Hmmmm..... results in - should I be pleased or not ??

[goingholiday]

Hello wonderful people,

Following a thyroid and vitamin blood test with Medichecks in May this year, my GP increased my Levo from 75mcg to 100mcg (yaay). I have recently had an NHS blood test and was tested for TSH...... T4 AND T3 .... (another yay). Not sure how to interpret the results and was hoping you kind, knowledgable lot could help me out.

Here are the Medichecks results from 24 May 2022:

TSH 1.28 (0.27-4.2) 25.7% through range

FT4 17.3 (12-22) 53% through range

FT3 3.94 (3.1-6.8) 22.7% through range

Here are my results from 18 August 2022:

TSH 0.23 (0.2-5.5) -1.35% through range

FT4 16.5 (12-22) 45% through range

FT3 4.2 (3.1-6.8) 29.73% through range

I followed the pre-blood test advice given here for both tests. I did actually do a fasting test for the NHS test as well as the Medichecks, not sure if that was necessary thinking about it. After receiving excellent advice about vitamins from Seaside Susie in May, I now take Thorne B complex, D3, D2 MK27, magnesium spray and get selenium from Brazil nuts .... grown in selenium rich soil - another good nugget of information gleaned from this site!!

Symptom wise, I feel better now than I did in May, however the negative value of my TSH in August looks scary. I'm sure I've read that the FT3 should be 65% through range and FT4 should be 50% through range, which I'm not achieving at the moment.

So what I'm asking is - do I worry about the negative TSH? Do I need to do something to increase my FT3 and FT4 ranges? Oh and is the advice to fast prior to a blood test for TSH,T4 and T3?

Much appreciate all the help this forum has given.

[SeasideSusie Remembering]

goingholiday

however the negative value of my TSH in August looks scary.

Please don't look at percentage through range with TSH. It's not needed, we need percentage through range for FT4 and FT3 but with TSH we are looking, generally, for a low in range TSH.

Mose hypo patients are best when TSH is 1 or below but it actually doesn't matter because even though TSH is useful for diagnosis, it has no real use once diagnosed and on thyroid hormone replacement because it's a pituitary hormone not a thyroid hormone, we need the FT4 and FT3 tests to tell us our thyroid status.

I'm sure I've read that the FT3 should be 65% through range and FT4 should be 50% through range, which I'm not achieving at the moment.

You don't have to aim for that. The aim is for you to feel well and you might need levels higher than that, you might need them lower than that, so don't get hung up on having to achieve a particular number or percentage.

So, how do you feel at the moment with FT4 at 45% through range with FT3 at 29.73% through range? I imagine you're not there yet and need an increase in your dose of Levo.

Oh and is the advice to fast prior to a blood test for TSH,T4 and T3?

It's not fasting exactly, it's eating normally the night before but delaying breakfast until after the test on the day (arrange an early test, no later than 9am), just have water, because some food and drink can affect TSH.

[goingholiday in reply to SeasideSusie]

Thank you for the advice and reassurance SeasideSusie. I would certainly like to try a little higher dose of Levo. It's difficult to know if you've reached optimal levels because you always wonder if you could feel a little better. I suppose expecting to feel the same as you did prior to thyroid issues is unrealistic. I did delay breakfast (and my Levo dose), had just water and an 8.10am appointment.

[Regenallotment Ambassador]

Just wondering if you stopped the B Complex for 7 days before testing?

[goingholiday in reply to Regenallotment]

Hi Regenallotment, thank you for the reminder. I stopped B Complex for five days before the test. I had read to stop between 3-7 days so five seemed not too much and not too little!

[Regenallotment Ambassador]

Ah good I was just trying to spot any gaps but you have that covered. 👍

[goingholiday in reply to Regenallotment]

It’s always worth checking, there’s so much information to absorb, it’s easy to forget or miss something. That’s one of the reasons this forum is so good, someone is always there to check, so thank you 😀

[SlowDragon Administrator]

Looking at previous posts you have had very slightly raised thyroid antibodies in previous tests

Have you had coeliac blood test done

Have you tried strictly gluten free diet

[goingholiday in reply to SlowDragon]

Hi SlowDragon, I did have a coeliac blood test done when I was originally diagnosed but need to find out what the result was. Though that was five years ago and I guess that result may not be relevant now. I haven’t tried strictly gluten free and I know I need a test for coeliac before starting a gluten free. Will discuss with my GP. Suppose I’ve been hoping the levo increase and vitamin regime would be enough without having to drastically change my diet 😩 but maybe not !

[SlowDragon Administrator in reply to goingholiday]

If test had been positive you would have been told

Suggest you consider trialing strictly gluten free diet

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common.

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps, sometimes significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse

chriskresser.com/the-gluten...

amymyersmd.com/2018/04/3-re...

thyroidpharmacist.com/artic...

drknews.com/changing-your-d...

Non Coeliac Gluten sensitivity (NCGS) and autoimmune disease

pubmed.ncbi.nlm.nih.gov/296...

The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported

nuclmed.gr/wp/wp-content/up...

In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned

restartmed.com/hashimotos-g...

Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.

Splitting dose levothyroxine and/or gluten free diet significantly improved conversion for this member

See my reply right at bottom of thread

healthunlocked.com/thyroidu...

[goingholiday in reply to SlowDragon]

An informative and helpful response SlowDragon, thank you. Also persuasive ………after this week away on holiday, I shall discipline myself and go gluten free 😊

[Onlymeandyou in reply to SlowDragon]

The link to the thyroid pharmacist article is very interesting, a point of particular interest mentions that gluten can lead the body to attack it’s own thyroid. I often wonder how this relates to people such as myself who have had their thyroid surgically removed? A lot of articles relate to the health of the thyroid etc., How does the advice relate to those of us without?

[McPammy]

Your T3 results look pretty low. Have you considered trying to add some T3 along with your T4. For this you may have to go private for a trial.

[goingholiday in reply to McPammy]

Hi McPammy, the T3 route could well be an option. I know from reading here how difficult it can be to be prescribed T3. The whole thyroid treatment system needs updating.

[raglansleeve]

I don't think that you've done the math correctly. A result of .23 is higher than the reference low of .20. You are still in positive territory.

[goingholiday in reply to raglansleeve]

Well maths was never my strong point 😂but I fed the number into the calculator and it did say on the results from the blood test, “below the low reference range”….. but we all know how misleading reference ranges can be and the best judgement is made by how we feel.

[SlowDragon Administrator]

TSH: 0.23 mU/l (Range 0.2 - 5.5) 0.57%

Many people have TSH below range when adequately treated

T4 therapy

ncbi.nlm.nih.gov/labs/pmc/a...

In a study evaluating tissue function tests before total thyroidectomy and at 1 year postoperatively when using LT4, it was found that peripheral tissue function tests indicated mild hyperthyroidism at TSH <0.03 mU/L and mild hypothyroidism at TSH 0.3 to 5.0 mU/L; the tissues were closest to euthyroidism at TSH 0.03 to 0.3 mU/L [48]. A normal serum TSH level consequently does not necessarily indicate a euthyroid state at the tissue level.

[goingholiday in reply to SlowDragon]

Aaah interesting article and thank you SlowDragon for correcting my maths. Top marks to yourself and raglansleeve 😊