Very strange blood test results

[OudMood]

Hi everyone,

I have done my MMH results.

I have been on 100mcg of accord for over 10 weeks with no breaks.

My results look very strange as not only TSH is suppressed but also both FT3 and FT4 are out the scale high, but I actually felt as if I wasn’t on enough Levo as I am struggling so much with tiredness. I am back on having energy only for 4-5hrs every day and yawning the rest of the time! Basically energy is like drawing blood out of a stone.

******

MMH Results: 14/12/2022

Levo= 100mcg Accord

TSH: <0.01 mU/l (Range 0.27 - 4.2) -6.62%

FT4: 29.9 pmol/l (Range 12 - 22) 179.00%

FT3: 9 pmol/l (Range 3.1 - 6.8) 159.46%

*******

I was certain at the time that I did not take my Levo for 24hrs before, but given these results I’m worried wether I had a memory lapse and I did take the dose?

How likely it is that if I would have taken 100mcg Levo say 6hrs prior to the test that I would have this level of false high FT3 and FT4?

Otherwise is it possible the lab made a mistake?

I have a GP blood test on the 21st and if they see these results they’ll cut my dose guaranteed.

for reference these are the previous results while on lower Levo dose.

MMH Results : 31/05/2022

Levo = 75mcg (teva+accord)

TSH: 5.19 mU/l (Range 0.27 - 4.2) 125.19%

FT4: 14.9 pmol/l (Range 12 - 22) 29.00%

FT3: 5.9 pmol/l (Range 3.1 - 6.8) 75.68%

P.S. based on the weight guidance my dose should be around 225mcg more or less. (The 1kg =1.8mcg)

[GlowCoach Administrator]

It's a strange result indeed. Have you changed the way you take your tablets during the time between last test and this?

Do you take your tablets on an empty stomach an hour away from food and coffee?

Taking Levo 6hrs before wouldn't suppress your TSH.

Edited to add:

I see your last results were declared invalid as you hadn't taken Levo regularly. If you have now taken Levo on a regular basis then your current results are correct and you need to drop the dose slightly and continue to take Levo regularly. It can take months to begin to feel well once on the right dose.

[OudMood in reply to GlowCoach]

to be fair though I had been regularly taking the Levo for 4 weeks when testing the last time.

And the result with 75mcg is the last one below and as you can see I don’t thing 25mcg can really produce such a variation from in TSH (from 5.19 to <0.01?) and even the other markers.

I suspect something is wrong with the sample 🙈

But I don’t think I could have a retest for free 😥

[GlowCoach Administrator in reply to OudMood]

4 weeks isn't enough for blood levels to stabilise for an accurate test. It has to be minimum 6 weeks + regular scheduled daily dosing. So now it's not really possible to compare results.

Approx how much do you weigh? It's possible to estimate dose very roughly based on weight in kilos.

It looks like you convert well as your first result shows a low FT4 and higher FT3.

[OudMood in reply to GlowCoach]

I see. I guess we can still compare results with the first test and the last as for both test I was in my dose for 10-12weeks.

I weigh 126kg at the moment so in theory a 100mcg dose shouldn’t produce such a result..

Especially since 75mcg didn’t really do much..

[GlowCoach Administrator in reply to OudMood]

If you are certain that you always take your Levo 1 hour before food and coffee then even the first result is odd as the FT3 is so high. Could you be having Hashi swings? Are you supplementing with anything that might contain T3?

At the moment, for whatever reason you likely wouldn't need anywhere near your dose based on weight as even at 75mcgs your FT3 was looking OK.

[OudMood in reply to GlowCoach]

yes I take my Levo at night to ensure I don’t eat or drink coffee near it.

just to clarify, the results in May were

MMH Results : 31/05/2022

Levo = 75mcg (teva+accord)

TSH: 5.19 mU/l (Range 0.27 - 4.2) 125.19%

FT4: 14.9 pmol/l (Range 12 - 22) 29.00%

FT3: 5.9 pmol/l (Range 3.1 - 6.8) 75.68%

And the results from Today are these high ones:

TSH: <0.01 mU/l (Range 0.27 - 4.2) -6.62%

FT4: 29.9 pmol/l (Range 12 - 22) 179.00%

FT3: 9 pmol/l (Range 3.1 - 6.8) 159.46%

[GlowCoach Administrator in reply to OudMood]

How long before the May test did you stop taking Levo? If it was over 24hrs then that could explain the low FT4 and high TSH.

