Test results: what is going on? Longish post and history

[gabkad]

Perhaps someone can help me out here in regards to what I should do going forward:

Since September 2022 I take 150 mcg thyroxine in the a.m. an hour before consuming anything.

And 12.5 mcg liothyronine in the evening before sleep.

Blood was taken today before 8 a.m. (close to but still, before)

No thyroxine taken since 6 a.m. the previous day.

Liothyronine was taken 12 hours before phlebotomy.

Thyroid Stimulating Hormone

LO <0.01 0.32-4.00 mIU/L

Free T4 13 9-19 pmol/L

Free T3 4.7 2.6-5.8 pmol/L

I'm now 65 years old. 23 years ago I was taking 112 mcg thyroxine

and my blood level was TSH 0.64 (0.4 - 5.0)

fT4 15 (10 - 20)

fT3 4.5 (3.5 - 6.5) SEE WHAT THEY HAVE DONE HERE? Back then

3.5 was bottom of range. Now it's 2.6 to 5.8.

So what's going on here? For a 'normal, healthy person, the current

fT4 and fT3 results would net a TSH over 1.0. Even when I was not taking

liothyronine, TSH was low. I can't attribute the low TSH

to liothyronine when it was low like this with only thyroxine.

Am I just not absorbing thyroxine the way I used to? I can't think

of any other reason given I've been taking thyroxine since my

mid 20s and I'm now 65.

HbA1c was 5.6%. I'd rather it was a bit lower but it's okay.

Ferritin 134 (range 15 - 272)

B12: 311 (138 - 652) ***********.... I've been taking a 'hi potency B complex' once every 5 days

or so. Did not take anything for a week because of the biotin. So this is not fantastic and I'll

need to take B12 separately.

Did not do vitamin D because I am taking the same amount as ever and previous results

were 108 and 112.... nmol/l. Don't see the point of paying for this test given the consistency

of past results going back to 2013.

How do I feel? I had Covid in early December and that was my last month working before

retirement so the stress of trying to get everything accomplished plus not being able to do so

due to the horrible fatigue caused by everything....... predictable as far as being exhausted.

A couple of times I thought I was dying the exhaustion was so terrible.

I started to get my energy back at the end of January.

When I go for long walks the muscles in my hip hurt.

I also reinjured a muscle in my upper left back and it has made life miserable.

Recently I've started doing dead hangs and lots of exercise plus walking.

Hopefully this pain will stop eventually.

So I can't answer a question about how I feel now because it's all very transitional.

September 2022 after starting the liothyronine I had energy. After I injured the muscle

in my back the pain sucked the energy out of me. I had to take prednisone for the

inflammation.

How do I feel? Hopeful.

Biggest question though is should I up the dose of liothyronine? The new GP said she would increase the dose of thyroxine if it looks like the 150 mcg dose is insufficient. I DID NOT TELL HER that I am taking liothyronine, privately sourced because I was very curious to see what difference it makes on the fT3 result.

August 2022: 48 hours after taking thyroxine:

Thyroid Stimulating Hormone [TSH] LO 0.06 0.32-4.00mIU/L

Thyroxine Free [Free T4] 12 9-19 pmol/L

Triiodothyronine Free [Free T3] 3.5 2.6-5.8 pmol/L

July 2021: 24 hours after taking thyroxine:

Thyroid Stimulating Hormone [TSH] LO 0.03 0.32-4.00 mIU/L

Thyroxine Free [Free T4] 15 9-19 pmol/L

Triiodothyronine Free [Free T3] 4.2 2.6-5.8 pmol/L

[radd]

gabkad

Levo mono-therapy commonly reduces TSH below range if a sufficient enough FT4 level for wellbeing is to be achieved. The TSH often becomes irrelevant when dosing thyroid hormone replacement meds because of wonky signalling/connects between the pituitary and thyroid hormones.

The test range numbers don’t matter, often varying between different labs. What matters is where your results lie within that range. Your latest results show FT4 40% through range and FT3 66% through range. 

Transitional periods and COVID can all add to not knowing exactly how we feel, as can inadequate thyroid hormone levels. I myself would function ok on these results but if you are feeling symptomatic on these results, a Levo increase should raise both FT4 & FT3 levels. 

