URGENT call from GP

[JellyJac]

Hi, I had my bloods taken early morning Friday. (Stupidly took my tiromel beforehand as forgot about appointment) -"menopause another story"

Had an urgent call from GP early afternoon to say my TSH was too low and to immediately reduce my Levo. He is unaware that I self medicate and unwilling to even discuss NDT or T3. I asked for my printout of results and my TSH is 0.04 but my FT3 is 23.1. Should I be concerned at all I am not having any hyper symptoms (quite the opposite in fact) the weight seems to be creeping up and up and I am constantly tired with brain fog. Only difference being I am now on HRT and a loading dose of B12. Could someone have a look at my results and give me their opinions... any advice as always gratefully received.

[Jaydee1507 Administrator]

How much T3 and Levo are you taking and how soon before the test did you last take it?

GPs do tend to go into panic mode when they see a low TSH. A well over range T3 also likely to send them into orbit. Suggest to them you can restes and obviously be careful last dose is 8-12 hours from test.

Your folate is almost deficient. Folate is a cofactor of B12 along with others. Recommend a good B complex to keep all the B's in balance such as this one amazon.co.uk/Liposomal-Soft...

Vitamin D should be around 100 - 150. Buy one that includes vit K2 to help it go to your bones. Some are available in oil or you can take it with an oily meal for better absorption. Use this calculator to work out how much to take to get your level to 100-150. wildatlantichealth.com/vita...

B12 also needs a good ferritin & magnesium level to work well.

Ferritin should be around 90 - 100 for best use of thyroid hormone. Suggest increasing iron rich foods in diet and eating them often. Chicken livers, pate, red meat etc

FT3 peak after dose

[JellyJac in reply to Jaydee1507]

Thanks so much Jaydee. I haven't been able to get hold of or afford NDT since covid hit. I take 2 tiromel tablets a day. I took them at around 7.30am and had the bloods don't at 9am. I used to take 1 tiromel and 1 grain of Thyroid S and felt great on that dose for about 4 years until 2020. Now I am trying to get my ducks in a row again. I am considering getting a private test to include all hormones since menopause seems to have thrown me out of whack.

[Jaydee1507 Administrator in reply to JellyJac]

I think a private test would be a good idea. You can tailor your timing accordingly then.

Even though you usually take it asll at once, it is better for the sake of an accurate test just for 1 day the day before to split it into 3 and take the last dose 8-12 hours before the blood draw.

Tell GP you want to retest, also you were tking a supplement containing biotin which has interfered with the results.

OPTIMAL vitamins support our thyroid hormone to work well.

[JellyJac in reply to Jaydee1507]

Thanks Jaydee. Yeah I think I made the foolish mistake of being on auto pilot in the morning. I am going to rejig my T3 and GP has asked to re-test in 2 months... by then I will be away from my loading dose of B12 also so that reading should be more accurate too.

[SeasideSusie Remembering]

JellyJac

How much T3 are you taking?

When did you take your last dose before the test (T3 should be split into 2 or 3 doses the day before and last lart lf dose 8-12 hours before the test.

3 weeks ago you were asking about suppljers of Thyroid S so when did you change to T3 ?

[JellyJac in reply to SeasideSusie]

Hi I've been taking t3 as I haven't been able to get hold of or afford NDT since covid hit. I take 2 tiromel tablets a day. I took them at around 7.30am and had the bloods don't at 9am. I used to take 1 tiromel and 1 grain of Thyroid S and felt great on that dose for about 4 years until 2020.

[SeasideSusie Remembering in reply to JellyJac]

JellyJac

OK, so you took 50mcg T3 one and a half hours before this blood test - have I understood that correctly? If so that is the reason for your very high FT3 result, T3 peaks in the blood 2-4 hours after ingestion so your level was just coming up to it's peak at the time of your test. Always follow our advice when having thyroid tests in future:

* Book the first appointment of the morning, or with private tests at home no later than 9am. This is because TSH is highest early morning and lowers throughout the day.

In fact, 9am is the perfect time, see first graph here, it shows TSH is highest around midnight - 4am (when we can't get a blood draw), then lowers, next high is at 9am then lowers before it starts it's climb again about 9pm:

healthunlocked.com/thyroidu...

If we are looking for a diagnosis of hypothyroidism, or looking for an increase in dose or to avoid a reduction then we need TSH to be as high as possible.

