Test results help please

[Fourwhitesheps]

Hi I am new to the site so thank you. I have had an under active thyroid for 20 years plus and have always been on 125mg of levothyroxine . I have always relied on the doctors blood tests and always been told that my levels were in range. Have just had a lab test done results are.

TSH result 0.7mu/L(normal range 0.27-4.2mU/L

FT4 result 22.1 pmol/L high normal range 12 - 22 pmol/L)

FT3 result is 4 pmol/ normal range 3.1 - 6.8 pmol/L)

Vitamin D result is 76 nmol/L

I am seeing my doctor on Monday and will ask for B12 and iron blood tests. I have been poorly for 6 weeks now had a funny turn with acid reflux and chest pain so my doctor has referred me to the chest pain clinic. I have been suffering with tinnitus, muscle aches in my arms and shortness of breath. The doctor has put me on sertraline as feels I am depressed but I am wondering if this is all connected to my thyroid. Thank you for taking the time to read.

[Buddy195 Administrator]

Welcome to the forum Fourwhitesheps,

I was diagnosed by my GP as having health anxiety and offered anti depressants, but in my case the increased anxiety was definitely related to my thyroid medication and key vitamins (ferritin, folate, vitamin B12 and vitamin D) not being optimal. High anxiety has been my most troublesome thyroid symptom, but has settled with optimal combination treatment (Levothyroxine plus Liothyronine).

One important thing I’ve learned from this forum is that when GPS say ‘in range’ this is very different from levels being ‘optimal’.

Many of us with an under active thyroid have stomach issues. I have found a gluten free diet really helpful in resolving all gastritis issues I had previously.

I’ve ended up in A and E with palpitations and fast pulse and been referred to cardiology for further tests. In my case, these symptoms occur when my FT4 goes over range.

Your FT4 is at the top of the range, but your FT3 is low, highlighting poor conversion. In the first instance, I would look to optimise key vitamins (after testing first) and if your FT3 remains low, I would seek an appointment with an endocrinologist mindful to prescribe Liothyronine.

[Fourwhitesheps in reply to Buddy195]

thank you

[pennyannie]

Hello Fourwhitesheps and welcome to the forum :

What was the reason given for your becoming hypothyroidism ?

T4 - Levothyroxine is a storage hormone and needs to be converted by the body into T3 the active hormone that runs all the body's functions including your physical, mental, emotional, psychological and spiritual well being your inner central heating system and your metabolism.

Your own ability to convert the T4 medication into T3 can be compromised by non optimal levels of ferritin, folate B12 and vitamin D, inflammation, antibodies, any physiological stress ( emotional or physical ) depression, dieting and ageing.

The accepted conversion ratio of T4 into T3 is said to be 1 / 3.50 - 4.50 T3/T4 with most people feeling at their best when they come in this range at 4 or under.

So, when taking T4 only medication - to find how well you convert you are converting T4 into T3 you simply divide your T4 by your T3 and I'm getting yours coming in at around 5.50 so showing you very wide of centre and struggling on T4 medication to function well.

Your doctor my say you are overmedicated as your TSH is low and your T4 slightly over range but it would be a retrograde step to reduce your dose as that will likely reduce your T3 even lower.

Your T3 is only 25% through the range, and we generally function better when T3 is up and over around 50 - 60% of the range and running slightly behind one's T4 % through the range.

Your conversion of T4 into T3 maybe resolved through optimal vitamins and minerals and if not the logical next step is to consider adding a little T3 - Liothyronine to your prescription to even up the T3/T4 imbalance.

In the first instance I believe you need a full thyroid panel to include the vitamins and minerals etc as detailed above and then we can see exactly what is going on .

If you doctor isn't able to run the full thyroid panel there are private companies listed on the Thyroid UK website - thyroiduk.org - which is the charity who supports this forum, who can and where we all start our thyroid health journey.

Arrange an early as possible morning appointment and fast overnight, just taking in water and take your daily dose of T4 after you have had the blood draw. Stop any supplements you maybe taking around a week beforehand so we can see exactly what your body is holding on to.

When with the results simply start a new post with the results and ranges and you will receive considered opinion about your next best step back to better health.

We are a patient to patient forum and this is where we all start off and then some of us tend to give back once well, with symptoms relieved, and happy to share our solutions.

[SlowDragon Administrator]

Which brand of levothyroxine are you currently taking

Do you always get same brand levothyroxine at each prescription

Do you normally take levothyroxine waking or bedtime

Any other medications or supplements must be at least 2 hours away from levothyroxine

Do you have autoimmune thyroid disease also called Hashimoto’s, usually diagnosed by high thyroid antibodies

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

Request full iron panel test for anaemia including ferritin

B12 and folate tested too

If not ever had thyroid antibodies tested request they are tested now

If know you have high thyroid antibodies, request coeliac blood test if not already on strictly gluten free diet

Ft3 is low …..improving low vitamin levels frequently increases conversion rate of Ft4 to Ft3

[TSH110]

Your T3 should be in the top third of its range ie above 5. 1 but it is only 4 so you are not properly optimised and this could be causing your symptoms. You have room for incraeasibg your dose as TSH could go lower (down as far as 0.2) but your T4 is top of range and could go over. It might be worth trying to get the T3 up at bit. Getting t3 prescribed is not easy.