I know that the best time of day to take a thyroid test is first thing fasting and not to take your medication before the test. I have a Medichecks test booked for next week at 10am - TFT and iron. The reason I chose 10a.m. was to avoid the rush hour which is horrendous near me and the 35 minute journey to the clinic could easily double. Medichecks advise to have the test before 10a.m but I am sure I have read somewhere that 8.30a.m is preferable. I do not want to waste the blood tests by having them too late but I also don't want to sit in a traffic jam for ages. I am taking NDT and suspect my TSH will be suppressed anyway. It was last time. Any suggestions?
Many thanks
Written by
Caze
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An early fasting test is only important for TSH. 9am is the best time if TSH is important if you look at the graph below. However, your TSH is going to be suppressed anyway so testing at 10am wont really make any difference. It's the FT4 and more importantly FT3 that you need to make sure are pretty accurate and you do that by timing your last dose of NDT 8-12 hours before the test, splitting your dose the day before if necessary into 2 or 3 doses.
Many thanks for your message. I recently had a blood test via my GP at 8.30a.m. I was taking 2.5 grains of NDT split throughout the day with half a grain before bed. My results were :
Serum free T3 level
6.1 pmol/L
2.4 - 6.0
Abnormal
25 Aug 2022
Serum free T4 level
17.8 pmol/L
9.0 - 23.0
Normal
25 Aug 2022
Serum TSH level
< 0.01 mU/L
0.30 - 4.20
Abnormal
25 Aug 2022eGFRcreat (CKD-EPI)/1.73 m*2
88 mL/min/1.73m2
> 89
Abnormal
25 Aug 2022
The last test was listed under urea and electrolytes so I believe it is to do with kidney function. I have looked it up and I do not think it is anything to worry about. Besides I have a GP telephone appointment next week so I can discuss then.
The T3 is over range and the FT4 is a little high. (STTM - ideal FT4 mid range)
I belong to the STTM forum and when I posted my results I received this reply
Re: #adrenalfatigue
From: Tammy Kuhn
Date: Wed, 31 Aug 2022 12:37:45 PDT
Sounds like RT3 So wish you had test! And we don't take a night time dose
before labs. Need to move those up! All that explained here!
With all the stress.....I would guess RT3! Drop down to 1 grain and add
T3. That would be the RT3 protocol. 2.5-5 mcg dosing every 4 hours three
times a day. Every 5-7 days increase each dose 2.5-5 mcg.
Your pot/sod needs love. 4.2 for pot and 142 for sodium.
So sorry about the car accident. Hope husband feeling better.
For night high, add some nice magnesium glycinate.
Tammy
The car accident she refers to was last Tuesday - car written off - other driver drove on the wrong side of the road going over a bridge. I was not in the car - husband driving - lucky to escaped with minor injuries.
So as I had already booked and paid for a full iron panel with Medichecks I thought I would repeat the TFT without the bedtime dose. I have also paid for a RT3 test from the Thyroid clinic so I can be sure I have done all the correct tests before making the changes Tammy has suggested. However I am not sure I needed to bother. What are your thoughts?
I have to say I don't follow STTM, and there are members here who don't really have much good to say about them.
As for rT3, there are many reasons for high rT3 and if you test it will tell you if it's high but it can't tell you why it's high. We tend to suggest here that it's not worth the expense or the long wait for the results because it really doesn't tell you anything that looking at your FT4 and FT3 can't tell you.
The only thyroid-related reason for high rT3 is an excess of unconverted T4.
Other conditions that contribute to increased Reverse T3 levels include:
· Chronic fatigue
· Acute illness and injury
· Chronic disease
· Increased cortisol (stress)
· Low cortisol (adrenal fatigue)
· Low iron
· Lyme disease
· Chronic inflammation
Also selenium deficiency, excess physical, mental and environmental stresses. Also Beta-blocker long-term use such as propranolol, metoprolol, etc. Physical injury is a common cause of increased RT3, also illnesses like the flu. Starvation/severe calorie restriction is known to raise RT3. Diabetes when poorly treated is known to increase RT3. Cirrhosis of the liver. Fatty liver disease. Any other liver stress Renal Failure. A fever of unknown cause. Detoxing of high heavy metals.
