New results. Hoping for clarification.

[arTistapple]

Results as follows.

Decided I needed a blood draw as I was having trouble doing finger pinprick method.

Unfortunately the first appointment was at 9.50 am! I knew this would probably effect the TSH but I was not so concerned about that. However I am now concerned about the thyroid levels as there is quite a difference and a considerably lowering of both % wise since the last test. Not sure if the ratios differ. Can’t get my head around that!

TSH 1.08 (0.27 - 4.2) Previous test 1.01.

FT4. 18.4. (12 - 22). 64% through range. Previous test 20.7. 87% through range.

FT3. 4.01. (3.1 - 6.8) 24% through range. Previous test 4.33. 33.24% through range.

CRP. 7.34. (0 - 5)

Ferritin 483 (13 - 150). Still high but slightly reduced. Apparently I could give blood!

Folate - serum. 13.82 (>3.82)

Vit B12. Active 136 (37.5 - 150) Improved from 118. 600ug per day.

Vitamin D 94 (50 - 200) Improved from 48. 5000 IU (125 ug) with K MK-7 per day.

Thyroglobulin Antibodies 269 (<115)

Thyroid Peroxidase Antibodies 176 (<43)

So, has the later blood draw caused the rather large differences in the thyroid levels?

I got a long letter about the ferritin levels and CRP levels, which are being checked by my GP. Another test for that on 17th October due to “high staff sickness levels”. Liver enzymes and kidneys checked already regularly by GP. I know I have 3rd stage kidney disease. Since last testing I have been told I have type 2 diabetes, a bit of a surprise since the tests results they send me make it look like I am always near or on the cusp of diabetes.

The Vitamin levels seem better so I had hoped for an up in T3 conversion but T4 also lower!

Should say I am better in myself (I think that is because of the forum frankly) but physicals are very poor. I have to be taken everywhere now. Daughter has insisted on me attending a craft class with her and mentally feel better for that too. Experiencing some of the real world not all just in my head. However we tried the theatre last week. It was absolute torture (muscles) attempting a short walk between public transport and back home. I had to be supported all the way. I have also experienced a very bad angina attack (shock of being trolled) not had since beginning levo. Exercise over the period has definitely been less (possible unhelpful effect). I just can’t get anything else done in my life if I exercise (tax returns, driving licence people, paperwork of any kind really, cooking and washing) I do no housework whatsoever. Survival only. And yet apparently I look well even if pretty obese.

AND WHAT TO DO NOW? Advice appreciated.

[SeasideSusie Remembering]

arTistapple

So, has the later blood draw caused the rather large differences in the thyroid levels?

No. Timing of blood draw only affects TSH.

However I am now concerned about the thyroid levels as there is quite a difference and a considerably lowering of both % wise since the last test. Not sure if the ratios differ. Can’t get my head around that!

You just divide the FT4 result by the FT3 result (as long as units of measurement are the same, which they generally are in the UK).

FT4. 18.4. (12 - 22). FT3. 4.01. (3.1 - 6.8)

So FT4:FT3 ratio is

18.4 divided by 4.01 = 4.58 : 1

Previous test 20.7. Previous test 4.33.

20.7 divided by 4.33 = 4.78 : 1

So allowing for natural fluctuation the ratio is basically the same.

[arTistapple in reply to SeasideSusie]

Thank you for getting back to me so promptly. OK so ratio is pretty much the same. Don’t quite get the implications of that. Does this mean I am ready to start T3? Elsewhere on the forum I have made a note from, “FT4 and FT3 should be 75% through the range”. I now realise this is not enough information for me as my circumstances are clearly different from that. I am nowhere near either of these percentages. It’s still my understanding that conversion is an issue but do I need more T4 to work alongside T3? Presently on 100mcg levothyroxine only. Doc does want to give me more! I do have Uni Pharma 25mcgs in my hot little hands, bought for self medication. If I am ready for T3 what dosage should I start at? I would prefer to start gently. Generally I respond quickly whether badly or well to medications.

[SeasideSusie Remembering in reply to arTistapple]

arTistapple

OK so ratio is pretty much the same. Don’t quite get the implications of that.

FT4 and FT3 should be reasonably well balanced, that can be seen by looking at FT4 and FT3 results and yours show they're not which shows poor conversion.