You have mentioned iron, Vit D & VitB12 but what about folate?

[gabkad in reply to radd]

I have never in my life had folate tested, not even before and during pregnancies.

Go figure! I take B complex and eat a lot of greens and tomato sauce and whatnot,

so I doubt there's a problem. But I could ask to have it checked.

I need to feel more resilient and be able to see realistic improvement in my ability to do physical activities. I'm far from where I want to be at the moment.

[Lalatoot]

Gabkad. There is no conspiracy with the change of ranges. The range is set by the testing laboratory. It depends on the equipment they use. It is common for ranges to change if their equipment changes. My TSH was below range on thyroxine only. Now that I have added 7.5mcg daily of liothyronine to the mix my TSH is so low it is undetectable. That's what happens when you add lio.

Taking lio also reduces ft4. My ft4 result is 10% lower since adding a small amount of lio.

I would forget about the whys and what's of the past results and focus on your current results. You are lucky that the doctor is focused on your ft4 and ft3 levels rather than the non existent TSH. This is as it should be but not many doctors do it.

If the doc is willing to increase levo then I would try a small increase to see how that makes you feel. Wait at least 8 weeks and then do bloods again. See what your levels are and how you feel then decide if you need any adjustments to doses.

It can take a year or 2 of slowly adjusting doses of lio and thyroxine, one thing at at time, to get us where we need to be.

[gabkad in reply to Lalatoot]

I'll find out what the doctor decides.

In the meantime I've now added 6.25 mcg lioththyronine to the a.m. dose of 150 mcg thyroxine.

[annnsandell]

Hi Gabkad,

This is slightly problematic because the UK does not routinely prescribe T3 and with your suppressed TSH result a UK GP would reduce your Levothyroxine but as you are adding T3, as radd says above, this will affect your results. Do you think you are overdoing the exercise in a rush to get fit when you already have an injury? Slowly does it and slowly increase, listen to your body. Good luck.

[gabkad in reply to annnsandell]

Definitely not doing too much exercise! I should be doing more. I did nothing at all for

almost 2 months due to the exhaustion from Covid and the added responsibilities of retiring. It's only the past three weeks that I have gone out for walks. Not hikes. Just walks.

[tattybogle]

Just a technical observation gabkad,

"Even when I was not taking liothyronine, TSH was low. I can't attribute the low TSH

to liothyronine when it was low like this with only thyroxine"

.

Don't make the mistake of thinking "TSH of 0.6 ( (or even 0.06) is a bit low anyway , so <0.01 is not much different "

On the TSH scale there is quite a big difference between those numbers .

<0.01 TSH is "totally supressed" , so small it's unmeasurable

0.01 - 0.03 TSH is basically so "low" it may as well be supressed

0.04 -0.4 TSH is "low but not supressed"

0.4 - 4 TSH is basically "within 95% reference range".

There are significantly different levels of 'associated risk' for all these groups,

eg in this study academic.oup.com/jcem/artic...

0.04 - 0.4 (low but not supressed) had no increase risks over TSH " in range "

but "low /supressed" did have sharply increased risks.

That study is on patients on levo , so not directly applicable to someone taking T3, as TSH will often be relatively lower with any T3 than it would on levo alone ,, but i just used it to illustrate the point about the big difference between 0.6 and <0.01

But .....If the GP said that about "potentially increasing dose of it looks like 150mcg is insufficient" "before she saw these latest results, she may well change her mind when she see's the totally supressed TSH.

..... especially if she is unaware of the reason for it becoming supressed (which is you adding 12.5mcg T3 since September.)

[gabkad in reply to tattybogle]

That's exactly what happened. She wants to reduce my dose. I've

been to that movie many times and it's always a tragedy. I'm 65 years old.

I don't know how much longer I'll be alive. I don't want my quality of life compromised by doctors who don't know what they are doing.

I posted today that she wants bone density and ekg testing. Fine by me. I'm curious

about my bones anyway.

Not to mention, it was when my dose was too low that I had terrible heart palpitations.

Nobody was interested then.

These days the old ticker is doing well as far as I am aware. Hopefully Covid didn't do anything to it.