need to hold this dose for several months whilst nutrient deficiencies are addressed as this will help meds work their best.

Even allowing for your time gaps between meds & blood draw, you are not over replaced unless thyroid hormone levels go over range.

[SlowDragon Administrator]

Results don’t show over replacement…..low TSH is to be expected when taking T3

When were vitamin levels last tested

[DippyDame]

Your test results don't show over replacement Carlax Why do you think that?

I absolutely would not alter a dose on the basis of TSH alone

It's a red herring to use TSH as a guide to dosing

The science...

bmcendocrdisord.biomedcentr...

TSH only indicates the level of hormone in the serum not the level of FT4 and

FT3 which are the important labs

You will not be overmedicated so long as the active hormone T3 remains within the ref range.

thyroidpatients.ca/2021/07/...

The 24hr T3 gap between dose and test will likely have returned a slightly lower FT3 result than after 8/12 hours... but with your result not so much that you are overmedicated.

If you feel well on 112.5mcg T4 and 10mcg T3 I would be inclined to maintain the status quo and test again with correct timing in 6/8 weeks

Or...

At most I would increase T3 to 15mcg and leave T4 until your next test

How you feel ( good old fashioned clinical evaluation!) is an important guide which medics tend to overlook in favour of a list of numbers on their computer screen.

Changing to 75mcg T4 and 20mcg T3 is excessive.

We are advised to change only on thing at a time which makes it easier for the body to adjust

T3 by 5mcg and T4 by 25mcg

Adding T3 will reduce FT4 in any case

Are your symptoms such that you feel you need more T3?

Have you optimised the essential nutrients....this supports thyroid function and conversion.

Unfortunately medics are rarely clued up about thyroid disease which is why over 120,000 patients have arrived here in need of help.

Just a few thoughts

Good luck

[Carlax in reply to DippyDame]

Hi DippyDame, I am digesting your email. I have had thyroid issues for over two decades but I am quite new to all the info shared here. Loads of good stuff but takes time to digest. I will come back to you with questions.

The comments re over replacement comes from the NHS Consultant. He wrote it down on the letter to my GP.

[DippyDame in reply to Carlax]

I wonder if that consultant is a diabetic rather than a thyroid specialist....many endos are!

Come back to us with any questions you have