I am lost here. GP TSH 0.01
T 4. 18.1 Range 12-18 (Not exact but the 18 top is correct) a blood test was asked for from a consult so I did drop my hormones for 2 days before because they always try to lower my dose . I hoped I could fool them !
Phone call to discuss !!
Not fine so snd order MMH test
Monitor my health taken 4 days later ;
I am stumped
Can anyone throw any light on this
I will post the one on hormones they want me to use
No thyroid my the way
stopping/ lowering levo dose for a couple of days before test won't have any effect on TSH , so TSH being same on both tests is not a surprise .
Stopping levo before tests will lower fT4 , but not TSH .
What is it that you are confused about ?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
the other results are here : healthunlocked.com/thyroidu... but it would be better to add them to this post , as it gets confusing having two posts open at the same time . You can add them in as reply to this post .
So these are your latest MMH results. Ones posted in a separate post (please post these as a reply to this post) were in October.
Please detail what dose you were taking for each test.
Tattybogle has explained that stopping levo for a few days will only affect FT4 and not TSH.
Your FT3 is only 24% of its range so far too low. Should be aiming for 60-70%.
How are you getting on raising your B12 which was still low 3 months ago?
Exactly what supplements are you taking - brand etc.
yes. I see that pausing wouldn’t make a difference T4 but it went over range first time ever !
Your TSH went under range likely due to the added T3. It has a tendency to do that.
Where is the over range result you are talking about for T4? You haven't quoted the GP's results.
Free T4 (fT4) 18.8 pmol/L (12 - 22) 68.0%
Free T3 (fT3) 4 pmol/L (3.1 - 6.8) 24.3%
If you are committed to adding T3 and it might be an idea to explain to your GP, then you could add another 5mcg T3 according to these results.
The B complex you have there is a good brand, however it is not a methylated/active type as recommended in this group. You get folic acid which a good percentage of people cannot use in this form. Methyl folate is much better. Also it has B12 in cyanocobalmin form where again methyl cobalmin is better. The B12 is at a low dose if you compare it to Thorne Basic B or any of the other brands we recommend. See label to compare yourself. I'll give you 3 B complexes to choose from all contain about the same as Thorne B complex + a whole lot cheaper than what you have.
amazon.co.uk/Liposomal-Soft...
amazon.co.uk/Yipmai-Liposom...
hempoutlet.co.uk/vitablosso...
I cant find the vitasorb B12 online. How much B12 does it contain and in what form?
thank you. I will change the brand.
I have posted Patient access photo to T4 now
Why were your GP surgery (I assume) wanting to reduce your dose when your TSH was still within the range?
Suggest you make a spreadsheet of results documenting the dose you were on, results and % through range to make a bit more sense of it.
you are right I must note everything down in future
I had thought I was going along ok until last Autumn when I needed to consult about something else and end up in this pickle
Thanks for help.
Adding these results from second post, this allows all information to be in one place which avoids confusion and makes it easier for members to respond.
this is the results on what they want me to use .
This is quoted from you other post here:
healthunlocked.com/thyroidu...
Who are "they"? Is this your GP or endo? If so why are they using your private MMH test results (if I understand correctly) and not their own?
the October MMH I did . Again they had wanted to lower dose . I was taking 75 Levo only prior to test . I could nt post the GP s one . but it shows the TSH in range ! But as you can see T3 below .
The GP sprung a test and for 3 days I stopped dose hoping to escape the same problem . Amazing the TSH was the lowest ever for me .
I went back on my normal 75 t4 and 5mcg T3
And that MM H was the result .
The last few tests (GP) have been done using the different range and this has been the only time it showed to be T4 over range .
I am puzzled to say the least
Thanks for replying
75 t4 and 5mcg T3
What level is your fT4 usually on GP's tests for this dose (when you havent missed any days)
good quotes range wrong.
I can include test as was on 75levo and 5mcg t3
I dose I’ve been on for some time .
Hope that clarifies it , Difficult to put across on my phone
Thanks
just noticed dates on one test was on the same blood. 2 different numbers shown for T4. (27/01/23) !!
