High T4 low TSH

[Knip]

Thyroid results with the normal range below.

Hi I have just seen my latest Thyroid test results. They are as below.

Serum TSH level

< 0.01 mIU/L

0.27 - 4.20

Abnormal

10 Aug 2022

Serum free T4 level

25.9 pmol/L

12.0 - 22.0

Abnormal

10 Aug 2022

My results are clearly abnormal as markded.

My Thyroxine was increased from 100mg to 125mg two years ago, so I guess I'm right in thinking it needs to be brought back down again. I have been on Methotrexate and a high dose of steroids so could these in anyway have caused the changes?

Has this happened to others? I know that mine is autoimme because the antibody was found five years prior to me needing medication.

Thank you in advance for any comments,

Knip.

[PurpleNails Administrator]

Your FT3 hasn’t been tested so it’s not known how well your T4 is being converted to FT3.

What time was the tests taken? TSH is highest in morning then lowers throughout day.

Was test taken after taking dose?

Doctor will suggest reduction usually alterations are by 25mcg - but how do you feel - Do you feel over replaced - have any symptoms?

Has Folate, ferritin, B12 and vitamin D been tested.

[Knip in reply to PurpleNails]

Thank you Purple Nails. I don't feel any different in any way and feel quite well. As with others in the south of England I am finding the intense heat hard to deal with...but I'm not alone in that. My test was taken at 11.30am after having my Thyroxine 7.30am. My Vitamin D3 and B12 were tested six months ago and both were in the normal range and I know that I am slightly anaemic...and have been for a couple of years. I will let you know when I hear from my GP, which will probably be in early August when I am have a check up re my Rheumatoid Arthritis. Take care, Knip.

[PurpleNails Administrator in reply to Knip]

Recommend on this that forum blood testing should ideally be earning morning. Just before 09.00 after fasting overnight (lots of water) Delay levo until after draw as taking a few hours before shows a peak level. Avoid biotin week before as can skew results as can interferes with testing process. (Check supplements).

This shows highest TSH lowest FT4 and ensures consistent results.

[Knip in reply to PurpleNails]

I'll follow that advice in future. I used to feel so auite tired and suffered from the cold until my Thyroxine was increased to 125mg from 100mg...it made quite a difference. I don't take Biotin, just Vitamin B6 plus calichew which is Vit D3 and Calcium. As I said I also take Methotrexate and Budesonide, along with a few other prescription drugs. Thank you again, Knip.

[greygoose]

As you have Hashi's, it could be that your high FT4 has nothing to do with your dose - which is not particularly high. If your last increase was two years ago, I imagine you have other results on the same dose, no? Was the FT4 equally high on those?

[Knip]

Yes Greygoose I only have only had one previous test six months after the dose change, so nearly two years ago. My results then were in range, Thank you, Knip.

[SlowDragon Administrator]

Steroids will lower or suppress TSH

Ft4 is falsely high as you took levothyroxine before test

Refuse to reduce dose based on this result

Only ever test thyroid levels early morning, ideally just before 9am and last dose levothyroxine 24 hours before test

Essential to test vitamin D, folate, ferritin and B12 at least once a year

Please add most recent results and ranges

Levothyroxine must be taken on empty stomach and then nothing apart from water for at least an hour after. No other medications or supplements within 2 hours. Some should be at least four hours away

[Knip in reply to SlowDragon]

Thank you SlowDragon for your helpful reply. I am very careful re the timing, and usually take my Thyroxine during the early hours around 4am, but didn't wake so took it later with my other meds an hour later.

[SlowDragon Administrator in reply to Knip]

If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test

If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal

[Knip in reply to SlowDragon]

Got it, thank you. I'll post how I get on when I see the GP in early August, unless of course, I get a call from them before then. K.

[SlowDragon Administrator in reply to Knip]

Suggest you get FULL thyroid and vitamin testing done yourself, with correct timing…..ideally 6-8 weeks after stopping steroids (if these are temporary)

Essential to test vitamin D, folate, ferritin and B12 at least once a year

How much vitamin D are you currently taking