I'm a 72yr old male. Diagnosed with hypothyroidism 15 years ago. Told I had autoimmune thyroid disease following blood test showing high antibodies. Currently on 125 msg thyroxine. Dr has never tested anything apart from TSH and occasionally FreeT4 and based my medication on these results. Fortunately I have been ok health wise and happily carried on with prescribed meds.
For years my TSH has been just under 1 but last year went up to 3.69. Dr said it's fine because it was within range. However my health has started to show similar problems that many people on this site experience - bad constipation, fatigue, poor concentration, and a hoarse croaky voice.
Rang Dr because I thought I was undermedicated. So Dr suggested further blood test. Armed with valuable information gleaned from this site(thank you everyone) I asked the nurse if they would test TSH, T3, T4, vit D, ferritin, folate and B12. She gave me a strange look but said she would ask the duty doctor. On her return she said the doctor wanted to know where I got my information from. I told her it was advised by Thyroid UK. She disappeared again and returned to say that the doctor agreed to the tests. RESULT!!
Not yet spoken to doctor but requested print out of results which I list below. Can't believe the TSH score! Totally expected it to be way above 4.0. All other levels appear OK. Can anyone explain this to me?
Nov 2022 TSH 3.69 (0.35-4.94) 3/8/23 TSH 0.03 (0.35-4.94)
T4 14 (8.0-19.1) T4 18.4 (8.0-4.94)
Cholesterol 5.4 T3 5.0 (2.4-6.0)
Vit D 66 (>50 adequate)
Ferritin 122.1 (20-300)
Folate 18.2 (3.0-20)
Vit B12 369 (200-700)
Written by
seasider162
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This is your 1st post so although you been a member for a long time, welcome to forum.
“T4 18.4 (8.0-4.94)” This looks incorrect. Can you please check it?
Doesn’t look like FT3 had been tested, so you can have low TSH & good / over-range FT4 but if conversion very poor your FT3 is low & you can have hypothyroid symptoms.
There always the possibility your FT3 is not low as over replacement can on occasion feel similar to hypothyroidism. Which is why testing FT3 is important.
Vitamin D & B12 are in range but could be improved as not optimal.
If dr suggest dose reduction based in low TSH - which is often the case - argue your FT4 is not over range.
Ok so you have decent levels with FT4 at 93% & FT3 at 72% through each range.
Most are well when FT4 in top 3rd of range & FT3 over 50%. Which yours are.
Your doctor likely won’t like your TSH being low (even though your FT4 & FT3 are in range) & will say you are “hyper” and often say things such as this will affect your heart & bones.
This is because over range high thyroid levels long term can affect you & they go by TSH not FT4 & FT3.
I’d expect they’ll suggest a 25mcg daily reduction & retest in 6-8 weeks. You might like to suggest a reduction every other day.
Have you previously been on higher dose?
Many doctors also believe older people need less hormones & a high TSH is better, some do find as they become older they need less replacement, but this is for many reasons and shouldn’t be the aim by doctor.
You have Hashi's, so not surprising if your levels fluctuate. Although it's perfectly normal that your TSH has dropped because your FT4 has gone up considerably. But, whether this is due to your dose or Hashi's fluctuations is anybody's guess.
However, TSH is the absolute least important number. In fact, once it gets below 1 it's more or less irrelevant because it's a very bad indicator of thyroid status. Your FT4 is not over-range, so refuse any attempt to reduce your dose. Low TSH is not dangerus in any way. It's low because you don't need it.
With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a separate B12 supplement and add a separate vitamin B Complex after a week
Then once your serum B12 is over 500 (or Active B12 level has reached 70), you may be able to reduce then stop the B12 and just carry on with the B Complex.
If Vegetarian or vegan likely to need ongoing separate B12 few times a week
IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results
In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate folate supplement (eg Jarrow methyl folate 400mcg) and continue separate B12
Post discussing how biotin can affect test results
Wow. Thank you so much Slow Dragon for all your advice. Much appreciated. Yes I stopped med 24hours before bloods and fasted even though dr gave me a pm appointment. I noted that you have advised many people of similar on this site. Dr said nothing about this of course!!
Never been tested for coeliac. Will mention this to doctor when he rings next week.
Thought I would ask for advice on this site so that I am prepared for what the Dr might say.
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Blood tests on NDT
I used to be good with figures.. 
Please help analyze bloods ranges included now 
Help analysing test results
when does the lab decide to test T4 & T3?