* Nothing to eat or drink except water before the test - have your evening meal/supper as normal the night before but delay breakfast on the day of the test and drink water only until after the blood draw. Certain foods may lower TSH, caffeine containing drinks affect TSH.

* If taking thyroid hormone replacement, last dose of Levo should be 24 hours before blood draw. If taking NDT or T3 then last dose should be 8-12 hours before blood draw, split dose and adjust timing the day before if necessary. This avoids measuring hormone levels at their peak after ingestion of hormone replacement. Take your thyroid meds after the blood draw. Taking your dose too close to the blood draw will give false high results, leaving any longer gap will give false low results.

* If you take Biotin or a B Complex containing Biotin (B7), leave this off for 3-7 days before any blood test. This is because if Biotin is used in the testing procedure it can give false results (most labs use biotin).

I used to take 1 tiromel and 1 grain of Thyroid S and felt great on that dose for about 4 years until 2020.

So you went from this to 50mcg Tiromel in one fell swoop, that is a big jump in the amount of T3, we should increase slowly (1/4 of a tablet of T3 at a time) then wait 6-8 weeks for levels to settle before testing and deciding on the next step.

How long have you been on T3 only? 3 weeks? If so it is too soon to test. We should be on a stable, unchanging dose for 6-8 weeks before retesting.

Your GP will be freaking out at your very high FT3, virtually non-existent FT4 and suppressed TSH. It appears that your GP thinks that you take Levo only and does not know that you were taking NDT and T3 and now only T3. I don't know how you are going to get around this, you will have to decide whether or not you are going to confess. Telling him that you take T3 only is the only way you will be able to explain your results, that is if your GP understands what T3 does.

If you decide to tell him then you will need to say that your results are showing a false high because you took such a large dose of T3 a couple of hours before the test, and that you need to retest. How you get around explaining the timing of taking meds before testing affects results I don't know, some doctors understand this but many don't.

If I was in this position I would reduce the amount of T3. When taking 1 grain NDT plus 1 Tiromel you were taking

38mcg T4 plus 9mcg T3 from the Thyroid S plus 25mcg T3 from the Tiromel.

I would have replaced that with one and a half Tiromel, ie 37.5mcg T3. Maybe consider reducing your Tiromel to that now, wait 6-8 weeks then retest, splitting the T3 into 3 x half tablet (3 x 12.5mcg) the day before, the 3rd dose 8-12 hours before the blood draw. That will be about the most accurate way of measuring the normal amount of circulating hormone avoiding any false high or false low levels.

PS - are you taking your HRT at least 4 hours away from your thyroid meds?

[JellyJac in reply to SeasideSusie]

Thanks so much. Yes that absolutely makes sense. I knew about not taking meds pre test and had meant to not take them until later in the day but am on auto pilot in the mornings. Plus I had had my last B12 loading dose the day before. GP has suggested a repeat test in 2 months so I think I will take your advice and reduce the tiromel and split throughout the day as opposed to all at once in the morning. I am also taking a vit D and magnesium supplement to try to.balance things out a bit.. thanks for your help I really appreciate it.

[arTistapple in reply to JellyJac]

I write notes to myself the night before testing and keep my meds away from their usual places so, if I do not remember in the morning I will at least wonder where they are and pull myself out of autopilot. I did all this for my last test and managed to blithely eat something before my test. What a plonker I felt.

[DippyDame]

Sorry but I think you need to take your thyroid medication more seriously!

How much levo/T3/ NDT are you taking, and for how long?

Keep a diary or spreadsheet to record all info re doses, symptoms, appointments etc.

I had dreadful brain fog and it was the only way I could keep track of everything.

So long as your FT3 is within ref range you are unlikely to be overmedicated....if over, you need to consider reducing dose.

A few of us need FT3 over range because we have a form of Thyroid Hormone Resistance but medics don't understand much about this

However when taking T3 or NDT your TSH and FT4 will drop with FT3 higher.

The results from your GP/NHS test will no longer be a reliable guide for dosing ....you can perhaps try juggling the dose before a test to achieve a result that keeps the GP satisfied!

[JellyJac]

FThanks Dippy. I apologise if I come across flippant with regards to my thyroid. I can assure you I take my thyroid health really seriously so sorry if it doesn't seem that way. I was taking t3 as I haven't been able to get hold of or afford NDT since covid hit. I now take 2 tiromel tablets a day. I used to take 1 tiromel and 1 grain of Thyroid S and felt great on that dose for about 4 years until 2020. Just trying to get my levels sorted out after a tumultuous few years