I have just recieved the following blood test results and I could do with your thoughts please. I treat my underactive thyroid with a comnination of T4/T3. T4 - 100 mcg 4 x week, 125 mcg 3 x week. I usually take 10 mcg T3 in the morning.
FT4 - 14.6 [11.0-22.6]
FT3 - 4.4 [3.5-6.5]
TSH - 0.06 (0.2-4.0]
My TSH has been suppressed for years but my GP is now wanting to bring it up into the reference range. I'm worried that if I reduce my thyroxine dose further, I will become symptomatic again. My blood pressure has recently become elevated (triggered by menopause) and she is worried about the TSH being suppressed and the additional risks.
Any thoughts or experience very gratefully received.
Thank you.
Written by
figster
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Yes, I followed the testing protocol although I took 5 mcg of T3 24 hours before the blood test and forgot to take the last 5 mcg 12 hours before the test.
Sorry, I regularly take 10 mcg of t3 in the morning.
Where do you think the ranges should sit ideally with a t4/t3 combination?
And is there any research to show that tsh is almost always suppressed on t3 please.
I can sense a battle looming with the GP - it was a difficult conversation today.
Ferritin right at the bottom of normal range - I'm not able to access my results for some reason but from memory it was 26.
Endocrinologist is only one who should have any say on changing doses
If GP says " I have to reduce your dose because the guidelines say i can't let you have a below range TSH" .....
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. "
The link between TSH, FT4 and FT3 in hyperthyroidism is very different from taking thyroid hormone (T4) in therapy. In hyperthyroidism, FT4 and FT3 are usually well above range and TSH is very low or undetectable. In therapy, FT4 can be high-normal or just above normal, TSH can be suppressed but FT3 (the important hormone that controls your health) will usually be in the normal range. FT4 and TSH are of little use in controlling therapy and FT3 is the defining measure. A recent paper has shown this graphically:
Heterogenous Biochemical Expression of Hormone Activity in Subclinical/Overt Hyperthyroidism and Exogenous Thyrotoxicosis
February 2020 Journal of Clinical and Translational Endocrinology 19:100219
DOI: 10.1016/j.jcte.2020.100219
LicenseCC BY-NC-ND 4.0
Rudolf Hoermann, John Edward M Midgley, Rolf Larisch, Johannes W. Dietrich
the best paper on this that I have seen indicates that a TSH of 0.03-0.5 is best on therapy. Above that is insufficient and below MAY or MAY NOT indicate slight overdosing
Interestingly, patients with a serum TSH below the reference range, but not suppressed (0.04–0.4 mU/liter), had no increased risk of cardiovascular disease, dysrhythmias, or fractures. It is unfortunate that we did not have access to serum free T4 concentrations in these patients to ascertain whether they were above or within the laboratory reference range. However, our data indicate that it may be safe for patients to be on a dose of T4 that results in a low serum TSH concentration, as long as it is not suppressed at less than 0.03 mU/liter. Many patients report that they prefer such T4 doses (9, 10). Figure 2 indicates that the best outcomes appear to be associated with having a TSH within the lower end of the reference range.
wow thank you so much slowdragon. I really appreciate you taking the time to give me such a comprehensive response. I will read through the material and come back to the group with any further questions.
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Blood Test results - help please 
Help please with latest blood results
Blood test results before consultation with GP.
Blood test results help PLEASE. 
