Surprise, NHS bloods fT3 level tested! - please could someone check& advise? also cortisol?

[turquoisea7]

Hallo,

further to my posting of last week's latest NHS bloods, which SlowDragon and greygoose kindly commented on - could someone advise on this FT3 result actually done by NHS and added to my list of results yesterday, please? what does this say about how well I convert?

We did establish last week that I'm undermedicated on 75mcg as TSH too high and FT4 too low (and I am symptomatic) so am pushing up to 100mcg.

(Of course, they haven't done the iron panel or Vit D again STILL because it's not important...)

So leaving aside comments about vitamins, as we did that last week - here are the thyroid results alone for relationship between T4/T3 : (as mentioned in last week's post, test done per protocol).

Serum TSH 1.69 (0.35 - 5.50)

Serum FT4 15.1 (10.5 - 21.00)

Serum FT3 4.9 (3.50 - 6.50)

also:

Serum Cortisol 529 nmol/L (>374) taken 8.55am

I don't know what the cortisol result means - from what I can research it looks about normal?

with my sincere and grateful thanks for your support.

[SlowDragon Ambassador]

FT4: 15.1 pmol/l (Range 10.5 - 21)

Ft4 only 43.81% through range

FT3: 4.9 pmol/l (Range 3.5 - 6.5)

Ft3 only 46.67% through range

Helpful calculator for working out percentage through range

thyroid.dopiaza.org

This shows you’re under medicated….but (currently) very good conversion rate

Get 25mcg dose increase in levothyroxine

Retest in 6-8 weeks

Approx how much do you weigh in kilo

[turquoisea7 in reply to SlowDragon]

Bless you thank you so much for replying SlowDragon especially with the link for the calculator, that's so helpful.

I thought the conversion looked OK. You say 'currently', does it change?

I am around 73kg (no matter how little I eat, how much I try and push myself to exercise, it is still going up). On that basis I would need around 116mcg - not much more than I'm taking now and feels like it would be nothing like enough. On how I feel now and the blood numbers I'm thinking likely 150mcg at the moment to get me to the ranges people look for at optimum on T4 alone.

[FancyPants54 in reply to turquoisea7]

Avoid the temptation to pick a number and think it will be right for you. You need more certainly, but you can't predict how much more. That must be determined by slow and careful monitoring. You definitely need to go up to 100 now. But from 100 - 125, I would break that step into 2 and increase by alternating those two doses every other day for 6 weeks and test again, then, if necessary go up to the full 125 a day. I say this because it's so easy to miss our sweet spot. I've done it. And it's really hard to unpick it, slow and depressing too. Again, if 125 isn't enough, the move up to 150 should be slow, Something like 150 twice a week and 125 the rest for 6 weeks. It's learning to tweak and let the body catch up that is important.

[turquoisea7 in reply to FancyPants54]

thanks very much for this, I was thinking the same about going up slowly; however doesn't look like this is an option for me at present, my conversion has dropped and I've hit the top of the FT4 range and still symptomatic, so having to stop and rethink what next.

[turquoisea7 in reply to SlowDragon]

May I ask, is there anywhere reliable please, to look for or understand what it is that changes or reduces conversion rate? Is there anything useful/practical to be done when that happens, or is it a case of having to start looking at T3?

[SlowDragon Ambassador in reply to turquoisea7]

Conversion tends to reduce as TSH gets lower (catch 22)

optimal vitamin levels are essential for good conversion of Ft4 to Ft3

Hashimoto’s patients frequently have poor conversion

Splitting dose levothyroxine can help some people. Taking half dose levothyroxine waking and half dose at bedtime….might increase TSH/improve conversion

Improving gut …..so often gluten free/dairy free

Always reduce/cut out soya

[turquoisea7 in reply to SlowDragon]

Thanks very much for this, much appreciated.

[SlowDragon Ambassador in reply to turquoisea7]

Personally

I always get same brand levothyroxine ….dose needs very fine tuning…

I split my levothyroxine, half waking and half at bedtime

Supplement vitamin D and B complex continuously

Strictly gluten free diet and virtually dairy free.

