My latest blood results are a complete puzzle to me. Can you help me to understand them?
To give you a little background.......following a Graves diagnosis I was started on 20mg carbimazole daily in May 22. This was gradually titrated down to 5mg every other day but was stopped on 25th January 23 as blood results at this date indicated that my FT4 and FT3 were slightly low.
Blood tests on 10.1.23
TSH 1.82 0.27-4.2mlU/L
FT4 11.4 12-22pmol/L
FT3 3.9 3.1-6.8 pmol/L
I would really appreciate your wisdom on the above.
Many thanks.
Written by
Meringue4
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Your TSH has lowered despite a further drop in FT3 & only a small rise in FT4.
Was the time of test very different?
How do you feel?
Many would feel hypothyroid with low levels.
You weren’t on carbimazole very long and as TRab was high along with TPO & TG antibodies there is a possibility you have both Graves & Hashimoto’s.
Was TRab repeated prior to stopping, often this is not retested but high TRab would indicate you’re susceptible to levels rising again.
As your FT4 & FT3 levels are low then staying on carbimazole isnt a good option either.
You might find your levels fluctuate with high TRab TPO & TG.
If FT4 & FT3 remain low & TSH rise doctors will need to consider replacement. The issue you may find is that many doctors go by TSH and if your TSH is not an accurate reflection on FT4 & FT3 you may be starting to get hypothyroid symptoms before doctors offer treatment.
The TSH can be low because antibodies affect it or it can become down regulated after being low. Low nutrients can also make TSH appear low.
Recommend you test folate, ferritin, B12 & vitamin D. optimal levels will help.
Monitor TSH, FT4 & FT3. For abnormal high or low levels & if the after you could also consider “block & replace” - higher dose carbimazole to fully block function along full replacement dose of Levothyroxine to restore levels. This is a good option for unstable levels which fluctuate unexpectedly, but doctors dislike as they prefer to avoid high doses.
Vitamin DI had vitamin d tested twice in last year. It is always a good level. In September it was 112nmol/L and since January 23 until last couple of weeks I have been taking at least 1000units daily via an oral spray.
Coeliac screen
Anti-TTG IgA tested 10/1/23 <1.9 (<20) so not coeliac
TRAb
This should have been retested in January as z private test. Unfortunately the organisation made a mistake and did the wrong test. I have issued a complaint and they are investigating. I cannot afford to pay for another test while this is unresolved- the test is very expensive!
Folate/ferritin/b12
To my knowledge never tested. I will get these tested as soon as I can. I would expect b12 to be a reasonable level as I am addicted to breakfast cereals that are fortified with these- my go to snack!
Ferritin/foliate may not be ideal as I am not a great meat eater. No red meat and only small amounts of white meat.
Supplements taken
Apart from vitamin d which I ran out of 2 weeks ago - I will resume, I am taking magnesium powder. I find this helps to prevent migraines which I am very prone to. My vitamin d spray also contains k2.
I have also decided that I will take a collagen supplement - a marine version. My reason for this us bone health as I also have an osteoporosis diagnosis. Infact, it was that that led to the identification of a thyroid problem.
I have given up being able to monitor how I feel. I do feel washed out but I am 60+, menopausal and experiencing empty nest syndrome as my 3 grown up children have all recently moved out and away. I also have an elderly parent that I worry about and am working full time in a very demanding profession. I would expect to feel washed out with all this.
Thank you again for your replies - I really appreciate your experience and advice.
I had vitamin d tested twice in last year. It is always a good level. In September it was 112nmol/L and since January 23 until last couple of weeks I have been taking at least 1000units daily via an oral spray.
Coeliac screen
Anti-TTG IgA tested 10/1/23 <1.9 (<20) so not coeliac
TRAb
This should have been retested in January as z private test. Unfortunately the organisation made a mistake and did the wrong test. I have issued a complaint and they are investigating. I cannot afford to pay for another test while this is unresolved- the test is very expensive!
Folate/ferritin/b12
To my knowledge never tested. I will get these tested as soon as I can. I would expect b12 to be a reasonable level as I am addicted to breakfast cereals that are fortified with these- my go to snack!
Ferritin/foliate may not be ideal as I am not a great meat eater. No red meat and only small amounts of white meat.
Supplements taken
Apart from vitamin d which I ran out of 2 weeks ago - I will resume, I am taking magnesium powder. I find this helps to prevent migraines which I am very prone to. My vitamin d spray also contains k2.
I have also decided that I will take a collagen supplement - a marine version. My reason for this us bone health as I also have an osteoporosis diagnosis. Infact, it was that that led to the identification of a thyroid problem.
I have given up being able to monitor how I feel. I do feel washed out but I am 60+, menopausal and experiencing empty nest syndrome as my 3 grown up children have all recently moved out and away. I also have an elderly parent that I worry about and am working full time in a very demanding profession. I would expect to feel washed out with all this.
Thank you again for your replies - I really appreciate your experience and advice.
I'm prompted to write that stress and anxiety are common triggers for Graves Disease having just read your last paragraph.
It seems you have Hashimoto's running along with your Graves.
As detailed on a previous reply the longer the AT drug is prescribed the better the outcome for the patient.
There will likely be antibody interaction on you TSH receptors which can distort any blood test readings - and even so blood test tend to run behind symptoms by a good few weeks.
Your T3 and T4 now ' look ' too low - but given time these may well creep up if your antibodies are now low and in range.
Your body has been in turmoil and your immune system triggered to go on the attack, rather than defend, and when the thyroid is attacked by the immune system the symptoms can be alarming, life threatening, and some just plan odd, as the thyroid synchronises ones whole bodily functions.
How are your eyes now - did get any help from TED ?
My eyes are now much better…obvious bulging is gone. I still have a problem with watering. This is most acute when I first wake and get up and whenever I go outside. This may not be related to my thyroid … It is a nuisance and can be embarrassing but not damaging.
What you have said about stress and anxiety makes so much sense. When I was first diagnosed with Graves I had just left a job in a senior position because of feeling permanently on alert. My new job carries less responsibility and, although still feeling stressed, it is nowhere near the stress levels that I experienced before. Unfortunately, I am a worrier and so always carry a certain amount of anxiety.
It was suggested in previous posts that I might also have hashimotos. At the time I did not read up on this. Now I will.
I would just like to do whatever I can to optimise my health and feel as good as I can. I who’ve taken up many tips from other posts. I will keep reading.
If using any drops, spray or lotion or potion to ease your eyes just ensure all products even those prescribed are Preservative Free:
Light sensitivity, watering though feeling dry and sore and the bulging are all known symptoms of thyroid malfunction - you might follow up on that TED link and get an appointment with a trained specialist in this field.
Both Graves and Hashimoto's are AI diseases - for which there is currently no known cure - Graves is the much more the serious of the two and considered life threatening if not medicated and takes precedence
With Hashimoto's only the thyroid and possibly eyes are attacked and ultimately the patient is with a damaged and reduced thyroid function, diagnosed hypothyroid and prescribed T4 - Levothyroxine - thyroid hormone replacement.
Graves is multi organ but generally only gets diagnosed when the thyroid and eyes are attacked and the consequences much worse - for some people needing a thyroidectomy if the AT drug doesn't resolve / control the immune system response and the antibodies keep raging and causing a roller coaster of symptoms which become intolerable.
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