Ignored it . Just can’t cope with it all
my husband , an engineer says the range is the range
I have just noticed that the trust that GP uses uses the low number but if you look they are measuring the same units ie. pmol/l !
Surely they have just shifted the number down .
! TSH quoted there is the familiar range only higher ! mlU/L 0.38-5.33
Diogenes wrote a test saying about the Bristol lab test being incorrect some time ago .
Can anyone understand because I don’t .
i understand the logic of where your husband is coming from , but (in theory) how fT4 test ranges work is this :
when you test the same sample on two different 'assay platforms' ( different machines from different manufacturers which use slightly different lab processes to separate the 'Free T4' from the 'Total T4' ) .. you will get a different pmol/l result from both tests.
So it's not just the ref range which is different on different platforms , the pmol/l 'result' is different also . so you can only asses the pmol/l result against the ref range that came with the test.
the ranges show the "95% healthy population range" when healthy people are tested on that particular test method . ( to get 95% ranges , they remove the highest 2.5% and the lowest 2.5% of results , and what is left is the ref range .
So eg the same blood sample with a high amount of fT4 would look like this on two different tests :
on the machine with [7.9 -14] range you'd get a result of 14 [7.9-14]
and on a machine using [12-22] range you'd get a result of 22 [12-22]
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
but in practice , yes, some of us do have doubts about the particular machine that uses the [7.9 -14] range , we suspect it is giving relatively higher fT4 results as a % through range .
The only way to prove it would be to get two sample from the same blood draw and send them to be tested at two different machines, one using the [12-22] and one using the [7.9-14 ]and see if both results come back as a similar % through range .
the calculator to compere % through range from different ref ranges is here thyroid.dopiaza.org/
Your GP tests show a range change from [12-22] to [7.9-14], but this is because the lab has purchased a different assay platform from a different manufacturer which uses a different method and therefore the range is different , but it should still be producing result that are a similar % through range .. they haven't just changed the numbers .
if you tested your latest sample of 14.5 [7.9-14] on their old machine , you'd expect it to give a result of about 23 [12-22]
See how when they bought a new machine , your % through range remained similar at next test , even though the results in pmol/l were very different.
Oct 22 ....... FT4: 17.6 pmol/l (Range 12 - 22) 56.00%
jan 23 ........ FT4: 10.6 pmol/l (Range 7.9 - 14) 44.26%
Were you taking the same dose for these two tests ?
at those tests I was taking the same dose
I have continued on the same dose until I was asked to test last Friday week .
That’s when I dropped T4 to 50 mcg for 2 days and
when it showed me just over range , ! First time ever .
This is the puzzle .
As shown the MMH test came back with numbers more typical for me . ( 4 days later having gone back to T4. 75 mcg and T3. 5 mcg )
That’s apart from the even lower TSH
PS. Is it thought that the Bristol lab test is showing rather unexpected results on the new range ?
Thanks again for helping to unravel
So , your real fT4 level (if you had not lowered the levo for those two days) will be higher than 14.5 [7.9-14] eg it might actually be 15ish [7.9 -14] , but that's just a guess, it's very hard to be sure how much 2 days of 50mcg instead of 75mcg will have lowered it . not much because it's only a very small adjustment in dose.
Re. Bristol (and other labs using 7.9-14... my area has it too), no we don't have any clear evidence that it is showing higher results ...and if it WAS giving significantly higher results when the dose was the same and the amount of fT4 in the blood was the same , then you would have expected to see an obvious change in your % through range when they changed machine .. but you didn't , you got mid range (45/ 55%) on last tets on old machine and first test on new machine ......... so that suggests it's giving correct result .... and if it was giving a correct result for your first few tests using the [7.9 -14] range , then it's reasonable assumption that the current results are correct too .
When did you add the T3 to your 75mcg levo ?
Can you show us the NHS TSH results that go with those fT4 results ?
