Blood Test Results

[mischa]

I've received my blood test results and my GP is not very happy with the suppressed TSH. I stopped taking B complex 2 weeks prior to test.

I am currently prescribed 75mcg Levo and 20mcg of Lio but I have added half a capsule of Metative 11.

I reduced the Lio to 15mcg 3 months ago. So these results are on the reduced amount. Everything else is the same.

March 2023

TSH: <0.01 (0.27 - 4.2)

FT4: 15 (12 - 22)

FT3: 5.6 (4.0 - 6.8)

I had a private test done in February of this year but forgot to stop taking B complex that contained biotin. These are the results.

February 2023

TSH: <0.01 (as above)

FT4: 17.6 (as above)

FT3: 5.7 (as above)

So its clear that my results are elevated as a result of the supplement but the TSH remained the same.

My TSH has been suppressed since 2021 and since the addition of the half cap of Metavive. Before that my TSH was around 0.014.

My concern is that I am clearly not over-medicated and if I reduce any further I fear the return of hypo symptoms which I really do not want to go through just to prove a point to my GP.

I would welcome any advice as to how I approach my GP in not reducing my medication any further.

Thank you.

[SlowDragon Administrator]

presumably your 20mcg T3 is prescribed by endocrinologist?

On almost any dose of T3 the majority of patients will have suppressed TSH ……that is just what happens when taking T3

Most important results are always Ft3 followed by Ft4

FT4: 15 pmol/l (Range 12 - 22)

Ft4 only 30% through range

FT3: 5.6 pmol/l (Range 4 - 6.8)

Ft3 at 57.14% through range

Were tests done as recommended…..early morning and last dose levothyroxine 24 hours before test. Last 5mcg dose T3 Approx 8-12 hours before test

Last dose Metavive 8-12 hours before test

[mischa in reply to SlowDragon]

Thank you for replying.Yes, my T3 is prescribed as per Endo's instructions. No longer under his care.

Yes, I followed protocol for testing. Last dose of T3 and Metavive 7pm. Blood test 8.30 am.

She will mention AF and osteoporosis and suppressed TSH. I am happy with the TSH as I really think this is scare mongering and over exaggerated. My quality of life, at my age, is fine as it is

[SlowDragon Administrator in reply to mischa]

so GP should not be meddling

Your treatment was overseen by endocrinologist…..even if not still seeing him

[mischa in reply to SlowDragon]

Thank you for the info.

[SlowDragon Administrator in reply to mischa]

If GP says " I have to reduce your dose because the guidelines say i can't let you have a below range TSH" .....

The first paragraph in the NICE (NHS) Thyroid Disease, Assessment and Management guidelines says :

nice.org.uk/guidance/ng145

"Your responsibility

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian. "

[mischa in reply to SlowDragon]

That is really helpful. Thank you.

[Lupaal]

Wish I knew. My doctor has reduced my thyroxine, last August was 0.06 and I felt OK, recent blood test showed it at 3.9 and I feel awful. He says it's in range and won't even discuss it with me. At my wit's end, thinking of changing to a different surgery.

[tattybogle in reply to Lupaal]

For Lupaal... see these ~:

healthunlocked.com/thyroidu.... list-of-references-recommending-gps-keep-tsh-lower

healthunlocked.com/thyroidu... explanation-of-what-*high-tsh-is-telling-us-when-our-ft4-level-is-normal-on-levothyroxine-the-shoe-size-analogy. ( *over 2.5/3ish)

[Lupaal in reply to tattybogle]

Can't get an appointment to discuss the results, they just say it's normal and won't let me speak to a doctor.

[tattybogle in reply to Lupaal]

Lupaal ...... Write to practice manager.....quote those references for keeping TSH under 2/ 2.5 ... say since dose reduction your TSH is over 3 and your symptoms of hypothyroidism have returned ..... say you need to speak to GP about these symptoms and have been unable to get appointment... say if they are unable to see you ,about this you will increase the dose yourself by buying Levo from an online chemist ..

I suspect that should put the wind up them and bring about a fairly rapid call back from your GP . (crude but effective )

i notice you haven't written a post of your own yet Lupaal , otherwise i would have replied on there as i don't want us to take over mischa 's post .. but as you have AF / PPI/ omeprazole/ Statins going on .. all of which have thyroid medication implications, it may be good idea for you to write a new post asking for help with your current thyroid dose since you are feeling so rubbish since the dose was reduced.

[Lupaal in reply to tattybogle]

Thank you, will be contacting surgery, we've been thinking about changing to another practice so will see how that goes.

[tattybogle]

Mischa ... Some of this may be useful....unfortunately you can't use the first reference , because it shows increased risk when TSH is below 0.04 .. but there's one showing no significant bone loss when TSH suppressed by levo as longas fT4 in range , and links to some other very useful discussions.

healthunlocked.com/thyroidu.... useful-evidence-that-tsh-between-0.04-0.4-has-no-increased-risk-to-patients-on-levothyroxine-as-long-as-ft4-and-ft3-are-in-range-.

[mischa in reply to tattybogle]

Thank you very much for the information you have provided. Very helpful indeed.

The uniqueness of this forum is the vast amount of research papers available for members to look at.

I would add that I did read the TEARS research paper a few yeas ago and it was quite an extensive piece of research. However and unfortunately, there are failings in that the authors did not look at FT4 and FT3 levels and focused solely on TSH levels. Nor did they include patients on T3. They acknowledges this: '...It is unfortunate that we did not have access to serum FT4 in these patients to ascertain whether they were above or within the lab reference range...' . But still ignoring FT3 levels and those on T3.

They did not explain or explore why patients had high or suppressed TSH levels. And for some reason did not include a control group for comparison. The study was confined to 'guidelines' as opposed to signs and symptoms. At the end of the day, the most they could point to was an association between AF and Osteoporosis rather than a causative link.

There may be further studies that expand on the above. However, it is very useful for those whose TSH levels fall within that category that allows them to challenge resistant GPs.

Once again thank you for taking the time to respond and for the information.

[Lovecake]

unfortunately many of us seem to get a very low TSH when taking some T3 and it freaks the GP and endos. My levels are similar to yours and yet they constantly say I need to lower my dose. I tried it - felt dreadful - and put it back up again. My endo spouted the “you might get heart issues and osteoporosis” to me and I had to let him put it in writing to the GP. So if I come off the T3, my TSH will go up. They will be happy, but I will be more housebound than I am now and will probably get diabetes and a heart condition due to the lack of movement and weight gain.

The only good thing with a zoom consultation is that I generally look dreadful on screen so he feels sorry for me 😂

[mischa in reply to Lovecake]

Sorry to hear you are having the same problem. Yes you are so right and you would have thought GP/Endos would be very aware that reducing thyroid hormone leave their patients with diminished lives. They must see this but sadly choose to ignore it for the sake of a TSH number or blame it on something else.

Could you not stand your ground and tell them you do not want your medication reduced and that you want it on your records that it makes you very ill when it is. Tell them you know what the risks are and are prepared to accept those risks and that your quality of life is more important to you than an in range TSH which would affect that quality of life. You must argue your case.

I like your sense of humour 👍 - we need it.

[Lovecake in reply to mischa]

oh yes, I stand my ground.

I even told my endo that if I couldn’t look after my grandchildren then my life wouldn’t be worth living. Bit over dramatic, but quite frankly it was the truth on how I feel.

We have brilliant people on here and around the world trying their best to put the correct info forward so that we get treated correctly. I am in awe of their knowledge and tireless work. One day……..we will feel amazing and not have to fight to get there 😎

[mischa in reply to Lovecake]

Yes indeed. 😊