[OudMood in reply to GlowCoach]

just the usual 24hrs…

Which is why this result is so baffling 🤷🏼‍♀️

[GlowCoach Administrator in reply to OudMood]

All you can do is retest at 9am, making sure of 24hr gap with Levo and regular, scheduled daily dosing.

[Enantiodromia77 in reply to OudMood]

From my experience deranged results can infer as you thought initially overdosing. We could also consider some technical pre analytical variables too from a laboratory persepctive but most often this would have been investigated prior to a validating the result.

Things to consider: Changes time of dosing.

Supplements that contain biotin, can exhibit interference in immuno assays as it can cause non specific binding , Usually a laboratory would or should rule out by using a different analytical method this would delay turn around time obviously. Persons known to have a history of deranged results should be advised of what medication/supplements even foods that can cause interference but personal awareness as my experience has shown not even medical Drs check interactions properly .

A repeat should ALWAYS be done as standard and dont adjust medications becuase of one test. ALSO ranges are Reference ranges not NORMAL ranges and are based on population demographics (normal distribution/Gaussian curve). The problem is we only have blood tests when we feel unwell. So there isnt a "healthy" baseline as such for an individual.

Other factors to consider are what time of the day are you also having your bloods done? Consider having your levels checked at the end of your working day consistently or at a time that is convenient for you and not how you feel. You said you taking your tablet at night. How is your sleep quality and pattern? I havent read all replies and so maybe be repeating.

All the best and hope things get better.

[SlowDragon Administrator]

You need to be on constant unchanging dose and brand of levothyroxine for at least 6-8 weeks….and ideally longer before test

Always test thyroid levels early morning and last dose levothyroxine 24 hours before test

Essential To test vitamin D, folate, ferritin and B12

If not been taking levothyroxine regularly likely low vitamin levels

[OudMood in reply to SlowDragon]

just to clarify, I have been on this dose for over 10weeks (almost 11) now and these are the results.

MMH Results: 14/12/2022

Levo= 100mcg Accord

TSH: <0.01 mU/l (Range 0.27 - 4.2) -6.62%

FT4: 29.9 pmol/l (Range 12 - 22) 179.00%

FT3: 9 pmol/l (Range 3.1 - 6.8) 159.46%

The previous results were on a 75mcg dose and was also for about 12wks before test.

MMH Results : 31/05/2022Levo = 75mcg (teva+accord)TSH: 5.19 mU/l (Range 0.27 - 4.2) 125.19%FT4: 14.9 pmol/l (Range 12 - 22) 29.00%FT3: 5.9 pmol/l (Range 3.1 - 6.8) 75.68%

My vitamins were all good last time I tested (sept I think) and I still take all my supplements.

I suspect something has gone wrong with this sample as I struggle to believe a 25mcg increase would Change my results THIS much? 🤔

[SlowDragon Administrator in reply to OudMood]

well you have Hashimoto’s

So it could be a Hashimoto’s flare

Do you wear a Fitbit or equivalent?

Noticed any changes in resting heart rate?

Perhaps reduce levothyroxine to 75mcg and 100mcg alternate days

Or get retested before Christmas if possible

Test early morning and last dose levothyroxine 24 hours before test

[OudMood in reply to SlowDragon]

yes, I wear a man Apple Watch.

I have noticed that my heart rate has normalised in the past month or so.

It went from a resting 100 heartbeats to a resting 85-88.

I will have a test via the GP on the 21st but it will only be TSH and FT4 (assuming lab is going to test this last one).

[SlowDragon Administrator in reply to OudMood]

well if TSH is still low and Ft4 still high they should automatically test Ft3

If Ft3 isn’t tested GP should ask lab to test ……..bloods are held in lab for few days after initial testing…..so they should be able to rerun test

[OudMood in reply to SlowDragon]

ok, I’ll see what those test say and take it from there I guess.