Did you stop the T3 for those 2 days . or just drop levo from 75 to 50 ?
yes it does seem a bit unexpected/ suspicious that the MMH is so much lower in range than the NHS with higher dose levo taken for 4 ? days before it
I have to babysit now. I glad you are trying to help.
I need to know what I should do . Lower dose ?
Seems so up and down despite little change
I can post GP.s TSH when back home but thanks so far. ☺️
good luck ....... don't know what you should do about you just yet ,will try to have a read of your previous posts while you're gone
.....as for the children , you should feed them blue smarties and coca cola just before you give 'em back to their parents ...lol
I have put your GP/ MMH tests next to each other here for comparison :
1st question .., (putting aside your worries about different ranges /fT4 being over range etc, for now) .
........ stopping the 5 mcg T3 for 6 wks in Oct made you feel very unwell , but DO YOU NOW FEEL OK AGAIN TAKING 75mcg Levo / 6.25mcg T3 ??
2nd question ... your GP reduced your Levo prescription to 50mcg at some point round Nov..... if they don't increase it back to 75mcg soon, WILL YOU RUN OUT OF LEVO .... if so could you get that from the pharmacy where you get your T3 ??
3rd question .. Did you get any support from the endo you were seeing for something else in Nov ?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
*SEPT 2022 75mcg Levo / 5mcg T3 Doing fine !!
TSH 0.02 [0.27 - 4.2]
fT4 19.4 [12-22]
unexpected test , Levo/T3 taken before test~ gp wanting to reduce to 50mcg (based on the TSH , taking the levo/T3 before test wasn't the problem. your TSH would still have been this low even if you had left 24 hrs from last dose levo /12 hrs T3)
In desperation to conform you dropped the 5mcg T3 for 6 weeks
*OCT 2022 75mcg Levo / No T3 8.45am. usual recommended timings .
GP test......................................................MMH test (next day 7 am )
TSH. 0.28 [0.27 -4.2] ........................ 0.33 [0.27 -4.2]
fT4 17.6 [12-22]..................................15.4 [12-22]
fT3. 3.0 [3.1-6.8]...................................2.7 [ 3.1-6.8]
(constipated , boiling hot , can’t pass urine easily , chest pain , can’t walk more than a crawl , tearful... GP wants phone call to discuss .... I’m going back to taking my dose as before and hoping to improve my quality of life that was trashed by this ‘experiment’ Hoping GP’s will continue to issue the 75mcg Levo , though until the phone call I don’t know what they are thinking about those last tests with the TSH still pretty low Putting that call off as long as possible.
meanwhile , Saw Endo about something else ..and got some support re thyroid .
*DEC 2022 ....My endo is willing to help
got Covid .
*JAN 2023 75mcg Levo / 5mcg T3 (9.30am)
GP test (Jan 27th) (new ranges) ..................... MMH tests (Jan 9th)
TSH 0.09 [0.38-5.33].......................................... TSH 0.2 [0.27 -4.2]
fT4 12.3 [7.9-14.4].............................................. fT4 18. [12-22]
And ?! (maybe deliberate duplicate? in process of calibrating their new machine?)
TSH 0.1 [0.38 -5.33]
fT4 10.6 [7.9-14]
fT3 4.3 [3.8-6.0].................................................. fT3 3.5 [3.1-6.8]
Started using Tiromel (25mcg tabs) instead of 20mcg tabs , so T3 dose now 6.25mcg
*FEB 2023 75mcg levo / 6.25mcg T3
GP test (24th Feb)
TSH 0.02 [0.38 - 5.33]
fT4 11.8 [7.9 -14]
*JUNE 2023 (you reduced Levo to 50mcg for 2 days before this GP test, hoping for higher TSH as GP is pressurising and has already reduced prescription to 50mcg a few months ago due to low TSH , but you have still been taking 75mcg ...then resumed usual dose for 4 days then did the MMH test)
GP test (9th June)...................................... MMH (15th June) usual dose 4 days prior
TSH <0.01 [0.38 -5.33]............................. 0.01 [0.27 - 4.2]
fT4 14.5 [7.9 -14] ...................................... 18.8 Range [12-22]
fT3 .................................................................... 4 [3.1 -6.8]
1. I feel better than I did then . Constipation is a problem though
2 my allotted Gp. Is supporting me in the 75 dose , so no problem there .