Also, rT3 doesn't hang around long, it gets converted, by deiodinase, to T2, T1, etc.
We suggest, with NDT and T3, that the last part of the dose should be 8-12 hours before testing. This is because the T3 has a half life of 24 hours so if you test too far away from last dose you will get a false low FT3 and if you take your dose before the test you'll get a false high FT3.
Now you have to decide which information you wish to go with 😊
Many thanks for all the information. but disappointed about your comments re STTM. As I was trialing a course of NDT I thought it best to join the STTM forum - thought they were the NDT experts!
Bought the book etc . Do you know the nature of the criticism by our members?
Not sure what to do now. My blood results are high - I am not low on thyroid hormone but I feel lousy so back to the drawing board.
I feel that I have 2 choices - lower the NDT to say 2 grains and see how I feel. Could then have a TFT plus RT3 test (already paid for!) or I could follow the RT3 protocol and drop to 1 grain and add in T3. Any ideas?
Of course it maybe that NDT does not suit me at all or the brand.
I know I do not convert well - on T4 alone - my T3 is always low.
My cortisol results were a mixture of highs and lows with DHEA low so I think there is a good chance I either have a reverse T3 problem or I am pooling . I am tired and not good on my current dose of NDT although my results are high so something is off. I am going to have a full iron panel next week as I know low iron can influence uptake of thyroid hormones. The STTM and RT3 adrenal forum both hold the opinion that it takes 12 weeks to clear RT3 but from the links you provided it would seem that RT3 is cleared quite rapidly. Very confusing. I am supporting my adrenals with adrenal cocktails, adrenal cortex 50mg for my late afternoon low and Holy basil at bedtime to lower my night time high but perhaps this is not enough so another saliva test might be an idea.
Do you know the nature of the criticism by our members?
I can't remember specific details I'm afraid, but certainly they're not held in high regard by some members.
Could then have a TFT plus RT3 test (already paid for!) or I could follow the RT3 protocol and drop to 1 grain and add in T3. Any ideas?
No ideas about the rT3 protocol because as I said, rT3 is said not to be around for too long, it's converted fairly quicky to T2, T1, etc.
FT3 level: 6.1 (2.4 - 6.0) = 102.78% of range
FT4 level: 17.8 (9.0 - 23.0) = 62.86% through range
Have you ever tried Levo plus T3? This gives freedom to fine tune dose of each hormone rather than have the set ratio of 4:1 in NDT and suit some people infinitely better. I didn't do well on NDT but find that on Levo plus T3 at a ratio of 8.5 : 1 is pretty good for me.
My cortisol results were a mixture of highs and lows with DHEA low so I think there is a good chance I either have a reverse T3 problem or I am pooling
Pooling is said to be discredited. You might want to read about pooling in this thread:
But the website has lots of out of date and inaccurate information. Wrong company names. Two different lists of ingredients for a single product. Typos. Things that you can ignore the first time you seem them, but when they remain wrong years later, undermine trust. And makes it more difficult to find the things she writes about!
It is a pity the information is not up-to-date as a lot of people turn to these sites for help when doctors have been unhelpful or their symptoms are unresolved.
Caze my TSH is suppressed and my surgery doesn't do early morning thyroid tests so I always have mine done around 2pm which fits perfectly with my t3 dosing. Do what suits you and then continue to do that for subsequent tests so you can compare like for like.
Many thanks for your message. I am having a full iron panel next week and vitamin D just done and fine. My last B12 was OK and I do supplement so I think that is OK too. I think the culprit is adrenals - so I may do another saliva test next month - last one done in April.
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