high T4, Normal TSH, lowish total T3, rising Lipoprotein(a)

[acousmetre]

Hi, I asked a similar question some time ago and I believe the consensus was that I'm not converting T4 well. So I'm here probably to express frustration.... My endocrinologist won't test free T3 for some reason. I went to a gp recently because I'm losing weight. He tested among other things, T4, total T3 and TSH. On this occasion my free T4 is slightly above the reference. It is 1.73ng/dl.Should be less than 1.72. I had thyroid cancer nearly 5 years ago so the idea is to suppress TSH. Oddly it remains "normal" and is currently 2.79 mcUI/mL and in March had peaked at 6.08. Before then it was closer to 0.5. Total T3 is 69 (ref. 60-181ng/dL) at its lowest and steadily declining since 2019.

My cholesterol has been rising. Started taking statins last year and this had it under control but now it is high again. Lipoprotein a was always around 50 (ref.is below 30) but has risen consistently since the cancer and is now 90. Blood pressure also rose but I'm taking medication and it's under control.

I have very bad insomnia and I feel I'm more anxious.

Not really sure of what to do,so if anyone has suggestions, please let me know.Am meant to see the endocrinologist in two weeks but have surgery for spegalian hernia in one week. Hopefully I can keep the appointment. I suspect she will reduce the T4 dose.

my weight loss is probably due to sulfasalazine which I have been taking since the beginning of the year for psoriatic arthritis.

Thanks!

[SlowDragon Administrator]

On this occasion my free T4 is slightly above the reference. It is 1.73ng/dl.Should be less than 1.72. I had thyroid cancer nearly 5 years ago so the idea is to suppress TSH. Oddly it remains "normal" and is currently 2.79 mcUI/mL and in March had peaked at 6.08.

Do you ALWAYS test thyroid levels early morning, ideally before 9am and last dose levothyroxine 24 hours before test

You need TSH, Ft4 and Ft3 tested together

Anxiety is common hypothyroid symptom

Most people when adequately treated will have TSH below one

After thyroid cancer, likely TSH should be below range

Important to test vitamin D, folate, ferritin and B12

What vitamin supplements are you currently taking

[acousmetre in reply to SlowDragon]

Hi, yes, always between 6:30 and 7 Am. I don't take any tablets before the blood test or eat anything. I also take euthyrox when I first wake up usually 5AM, by itself, and eat only after a half hour wait. I take the other medications after breakfast. These include a statin, a blood pressure tablet ("aval", I forgot the full name), bupropion (taking this for some years now) and since January, sulfasalazine. Perhaps it's this last one that's interfering but I've not found any information to say it does. It is known to have lots of collateral affect of which loss of appetite is one. I'm not taking any vitamins presently. Perhaps I should. My vitamin D was tested and was towards the lower end of the reference range. B12 result hasn't come back yet but I think it was tested. Usually it's ok. Ferritine and folate not tested.

[SlowDragon Administrator in reply to acousmetre]

High cholesterol is linked to being under medicated for thyroid

Cholesterol levels should reduce as levothyroxine dose is increased

Approx how much do you weigh in kilo

How much levothyroxine are you currently taking

Nothing to eat or drink apart from water for at least an hour after taking levothyroxine

Many people find it better/more convenient to take levothyroxine at bedtime

What’s your vitamin D result

[acousmetre]

89Kg, 187cm. 175mcg Monday-Thursday, 150mcg Friday-Sunday. I was advised to wait 1/2 an hour before eating anything or drinking coffee, etc, which I do. Vitamin D was 34ng/ ml (ref. above 20. "People at risk": 30-60). My TSH only started to go haywire in March where it jumped to 6. Before that, since starting treatment in 2017, it was always suppressed. The thing that has changed is sulfasalazine, which I started taking in January or February.

[SlowDragon Administrator in reply to acousmetre]

Looks like sulfasalazine maybe the issue then

Quick look through these papers…..Says it may lower folate levels. That would affect thyroid levels

There may be other info in here too

sciencedirect.com/topics/ve...

Discuss stopping sulfasalazine with your doctor