3 the Endo , somewhat reluctantly , agreed ,despite my low T3 to let me continue with dose I have used for much of the time since op .
still unsure whether or not to make any change ?!
Not very happy with the even lower TSH .
Thanks again Tatty
mmmm............ thinking...... 
will reply tomorrow x
just had a thought spo i'll write it now .
2 reasons why you can just forget about your TSH ....
1) you had thyroid cancer , so it "ought" to be supressed anyway (to reduce the chance of any thyroid tissue/ cancer regrowing)
2 ) you have a known pituitary adenoma .. so there's good reason to treat all your TSH results as a bit 'suspect' anyway .
So that just leaves your slightly over range fT4 result ...... long term over range fT4 is not ideal , so if you can feel well on a levo dose that keeps it within range , then that would be better .
(eg. If you lowered levo a little and kept T3 dose the same, or increase T3 a smidge to compensate , then that would get your fT4 back in range without you feeling lousy)
But FOR NOW, I think you should STAY ON SAME DOSE and do another MMH in a few months to make sure fT4 is not going any higher ... (compare MMH result to previous MMH results )
if fT4 does go any higher on MMH , or if it goes significantly over range on a future GP test , then you my want to consider a very small reduction in levo ... eg 62.5mcg / day .. this probably won't raise TSH .. but should hopefully get fT4 back in range
If GP says anything in the meantime about the over range fT4 on his test, then just ask "to be retested in a few months to check because you'd rather not lower your dose on the basis of just one over range fT4 " ~ say you have some concerns that their lower/ narrower range may be giving slightly 'higher' results as a % through range ... say you had MMH results within days that did not show an over range fT4 (obviously don't mention the '2 days lower dose', but it really wouldn't have made that much difference to fT4 level anyway ) .. .......ask if they would be willing to arrange a proper comparison of the NHS [7.9-14] range with the NHS 'Monitor My Heath' [12 -22] range , from SAME BLOOD DRAW to put your mind at rest ... (that request will probably shut them up for ages lol )
Sounds like a great plan which makes sense to me . Tatty
How grateful I am to you , all of you who helped me. Thank you
If you’re ever in the West country a welcome awaits 😘
p.s in case your hubby is seeking information/ explanation about the differences in fT4 ranges/ TSH ranges, you could give him this post to read .
healthunlocked.com/thyroidu.... freet4-testing-difference-in-reference-ranges-reading-matter-for-a-rainy-day-.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
and on the subject of Low TSH / Risk vs Quality of Life ~ this post has lots of information/ evidence / discussion : healthunlocked.com/thyroidu... useful-evidence
and this one explains why TSH might be lower than 'normal range' in people taking thyroid hormones : healthunlocked.com/thyroidu.... tsh-is-just-the-opinion-of-your-pituitary-about-your-dose-but-your-pituitarys-opinion-is-a-bit-warped-once-you-take-thyroid-hormone.
million thanks for putting it all together x
It was the chocolate orange that did it with my daughter in law last Xmas They have booked it away next year 🫤 mind you I don’t have a problem doing nothing these days !
This is from patient access .
I would have thought with no thyroid it would be easy but apart from when the docs interfer I have been on 75 levo and latterly 5mcg
I realise it is hard to work out for me . I jog along ok , this has been the worst excursion .
I resolve to keep a more comprehensive account in future .
The one thing for sure is that every night when up for the bathroom I have never missed my dose ! It’s 7 years since the op.
Can’t thank you enough for trying help me with this present dilemma .
I also have a pituitary adenoma ? Normal blood test but they don’t test god TSH secretion .
I never get an answer on that one . My 2 trusted Profs I used to see have retired . They are the new young ones , Well anyone under 50 id s mere boy !
Restaurant was too hot so hot off lightly .
Blood test
Blood test results
Blood test results
Blood test results
Blood test results 
