Blood test results,advice welcomed.

[Robbo1972]

Hi,

I have Graves disease and after having RAI in Feb have been on Levo(currently 100mcg).The only other medication I take is Proplanolol (2 x 40 mg) daily.

I took the blood test at 9am,24 hours after any medication.

I've been advised to contact my gp in the morning which I will do but am hoping for some expert analysis from you clever lot.

Ferritin 546 (30-400)

Vit B12 114 (37.5-150)

VitD 47 (50-200)

TSH 2.27 (0.27-4.2)

FT3 4.28 (3.1-6.8)

FT4 25.5 (12-22)

TgAb 3927 <115

TPo 312 <34

Would appreciate any feedback,thanks.

[PurpleNails Administrator]

The levo is not working well because it’s not converting to FT3.

Your FT4 is a little over range at 135% of range

But your FT3 is 31.8% or range.

Your doctor will likely say you need to reduce levo as over, but this will also lower FT3.

How do you feel? Do you have hypo symptoms?

Lowering propranolol very slowly might help. Propranolol lowers conversion and can also deplete magnesium. Try a magnesium supplement.

Vitamin D not optimal.

High ferritin can be due to inflammation. Is dr investigating?

[Robbo1972 in reply to PurpleNails]

Hi PurpleNails,Lack of energy and swollen hands and feet are the most noticeable symptoms.I walked 10k steps on Saturday and half way through my hands swelled up so much that I couldnt bend my fingers,not sure if that's a hypo symptom.

Not sure I can risk lowering propranolol as it's helped me so much mentally.

Magnesium supplement I will look into.

Forgot to put CRP was 2.31 (0-5),only just received results so will contact gp in the morning.

Many thanks for the reply.

[PurpleNails Administrator in reply to Robbo1972]

Could be a hypo symptom, it’s fluid retention oedema.

Your thyroid is still being affect by the RAI treatment.

The ablation can take many weeks, even months & longer to complete its full affect. You would expect high Antibodies at this stage.

They may be an alternative to propranolol. I reduced 10mg per week, from 3x 40mg daily but have stuck with last 20mg & I get migraines unless maintained.

Are you still monitored by endocrinologist?

[Robbo1972 in reply to PurpleNails]

Yes,have a blood test every 2 months and he rings me re the results.I wanted a bit more detail this time so went via Medichecks.Will contact him with the results.Also struggling with having a beer,low tolerance,do you know if that's due to being hypo or is it to do with the beta blocker?

[PurpleNails Administrator in reply to Robbo1972]

Alcohol intolerance is a hypo symptom.

Was folate tested?

[Robbo1972 in reply to PurpleNails]

Aah ok thanks.Yes unfortunately there was an error with the folate test,was a fringer prick test.

[jimh111]

Your blood test results are somewhat inconsistent. With your high fT4 and average fT3 I would expect your TSH to be low. You also have very high antibody levels. It’s possible you have some thyroid tissue left that is secreting some hormone as 100 mcg levothyroxine is not a lot for someone who weighs 90 kg.

The propranolol is not a good idea as it interferes with T4 to T3 conversion. On the one hand you are supplementing hormone and on the other you are taking propranolol to reduce hormone.

Do you have symptoms at the moment and what are they? I would aim to wean off the propranolol and reduce your levothyroxine. If you need a beta blocker they should use one that doesn’t affect thyroid activity now that you are no longer hyperthyroid (other than from too much T4).

Your symptoms are most important now with a view to coming off propranolol.

[Robbo1972 in reply to jimh111]

Hi Jim,6 weeks ago my TSH was 15 so there's been a massive reduction in that time.

I was advised on here re the negative effects of propranolol and conversion of T4 to T3 but unfortunately my gp said he'd never heard of that and checked the NICE website and confirmed that I was on the correct beta blocker.

I'll mention this again tomorrow and try and get it changed.

Many thanks.

[jimh111 in reply to Robbo1972]

NICE (BNF) recommends propranolol for treatment of thyrotoxicosis bnf.nice.org.uk/drugs/propr... . Hence, it should not be used for treatment of hypothyroidism.

[pennyannie]

Hey there again :

How are you feeling now, as it's been around 5 months since RAI hasn't it ?

RAI is a slow burn and there is no time limit on how long it takes for this toxic substance to fully disable the thyroid in situ.

Well your T4 is over the range and your doctor will likely suggest a dose reduction, and your TSH though in the range is too high for someone on thyroid hormone replacement.

Reducing your T4 may see your T3 reduce further which currently is only at around 32% :

We generally feel at our best when both the T3 and T4 are in the ranges and with a T4 up towards, or in the top quadrant of it's range at around 80% as this should, in theory, then convert to a decent level of T3 at around 50/60% of it's range.

The accepted conversion ratio when taking Levothyroxine only is said to be 1 / 3.50 - 4.50 T3/T4 and we generally feel at our best when we come in at around 4 or under.

So if we divide your T4 by your T3 we get your conversion coming in at 5.30 so wide of centre and you are struggling to utilise well the T4.

The propranolol will likely be compounding the T4 conversion, so maybe, if a beta blocker is still required ask to switch to one that doesn't block T4 to T3 conversion.

Your vitamin D needs to be up at around 100 :

Your ferritin looks very high - do you have a reading there for inflammation ?

I read that RAI can cause antibody interaction which may explain the Tgab and TPO readings at this point in time.

[Robbo1972 in reply to pennyannie]

Hi PennyAnnie,To be honest I don't feel any different,still feel tired after 10 mins gardening for example.

Will ask about swapping beta blocker.

CRP HS 2.31 (0-5)

Thanks for replying.

[pennyannie in reply to Robbo1972]

That's not unusual I was exhausted for a good few years :

Just do what you can - don't push yourself as you haven't enough T3 ( energy ) and will likely get ' payback ' if you overdo things and feel even more tired.

Ferritin can be high because of inflammation - but it needs mentioning to the endo:

Your inflammation marker isn't very high and likely due to RAI aggravated antibodies.

If you go into the Thyroid Uk website there is a list of both hyper and hypo symptoms

it just might help you focus on symptoms as you go through this phase, so you have an idea what's going on, as blood tests are just a snapshot in time :

It's quite amazing how many symptoms there are, and yes, there are those that can be both hyper or hypo so you may well be ticking boxes in both columns.

thyroiduk.org

[Robbo1972 in reply to pennyannie]

Many thanks for the advice!

[Gingernut44 in reply to Robbo1972]

Have a look at the following, you could print it off to show your GPpubmed.ncbi.nlm.nih.gov/168...