Recent MMH blood test

[Gymbuni]

Good morning, some of you may remember that I was going to do my first finger prick blood test with MMH but I bottled it!

I managed to get the lovely nurse at my GP surgery to fill my 2 tubes when she was doing my routine thyroid tests in readiness for my Endo appointment next week. She filled an empty blood tube and then poured it into my tubes, the first one too much came out and she over filled it and had to tip some back out, I didn't really check the level until I got home and it was on the minimum level and this morning I got a message from MMH to say test error, it appears that there wasn't enough blood, very frustrating as she threw the remaining blood into the clinical waste bin. 🙃

According to the message on MMH it is the Vit D that they didn't test due to lack of blood, that is one of the ones I really wanted. I haven't got any results for B12, ferritin, folate etc, could it be that they are tested them and they are just not done yet? I got the results for thyroid, cholesterol and HbA1c and I have posted these below:

I have been on 2 x 15mcg T3 and 50mcg T4 since 13/01/23

TSH 0.1 (0.27 - 4.2) -4.33%

T4 10.5 (12 - 22) -15%

T3 3,4 (3.1 - 6.8) 8.11%

Test was done fasting at 9.40 am (earliest I could get), last dose of T4 taken 24 hours before test and T3 spilt over 3 doses, last dose 13 hours before ( I cant take it later than that as my sleep is affected by it).

MMH said my thyroid results show unusual pattern. I am very surprised at how much my TSH has dropped with those really low T4 & T3 results.

My other results were good (I think)

HbA1c - 31 nmol/mol (<42 good)

Total cholesterol 5 nmol/L

HDL 2 nmol/L

non-HDL 3.04 nmol/L

Triglyceride 0.85 nmol/L

I will edit the post shortly to copy and paste my previous results, haven't worked out how to do that without losing this post.

I am tagging  helvella as he will be interested in these results after our conversation about Accord levo, which I have been on for the past 4 weeks. Do you think these results suggest I do a yellow card?

Edit here are my previous results on 30mcg lio only from 09/09/22 (split into 3 x 10mcg doses), blood test 04/01/23 @8.35am, last dose of T3 12 hours before test.

TSH - 5.71 (0.35 - 5.0)

T3 - 3.2 (3.8 - 6.7)

T4 - 3.2 (7 - 20.0)

Personally I found being on T3 only was how I felt best even with a lower than 5 T4, 60mcg of T3 only I felt great but suffered with some palpitations later in the day on occasion (I took my T3 in one dose early morning at the palps would be later in the day, late afternoon or evening, so I wonder if that was my body saying I like that T3 stuff give me some more) with hindsight I should have split the dose into 2 or 3 doses. I felt OK on 40mcg of T3 only (this was split into 2 doses) but I still felt slightly hypo.

With those results what would you do in my shoes at me next Endo appointment, I am veering towards asking to go back to T3 only and suspect 50mcg a day will be my required dose. The Endo may well suggest more T4 and he suddenly seems more concerned about low TSH when he wasn't too bothered when I first saw him.

[Jaydee1507 Administrator]

Obviously you're now horribly under replaced. If you felt well on the Lio only then I would go back there if you possiby can. Hopefully the vitamin results will come back later in the day or tomorrow so we can then see whats going on there.

perhaps take along some good information about low TSH to help persuade him its not such an issue.

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. "

[Gymbuni in reply to Jaydee1507]

Thanks Jaydee1507 , I will have that information to hand, it is a telephone consultation this time.

Yes, I am under replaced and I knew that without the results as I feel pretty crap and have no energy and have put on a stone since the drop in meds in September.

I will be glad when I get my levels right and don't have to keep chopping and changing doses.

[helvella Administrator Thyroid UK]

I don't think that your results can readily be used to support a Yellow Card. It is always difficult when looking at results of those who take T3 - on its own or in combination. That TSH looks too low for the FT3/FT4 numbers. And I suspect that the FT4 is low even though you are only on 50 micrograms.

Have you got anything other than Accord to try?

[Gymbuni in reply to helvella]

I have Teva but reluctant to use that as I didn't get on with it previously. I might have some 100's from Mercury Pharma (my preferred brand) I could split them.

It is very odd how low my TSH has gone since January, but very low/supressed is normal for me. I suspect I had a false high TSH in January after Covid and taking Paxlovid just before Christmas. Anyway even with that low TSH I am still undermedicated with those T4 & T3 results.

[helvella Administrator Thyroid UK in reply to Gymbuni]

Agreed - they do look low.

[SlowDragon Administrator in reply to Gymbuni]

If going to stay on levothyroxine plus T3 …next step is to increase levothyroxine to 75mcg

Retest in 6-8 weeks

How much levothyroxine were you taking BEFORE you originally added T3

[Gymbuni in reply to SlowDragon]

I think it was 150mcg levo just before lio added and this was dropped to 100mcg when 20 mcg lio added, had been on 175mcg around 6 months before that and been on as much as 225mcg levo in the past. I am a poor converter.

[SlowDragon Administrator in reply to Gymbuni]

so very likely Levo was reduced too much when T3 was added

you might eventually find you might need 125mcg levothyroxine plus 20mcg T3

But it’s all experimental as to what suits each person

[SlowDragon Administrator]

previous post not long after starting T3

healthunlocked.com/thyroidu....

Did you ever try increasing levothyroxine to 125mcg and keeping T3 at 20mcg

[Gymbuni in reply to SlowDragon]

No, I haven't tried that combo, I am under NHS Endo and he increased my T3 to 40mcg a day and left me on 100mcg. I think he should have reduced levo then but forgot to advise me as at follow up appointment he was surprised I was on 40mcg lio and 100mcg levo! He then changed me to 60mcg lio only, T4 was only reintroduced in January.

[SlowDragon Administrator in reply to Gymbuni]

so like an enormous bull in a china shop…..charging doses far too much

Typically dose levothyroxine is ONLY reduced by 25mcg ……..and starting SLOWLY on just 5mcg T3 …..and slowly increasing……. initially to 2 x 5mcg after a fortnight (Approx 10 hours after first dose) and ….possibly increasing to 3 x 5mcg after a further 3-4 weeks

Then retest 6-8 weeks after being on constant unchanging dose and brand of levothyroxine and T3

Also essential to test vitamin levels at least annually and maintain at optimal levels

[Gymbuni in reply to SlowDragon]

I did the full Health Screen with MMH and have been told the Vit D test has failed, I haven't got the results of the other vitamins yet.

I know the advice on here is to go slow with T3, but I didn't feel any negative affects from going straight onto 20mcg, but I agree all the constant changes have not been good for me, I would have quite happily stayed on 60mcg lio only or even on the 40mcg lio only I felt much better than I do now.