Saying this, could I try and ask MMH if they could re-test? 🤔

[SlowDragon Administrator in reply to OudMood]

unlikely to oblige

It could be that dropping Teva brand has improved absorption

Many people react badly to Teva

[SlowDragon Administrator in reply to OudMood]

Being over treated can make you feel as exhausted as being under treated

These tests suggest you need dose reduction in levothyroxine

But see what test on 21st shows before changing anything

What vitamin supplements are you currently taking

Remember to stop taking any vitamin supplements that contain biotin 5-7 days before test…..biotin can falsely affect test results

[OudMood in reply to SlowDragon]

thanks.

No biotin supplements.

I take

Vit D, Magnesium, Zinc, CoQ10, Omega 3, Folic acid, vitamin B6, Berberine and milk thistle. All of these were taken about 18hrs prior to test

[Wua13262348 in reply to OudMood]

I don't know if the following information will be of use or not. I found this on the internet last night, from"q10facts.com" ;

"Selenium has a special interrelationship with Co -enzyme q10 that can be exploited for clinical benefit in cases of heart disease. Adequate selenium must be available for cells to achieve optimal concentrations of Co-enzyme q10 , and similarly adequate levels of Co-enzyme q10 are necessary for cells to achieve optimal function of selenium."

I have taken Co-enzyme q10 for c. 30years. It helps with my gum health.I take a high dose in its most bioavailable form.

I started taking 200mcg selenium 1/8/22 as a supplement for eye symptoms. I stopped vitamin powders containing selenium, zinc , copper and various other things including biotin , 7 days before blood testing for thyroid TSH, FT4 and FT3. From the same blood draw, I tested zinc and selenium. Despite this my selenium levels were 367ug/L in a range of 67-135.

My thyroid results showed conversion at 3.18 or thereabouts.

Selenium is mega important for thyroid health. I was unaware , until last night, of the relationship between selenium and Co-enzyme q10.

I wonder whether I may have some kind of mutation up or down regulating what my body does with selenium, as I don't believe my levels should be as high as they are. I don't eat brazil nuts, a mega high source of selenium if grown in selenium rich soil, as brazil nuts are one of my food intolerances.

As reported on the forum, zinc and copper are on a see-saw. Usually, when hypo, it is zinc that is low and copper high, when it is best that they be balanced. My zinc was 5.11mg/L in a range of 4.5-9.0. I would have expected it to be better than that. I think whatever my copper level is must be influencing this, and possibly my selenium levels.

I read something else which inferred that selenium, zinc and copper will influence one another as to levels in the body .

I wonder if the supplements you list yourself as taking may be having an effect on your unusual blood test results, without really understanding why.

Have you, for example, upped your dose of Co-enzyme q10 recently, or switched to the more bioavailable type recently?

A bit of a long shot really, but thought the above may be worth bringing to your attention, just in case.

[Lalatoot]

OudMood taking your levo close to the test wouldn't affect TSH or Ft3 levels really. Just keep taking your levo regularly and see what the GP test comes up with.

[OudMood in reply to Lalatoot]

oh no.. so it’s just FT4 that would be affected then? 😱😱😱😱

[OudMood in reply to OudMood]

shouldn’t I feel fantastic with such a good FT3??? 🤔

[Lalatoot in reply to OudMood]

No it is all about balance, moderation and what suits you. You can have too much of a good thing!

[OudMood in reply to Lalatoot]

Makes sense.. although it seems 100mcg is not a great spot and 75mcg was even worse 😑

[Aurealis]

Your tiredness is consistent with thyroid hormones over the range. It might be test error or a dosing error on your part? Can you get a test done straight away? I’d be tempted to reduce dose to alternate days of 100 and 75. Leave required number of weeks before retesting, but if you start to feel better that will be a sign you’ve done the right thing.

[SlowDragon Administrator]

if you’re going to reduce dose to 75mcg and 100mcg alternate days……stay on only Accord brand levothyroxine

Cutting 50mcg tablet in half to get 25mcg

[OudMood in reply to SlowDragon]

am I correct in understanding then that the “advice” would be to retest and then if results are same/similar I should reduce to basically 85-89mcg daily?

Is there a way to split 100mcg tablets? I just renewed my prescription of 100 for 2 months and also cannot get new prescription until my new exemption certificate comes through.