Good conversion takes place when the ratio of FT4 : FT3 is 4:1 or below. Your ratio is 4.58 : 1 (previously 4.78 : 1) so again that shows poor conversion.

Does this mean I am ready to start T3?

Possibly. See below **

Elsewhere on the forum I have made a note from, “FT4 and FT3 should be 75% through the range”. I now realise this is not enough information for me as my circumstances are clearly different from that. I am nowhere near either of these percentages

That is a generalisation and not set in stone. It's not a phrase I use because we are all different and can feel well with different percentages/levels. It's very individual.

It’s still my understanding that conversion is an issue but do I need more T4 to work alongside T3? Presently on 100mcg levothyroxine only. Doc does want to give me more!

** We tend to suggest that members take enough Levo to bring their TSH down to below one, this then gives the highest possible FT4 level to compare with FT3 to check conversion.

Your TSH is 1.08, it might possibly have been a little higher if you'd tested at 9am - see graph below.

So you could try an increase in Levo which would reduce your TSH and increase your FT4, it may also increase your FT3 but it's my guess the FT3 will only increase by the same proportion as before and your conversion will still be around the same.

You could start your T3 now. The way to start is just add 1/4 of a tablet and any increments should only be by 1/4 of a tablet. Don't reduce your Levo, some endos automatically reduce Levo dose when adding T3 but that's only necessary when FT4 is close to the top of the range or over range. Adding T3 lowers FT4 (and TSH) and you don't really want to lower your FT4 as it's only 64% through range.

So you could add 1/4 of a tablet, you can take it at the same time as your Levo, and wait 2 weeks, see how things are. You can then add a second 1/4 of a tablet and take as a separate dose, maybe late afternoon, maybe before bed - you'd need to experiment to see which suits you. Then I would suggest you wait 8 weeks and retest to check your levels, see how they've changed, and how you feel. You may or may not need to add more. More isn't necessarily better, it's the right balance of Levo and T3 that you need to aim for. I got up to 31.25mcg T3 with my Levo at one point but time and tweaking has shown me that I actually only need 18.75mcg (3/4 of a 25mcg tablet). Some members are fine with a lowish FT4 as long as FT3 is in the upper range, experimenting has shown me that I need both FT4 and FT3 somewhere around 60-70% through range. We just have to find what's right for us.

TSH

[arTistapple in reply to SeasideSusie]

Thank you SeasiseSusie. I will take time to read this thoroughly, again and again. I am very emotional receiving this reply from you. I am quite overcome. I hope I can make this work.

[arTistapple in reply to SeasideSusie]

OK SeasideSusie. I think I have got that. I have now been reading more posts re: taking T3 now that I seem to be ‘there’. One question hanging out there about my last results. Why, when I have been so good on compliance, taking my meds correctly and upping my vitamins etc, has T4 level dropped? I understand the T3 conversion ratio is the same. That makes so much sense but I don’t understand why the T4 has dropped. It might have nothing to do with anything but is there an answer I am just not seeing?

[SeasideSusie Remembering in reply to arTistapple]

arTistapple

I don’t understand why the T4 has dropped.

Levels aren't static, they fluctuate to a degree all the time. You can have a blood draw at 9am and another one the same day at 9.10am and chances are the results wont be exactly the same. You could repeat the tests a week later and the new results probably wont be the same as the previous ones.

FT4. 18.4. (12 - 22). 64% through range. Previous test 20.7. 87% through range.

Looking at the results, the difference in percentage looks quite large. However, when you look at the difference in the actual number it's 2.3 points difference and it isn't as though you've gone from top of range to bottom of range, it could just be the natural fluctuation. You can see from the graph below how FT4 level fluctuates throughout the day.

Also, this new test was at 9.50am, what time was your previous test?

FT4

[arTistapple]

Old test was about 8.30am. I see from the graph even less than an hour makes a difference! It’s another reason to be tested at a regular time of day; even if we are not bothered about the TSH. Still, as you have pointed out other things have pretty much stayed the same, particularly that conversion ratio. I was focused on my symptoms. I feel more steady in myself since I joined the forum (although you might judge differently if you saw some of my angrier posts) but physicals no better and ‘spreading’. So thank you for satisfying me. You can only learn so much from other people’s posts, particularly if you have any brain fog. I see there is a lot of merit in that old saying, “physician heal thyself”. It’s what we are all trying to do with your help and experience. Thanks again.