I’d Be Grateful For Some Advice On These Blood Results For My Mother

[Star13]

So my 83 year old mother has had her blood test back from both her GP and MMH at my insistence. Here are the results:

2021

GP: TSH. 0.7 (0.27-4.2)

FT4. 22pmol. (12-22)

2022

GP: TSH. 1.5. (0.27-4.2)

FT4. 20pmol. (12-22)

MMH: TSH: 1.92. 0.27-4.2)

FT4: 31.6. (12-22)

FT3. 3.2. (3.1-6.8)

I can see that her FT3 is far too low but her FT4 is too high as is her TSH. She is - or was on 75mcg of Levo but GP has just told her on his results to reduce to 50mcg every other day and test in 2 months. He hasn’t seen the MMH results yet.

Be grateful for advice on what best to suggest to her.

she also takes propranolol which was for palpitations 80grams 3 x day. Been on that for 35 years! She takes no vitamins and I can’t get her to test either. The GP is not helpful.

Thanks

[SlowDragon Administrator]

Propranolol slows uptake and conversion of levothyroxine (Ft4 ) to active hormone (Ft3)

Propranolol is frequently used to treat HYPERthyoid patients

It’s extraordinary how many GP’s (and endocrinologists) don’t see the significance of propranolol when hypothyroid and on levothyroxine

She absolutely must NOT stop propranolol…..it has to be weened off extremely slowly

Typically reduce by 5mg per day …..wait 4-6 weeks

Reduce another 5mg …..wait 4- 6 weeks

Etc etc

Last 5mg is hardest ….stop one day a week

Next week stop twice week (not consecutive days) etc

Propranolol

pubmed.ncbi.nlm.nih.gov/168...

labtestsonline.org.uk/tests...

Drugs that may decrease PTH include cimetidine and propranolol.

rejuvagencenter.com/hypothy...

Meanwhile strongly recommend getting vitamin D, folate, ferritin and B12 levels tested

Does she have autoimmune thyroid disease?

Also called Hashimoto’s, usually diagnosed by high thyroid antibodies

[SlowDragon Administrator]

Are you saying she takes THREE 80mg propranolol a day!?!

Request referral to endocrinologist

[Star13 in reply to SlowDragon]

Yes thats what she takes. Its apparently right at the top of the dose range. She's been on it for 35 years. GP is not suggesting she comes off it. As far as I know she's never had her antibodies tested.

Id get her to do a medichecks test with the vitamins and antibodies but its bad enough getting enough blood for the finger prick test for the above test. The GP will only accept tests that he orders and is unhelpful at being told about doing tests he does not suggest.

What is the significance of high TSH and FT4 and low T3 apart from low conversion?

As someone who has Hashi and has always struggled with deficient TSH and low T4 this is new to me. Im on combination therapy but I doubt her GP will prescribe T3.

What is the significance of all of this on a woman of 83 as I thought age can play a part in how much levothyroxin people need?

[SlowDragon Administrator in reply to Star13]

Palpitations can be due to being UNDER medicated

Likely she’s extremely hypothyroid, as seen by rock bottom Ft3

Propranolol stops levothyroxine being used or converted into Ft3 ……puts the brakes on

as you have Hashimoto’s she almost certainly does too

Propranolol tends to lower magnesium

She likely has low vitamin levels that would need improving and levothyroxine dose fine tuning….and get off propranolol…..before even considering adding T3

Would probably take at least a year weening off propranolol ….

I was stuck on propranolol almost 20 years …took me almost 6 months to get off 40mg . More on my profile.

Has she had cholesterol levels tested

High cholesterol linked to being hypothyroid

GP can not initiate T3

Could she see your endocrinologist?

[Star13 in reply to SlowDragon]

GP has made noises about referring her but to a cardiologist NOT an endocrinologist! He thinks by lowering her T4 will sort her out. I have said that her palpitations are thyroid related not heart and she needs an endocrinologist but again the GP won’t be told. He has recently put her on a statin too. He even said that her 44 Hb1 means she has borderline diabetes and must watch watch she eats!! I mean at 83 - really can’t she enjoy life for what time she has left. It’s not as if she eats loads of sugar and she’s hardly over weight either.BTW she’s my step mum so no genetic link to me.

[SlowDragon Administrator in reply to Star13]

She needs to get vitamins tested and go see thyroid specialist endocrinologist privately if GP won’t refer

It’s approx year wait on nhs anyway

Email Thyroid U.K. for list of recommended thyroid specialist endocrinologist and doctors

[e-mail]

nhs.uk/conditions/statins/c...If you have an underactive thyroid (hypothyroidism), treatment may be delayed until this problem is treated. This is because having an underactive thyroid can lead to an increased cholesterol level, and treating hypothyroidism may cause your cholesterol level to decrease, without the need for statins. Statins are also more likely to cause muscle damage in people with an underactive thyroid.

[humanbean]

Low iron and/or ferritin (iron stores) can cause palpitations, tachycardia (heart rate > 100bpm), even chest pain if it gets very severe.

Low iron and/or ferritin is very common in people with thyroid disease.

There is a private finger-prick test which can be done :

medichecks.com/products/iro...

And there is a discount code available for Medichecks on this link :

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