Would it be ok to split my tablet into 4 and take 3/4 one day and fill the other? 🤔

[SlowDragon Administrator in reply to OudMood]

yes….if second test still shows you are over medicated you will need to reduce dose levothyroxine

Retest 8-12 weeks later

you can cut 100mcg tablets into 1/2 and 1/4’s to get 25mcg and 50mcg

Get a weekly pill dispenser for the spare pieces

[JAmanda]

no matter the previous results, these look a solid set of results. Not everyone needs the multiple x weight dose. Being over medicated can give similar symptoms as being under. I would reduce to 87.5 for 8 weeks and retest but it’s possible that 75 was correct dose ( you just weren’t taking it consistently).

[FAB-jellybean]

As Slowdragon said, it's probably your change from Teva to Accord, and the accord tablets agree with you much better than the Teva. That was my very first thought because a similar thing happened to me but in the opposite direction, I was given Teva instead of my usual brand I very quickly became undermedicated. I now make sure that I stick the brand that I know works well for me. The GP gives me them in 50mcg tablets so that I can split them as I need to. I put a yellow card report in for the Teva so that I can argue the point with the pharmacist if they try to tell me they can't get my usual brand and try to give me Teva.

And also as Slowgragon said, the symptoms of being undermedicated and overmedicated can be very similar, so it's more than likely that your results are correct. I personally would cut 12.5mcg a day (75 and 100 on alternate days) and see where you are in 6-8 weeks. I also take longer for my levels to settle so tend to test after 8-10 weeks to get a truer picture of what's going on. If you need to cut again, then another 12.5 mcg daily drop would take you down to 75mcg daily, but bear in mind that this won't be the same as the 75mcg dose that you had when taking the Teva, in case you're worried about going too low again. Small tweaks are much less disruptive to your body than big dose adjustments. Be aware that the GP might want to drop you back to 75mcg daily but explain that you're happy to drop, just in smaller increments than 25mcg daily. Good luck 🙏

[AbiKat1]

You poor thing, I went through the same recently. You have turned thyrotoxic. Overactive .

Mine was a result of viral thyroiditis - de quervains - triggered by covid, it came on two months after having covid.

I was taken off thyroxine while the levels come back down.

You really need to see an endocrinologist.

I felt dreadful and ended up with a thyroid storm. A&E was the best place I found help.

I’m still on the road to recovery, if they had taken me off the thyroxine sooner I may have avoided the thyroid storm. Try and find a doctor who knows what they are doing.

You must feel awful, hope you get the help you need to recover soon.

[OudMood in reply to AbiKat1]

oh wow. So sorry you had to go through that.

What happened after? Are you now back on Levo?

[AbiKat1 in reply to OudMood]

Not yet, I should probably start a separate post. I have had so many conflicting diagnoses since.

[JeniMac]

These are mine I'm on 175mg levo

Results

[FAB-jellybean in reply to JeniMac]

Hi Jeni, your latest results suggest that you are very undermedicated - TSH should be 1 or less and your T4 is only 30% through the range. To get a true indication of what's going on you need to know what your T3 levels are. You would be better doing one of the private tests (see link below). Monitor My Health private test is cheapest with 10% discount through Thyroid UK. As things look, you could do with a 12.5 mcg -25mcg daily increase depending on how well you tolerate dose changes. Personally I do better with low changes over a longer space of time but we're all different. Given those results, your GP should have automatically increased your dose. If you get your results including T3, add them as your own post and the lovely knowledgeable people here will let you know if you appear to converting well or if perhaps need to add T3. Best of luck.

thyroiduk.org/help-and-supp...

[Bearo]

if the GP isn’t cooperative in prescribing alternate day dosing, or if you don’t want to ask, you could achieve a similar result by skipping a tablet once a week. I did this when my bloods showed 100mcg was overdosing. I didn’t want my prescription permanently reduced so I successfully brought my frees back to a good place by skipping my dose on Sundays. I don’t seem to suffer any I’ll effects and I’ve avoided negotiating with the GP.

[OudMood in reply to Bearo]

unfortunately I can’t do that…

Whenever I skip a pill due to forgetfulness, I am so sick. Horrible headache, unable to get up until I slept like 12 hours, pain in eyes, can’t think, etc.

I will ask for an additional 25mcg tablets and just cut my 100 in half if not I’ll attempt to keep cutting the pills…