Newbie test results- do I need T3: Hi I was... - Thyroid UK

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Newbie test results- do I need T3

15 Replies

Hi

I was hoping for some help with my results as I am still feeling unwell. I have Hashimotos (15 years) and taking 75 of levothyroxine. Do I need to take T3, why is FT4 so high? Here they are:

Vitamin D 88

B12 102

Ferretin 135

TSH (0.27-4.2) 2.46

FT4 (12-22) 24.8

T4 (66-181) 150

FT3 (3.1-6.8) 3.6

Tpoab 191

Tgab 257

I would apprciate any help, thank you

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15 Replies
SlowDragon profile image
SlowDragonAdministrator

welcome to the forum

Was test done early morning, ideally around 9am and last dose levothyroxine 24 hours before test

Are you in U.K.

what’s the units on vitamin D result….nmol?

Presumably both TPO and TG antibodies are high in range

This confirms as you say …that you have autoimmune thyroid disease also called Hashimoto’s

About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high thyroid antibodies 

Autoimmune thyroid disease with goitre is Hashimoto’s

Autoimmune thyroid disease without goitre is Ord’s thyroiditis. 

Both are autoimmune and generally called Hashimoto’s.

In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)

What vitamin supplements are you currently taking

Have you had coeliac blood test done

Are you on strictly gluten free or dairy free diet

Which brand of levothyroxine are you currently taking

Many people find different brands are not interchangeable

in reply toSlowDragon

Than you so kindly for replying. Test was done early morning, last dose of throxine morning before . I am in UK and currently taking a thyroid support and multi. I've been gluten free for 3 years, not dairy free (but have A2 milk). I am thinking I need T3 as well as this does not look like I convert well. The levo are always different brands. I want to bring down TSH but FT4 is already high so not sure what to do........vitamin d 88 nmol, both antibodies high. Not coeliac but am gluten/dairy intolerant

SlowDragon profile image
SlowDragonAdministrator in reply to

EXACTLY what thyroid “support” and multivitamins

Nether of these are ever recommended on here

Suggest you stop both and retest again after 6-8 weeks

Anything labelled thyroid support usually contains kelp or iodine NEVER recommended for anyone with Hashimoto’s

Levothyroxine contains all the iodine you need

Any supplements that contain biotin should be stopped a week before all blood tests

in reply toSlowDragon

Also very confused as it seems the advice around iodine is different. I have also been told I MUST supplement iodine! So confused now

SlowDragon profile image
SlowDragonAdministrator

TSH is too high

Ft4….if you took levothyroxine before test result is falsely high

If last dose levothyroxine was 24 hours before test, you have terrible conversion rate of Ft4 to Ft3

Ft3 far too low

Most likely you need dose increase in levothyroxine

lots of useful references for why TSH should be around or under one on levothyroxine

healthunlocked.com/thyroidu...

Approx how much do you weigh in kilo

pathlabs.rlbuht.nhs.uk/tft_...

Guiding Treatment with Thyroxine: 

In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months. 

The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).

The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range. 

……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.

The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.

in reply toSlowDragon

Many thanks for responding. Last levo was day before. But I was thinking I should be trying T3 rather than more T4? as T4 already so high?

SlowDragon profile image
SlowDragonAdministrator in reply to

if you’re dairy intolerant you need lactose free levothyroxine and dairy free diet

Which brand of levothyroxine are you currently taking

in reply toSlowDragon

The supplements are a very new addititon and I stopped before the test by 3-4 days. The levo is 'accord 50mcg' and' Northstar 25 mcg ' but these brands do change. Was taking Biocare thyroid support but only just started for a few days, then stopped before test. Are you sure I should not be on T3?

SlowDragon profile image
SlowDragonAdministrator in reply to

Accord levothyroxine is not lactose free

Northstar 25mcg is Teva, which is lactose free

Many patients do NOT get on well with Teva brand of Levothyroxine.

Teva contains mannitol as a filler, which seems to be possible cause of problems.

Teva is the only brand that makes 75mcg tablet. So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half

But for some people (usually if lactose intolerant, Teva is by far the best option)

Glenmark or Aristo (100mcg only) are lactose free and mannitol free.

May be difficult to track down Glenmark, not been available very long 

More options on Aristo tablets in pipeline

healthunlocked.com/thyroidu...

I didn’t say you shouldn’t be on T3 ….you probably do

But first you really need lactose free levothyroxine tablets……And retest again

Meanwhile research which endocrinologist you want to see

Email Thyroid U.K. for list of recommended thyroid specialist endocrinologist and doctors who will prescribe T3

tukadmin@thyroiduk.org

Endocrinologist may initially trial liquid levothyroxine …..usually taken as split dose ……before adding T3

SlowDragon profile image
SlowDragonAdministrator in reply to

Biocare contains iodine at quite high dose so might have increased Ft4 levels

what multivitamin were you taking

request GP state on all future prescriptions “Lactose free only “

New guidelines for GP if you find it difficult/impossible to change brands 

gov.uk/drug-safety-update/l...

If a patient reports persistent symptoms when switching between different levothyroxine tablet formulations, consider consistently prescribing a specific product known to be well tolerated by the patient. If symptoms or poor control of thyroid function persist (despite adhering to a specific product), consider prescribing levothyroxine in an oral solution formulation.

academic.oup.com/jcem/artic...

Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).

This makes sense - thank you

jrbarnes profile image
jrbarnes

I had a TSH over 2 and high T4 levels with lower T3. I increased my calories, carbs, and started eating more often throughout the day and my TSH came down and FT3 came up. I always thought it was strange that I had such high T4 levels and an elevated TSH at the same time. It was a mystery to me. Turns out it was a food issue. In these times it's not a common problem to have but I read that fasting and under eating can lower T4 to T3 conversion and raise TSH. Just a thought.

in reply tojrbarnes

Ok- that does sound like a possibility.

Cup-cake7 profile image
Cup-cake7 in reply tojrbarnes

sorry I replied to wrongly person

My results are like yours and do fast. As keen to loose weight how did this go on with eating more regularly

Cup-cake7 profile image
Cup-cake7

interfering Thankyou

May I pm you. Mainly how was weight affected by increasing food as I'm desperate to drop weight and I do fast about I6 hrs most days as told this is good for liver and digestion you can win

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