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
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
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
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
Also very confused as it seems the advice around iodine is different. I have also been told I MUST supplement iodine! So confused now
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.
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?
if you’re dairy intolerant you need lactose free levothyroxine and dairy free diet
Which brand of levothyroxine are you currently taking
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?
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
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
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.
Ok- that does sound like a possibility.
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
Latest test results - do I need to increase my T4/ T3?
Latest results -Do I need to increase my t3? 
Blood test results - do I need NDT?
Do I need T3 or increase of levo?