Zero soya

Found I need to reduce levothyroxine a little since cutting dairy

And on 3 x 5mcg T3 via NHS

[turquoisea7 in reply to SlowDragon]

thank you. I have done everything right diet-wise, and I split-dose, but my conversion has dropped in the last 6 weeks; I stopped the B complex for a week or so to take the test, but as we have to do that, catch 22 again. I don't think this is an issue from just a week though, it seems more like the low TSH is the problem.

[SlowDragon Ambassador in reply to turquoisea7]

I always take a separate folate supplement (Jarrow methyl folate) and separate B12 drops during that week of stopping vitamin B complex

Your iron/Ferritin is likely the main issue if ferritin is still low

I have opposite issue….ferritin too high!

[turquoisea7 in reply to SlowDragon]

Thank you, yes I think it must have been your advice that made me get the separate B12 and folate - but will look up the Jarrow as am using Solgar. I do need the reassurance about the TSH issue. Despite reading everything I can and trying to stay level about it, the scare stories have got to me and I'm worried about what it's meant to do to your heart. Unfortunately with my bloods I seem to have no choice in the matter, it's either function and have no TSH or be immobile and have a TSH that will make the GP happy.

[SlowDragon Ambassador in reply to turquoisea7]

it's either function and have no TSH or be immobile and have a TSH that will make the GP happy.

Yes….exactly same for many of us

[turquoisea7 in reply to SlowDragon]

I am a little bit in love with you just for this, thank you thank you. I do need my hand holding with all this, if you hadn't said that I'd still be worrying. As it is if my FT3 doesn't clamber up to a feeling-well level I'll be looking at T3 supplementation. THANK you again for allowing me to breathe a huge sigh of relief and 'sleep' tonight (of course prior to having to battle GP just to stay on the dose I'm on.....)

Didn't I see a question a while back asking if TUK should run a helpline? This is exactly one of those days where I'd have used a service like that.

[SlowDragon Ambassador in reply to turquoisea7]

Usually need to see an endocrinologist to get the “ok” to run with very low TSH

GP’s tend to get the jitters

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

[e-mail]

[turquoisea7 in reply to SlowDragon]

Thanks, I've got the list.

[turquoisea7 in reply to SlowDragon]

Further to the above, may I ask please:

1)How long do you stick a dose out if you're concerned that you might be heading for over-medication on that dose? I read the 6-8 week advice here, I believe on the understanding that at 6 weeks you have maximum effect from a dose? What happens after the 6 weeks - does it continue to build, as I have read some people say, does it 'settle' and subside, or is there no way to know?

2) When is it considered OK to adjust or fine-tune your dose; and when it is it mucking about and not good for you?

[SlowDragon Ambassador in reply to turquoisea7]

Those are tricky to answer

Personally I try to not test until 8-10 weeks after any changes….but especially after a dose reduction

And will likely retest again in another 6-8 weeks after that

Eg …if originally….Ft4 21.8 (12-22)

Small Dose reduction of 25mcg a week (2 days a week of 12.5mcg reduction)

After 10 weeks - Ft4 might be 17

After another 6-8 weeks ….Ft4 might be 15

So you can see reduction is too much ….Ft4 is continuing to drop and likely to go too low

I have been messing about with my dose 28 years!

The adjustments get smaller…but life changes….and then you might need to adjust

Eg I have recently lost stone in weight and gone dairy free….either or both have meant I am now (slowly) reducing dose a very little

[turquoisea7 in reply to SlowDragon]

OK thank you, sorry I should have said I'm more concerned about how long I stick at a dose after a raise, before testing and tinkering, if I'm worried about the question of taking too much. I don't understand why it would be a good idea to keep going for longer if I fear I may be heading for my FT3 getting to the limit or over the top?

[SlowDragon Ambassador in reply to turquoisea7]

Any dose change…..it’s important how you feel

I don’t think there’s any point testing until 8 weeks after a dose increase when fine tuning

Early on, when on low dose, testing after 6 weeks is ok