I’m 65 year old female just had my blood work done recently. Would be grateful if someone could take a look at them. I have Hashimoto's and under active thyroid. I’m currently taking 125mcg Levo and 10mcg T3 per day. Have been feeling very tired recently no energy and can’t lose weight.
T4 19.6 range 12-22
TSH 0.02 😳 range 0.27-4.20
T3 6 range 3.10 to 6.80
Vit D 118
Antibodies 125
Can you tell us when you took your last dose of levo & T3 before this test please? It can make a huge difference to your blood results as there is a peak for each hormone up to a certain time after taking them.
Recommended blood test protocol: Test at 9am (or as close as possible), fasting, last levo dose 24hrs before the blood draw, last T3 dose 8-12 hours before blood draw & no biotin containing supplements for 3-7 days (Biotin can interfere with thyroid blood results as it is used in the testing process)? Testing like this gives consistency in your results and will show stable blood levels of hormone and highest TSH which varies throughout the day. Taking Levo/T3 just prior to blood draw can show a falsly elevated result and your GP/Endo might change your dose incorrectly as a result.
What vitamins are you taking? Have you recently had bloods run for ferritin, folate, B12 & d3?
It's ideal if you can always get the same brand of levo at every prescription. You can do this by getting GP to write the brand you prefer in the first line of the prescription. Many people find that different brands are not interchangeable.
I got my bloods done at 9.30 am fasting last T3 would have been the day before in the morning and T4 which I would usually take before bed I didn’t take it the night before my blood work
What about vitamin results or what supplements you are taking?
So the last T3 you took was around 24 hours before and Levo 18 hours? For the T3 it was too longer gap as will now be showing a false low. T4 will be slightly higher than if you had left 24hrs.
Free T4 (fT4) 19.6 pmol/L (12 - 22) 76.0%
Free T3 (fT3) 6 pmol/L (3.1 - 6.8) 78.4%
So although these numbers look pretty good it may be that if you had tested as per the protocol recommended here your FT3 inparticular would have been higher. Its hard to be certain unless you retested with the recommended timings for a blood test but its possible your FT3 migh tbe on the high side.
I would recommend retesting using the blood test protocol.
Vit D 118 no range given
Ferritin 136 range 13.00-300
Serum transferrin 2.14 range 2.00-3.60
Serum Iron level 16.4 range 10.00-30.00
Transferrin saturation index 30.7 <55.00%
What supplements are you taking?
selenium/zinc
D3/K2
Agnus Castus
Turmeric
Krill Oil
Magnesium L Threonate
So the area missing is B12 & folate. Bloods required.
Iron is a very complicated mineral so I will ask SeasideSusie if she can have a look at your iron panel results.
You need B12 & folate tested if you dont have results for those.
Your D3 is good.
Thank you
I disn’t have B12 done but will get that the next time I’m a bit convergence about my TSH being so low
If you're not taking any B12/folate then one or both are likely to be on the low side. If ALL our key vitamin levels are not OPTIMAL then our thyroid hormone cannot work well.
As far as a low TSH goes then almost any amount of T3 will reduce TSH to very low if not suppressed and is nothing to be concerned about.
Optimal iron panel levels according to rt3-adrenals.org/Iron_test_... are:
Serum iron: 55 to 70% of the range, higher end for men - yours is 16.4 (10-30) = 32% through range so it's on the low side.
Saturation: optimal is 35 to 45%, higher end for men - yours is 30.7% to not too far off optimal.
Transferrin: Low in range indicates lack of capacity for additional iron, High in range indicates body's need for supplemental iron - yours is 2.14 (2-3.6) = 8.75% so it's low in range suggesting supplementation isn't necessary.
Ferritin: 136 (13-300)
Some experts say the optimal ferritin level for thyroid function is 90-110ug/L.
Was CRP (an inflammation marker) tested at the same time? Ferritin rises with inflammation so testing CRP will let you know if your ferritin is a true normal level or whether it's elevated due to inflammation.
Your serum iron and saturation are a little low but certainly not dire and your transferrin doesn't suggest that you supplement.
Thank you for your help. I will ask for CRP and B12 to be tested in a few weeks. Do you think I should still continue with T3
CRP needs to be tested at the same time as ferritin to know if your ferritin is raised due to inflammation.
Do you think I should still continue with T3
Why? Are you considering stopping it? You've been on it for a few years so presumably you've benefitted from it and your endo is happy to continue prescribing?
You have a false low FT3 result due to taking your last dose of T3 24 hours before the test so it could be that a reduction in T3, say 2.5mcg and then retesting (using our advised timings for last dose) 6-8 weeks after reducing dose would be a good idea.
Thank you
How do you normally take your 10mcg dose T3 ?
As a single 10mcg dose?
Or as 2 x 5mcg roughly 12 hours apart
Which brand is T3
Day before ANY thyroid test ALWAYS split T3 as 2 or 3 smaller doses spread through the day
Eg on 10mcg total per day…..day before test….5mcg waking….2.5mcg mid afternoon and last 2.5mcg at approx 8-12 hours before test
Last dose levothyroxine 24 hours before test
If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test
If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal
do you always get same brand levothyroxine at each prescription
You need B12 and folate tested, especially if not taking any vitamin B complex or separate B12 supplements
I usually take my T3 first thing in the morning 2x5mcg The brand is Morningside
Since Covid I don’t get the same brand each script is different.
recommend you experiment with splitting your T3 every day for 6-8 weeks…..see if that’s an improvement
Retest thyroid levels
Timing
5mcg waking and 5mcg 10-12 hours later
Or
5mcg waking, 2.5mcg mid afternoon and 2.5mcg at bedtime
Levothyroxine
Have you noticed any difference when on different brands
If yes…..Which brand suits you best
Request GP specify that brand on prescription
Government guidelines for GP in support of patients if you find it difficult/impossible to change brands
gov.uk/drug-safety-update/l...
If a patient reports persistent symptoms when switching between different levothyroxine tablet formulations, consider consistently prescribing a specific product known to be well tolerated by the patient.
academic.oup.com/jcem/artic...
Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).
If your dose had been taken 12hrs before the test, as per protocol, your FT3 may have been higher. In that case your dose may be too high.
This may cause the converse effect of T3 with symptoms of overmedication appearing as being undermedicated....eg tiredness.
Before changing your dose I'd suggest you test again following the correct protocol as described in replies above.
Accurate results will point the way forward
Your Ft4 might have been over range if you tested with 24 hour interval between last dose levothyroxine and test
Retest correctly before considering reducing Levothyroxine OR T3
Only reduce one or the other….not both
Might only need tiny reduction
Eg if Ft4 is over range….reducing levothyroxine from 125mcg daily
Initially try 112.5mcg 4 days week and 125mcg 3 days
Wait 8-10 weeks and retest
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