Test results advice please

[WeeB]

Hi, just got these results back and looking for more advice please. I have hashimotos and have a lot of symptoms just now including exhausted, joint pain and high anxiety . I take 40mg propanolol daily for headaches which is working for the headaches. i am on 125 mg levo.

[WeeB]

here are my june 2022 results

Blood tests

[WeeB in reply to WeeB]

this is my Jan 2019 results , i started propanolol around october 2022 and have been pretty i’ll for last 2/3 years.

blood test

[TiggerMe in reply to WeeB]

With these result they should have given you a little more T4, can you remember if they did as your TSH is too high and you had a little more wiggle room with your fT4 possibly even a little more depending when you last dose was before the test... would it have been 24 hours?

[WeeB in reply to TiggerMe]

i think i went up to 125 from 100 nearer the end of that year 2019 but had to convince gp cos they think tsh anything within the range is fine .

i usually try to do the 24 hour dose spacing before tests but back in 2019 i can’t remember

[TiggerMe in reply to WeeB]

It would seem they haven't much of a clue 😟

[SlowDragon Administrator]

You can see that propranolol has significantly reduced your conversion rate of Ft4 to Ft3

Discuss other options instead of propranolol with GP

Propranolol is used to treat hyperthyroid patients because it lowers uptake and conversion of Ft4 to Ft3

You must not stop propranolol suddenly. It has to be weened off very very slowly. Reducing by 5mg…..wait 2-3 week…..lower by another 5mg etc etc

When were vitamin D, folate, ferritin and B12 levels last tested

What vitamin supplements are you currently taking

We need optimal vitamin levels for good conversion of Ft4 to Ft3

Low Ft3 results in low vitamin levels

FT3: 3.9 pmol/l (Range 3.1 - 6.8)

Ft3 only 21.62% through range

Currently your Ft3 is terrible as direct result of propranolol

How much levothyroxine were you taking in Oct 22 before starting propranolol.

Results in June - TSH shows you were not on high enough dose levothyroxine. Headache is hypothyroid symptom

[TiggerMe in reply to SlowDragon]

Snap! 🤗

[WeeB in reply to SlowDragon]

Hi, vitamin d was tested last week and good result . b12 and folate are ok but could be higher . my iron levels are ok but tricky as sometimes they drop a bit but i can’t supplement regularly because i have the genetic disorder haemachromatosis and my body overstores iron so haematology deliberately keep my levels on the low side .

i was on 125mg of levo last year too.

can i ask , while i m on propanolol , does it help to take it hours away from levo , or does it mess up conversion to t3 regardksss of when i take it ?

[SlowDragon Administrator in reply to WeeB]

Propranolol will mess uptake and conversion up regardless

Take propranolol As far away from levothyroxine as possible…..at least 4 hours minimum

But presumably Propranolol is either slow release or as several small doses per day

[WeeB in reply to SlowDragon]

i take one 40mg per day in the morning , was taking it a couple of hours after levo but now thinking i’ll need to move my levo back to night time and take propanolol in morning . i’ve never needed to up the dose or take more than one dose a day because it seems to keep the eye pain away till late evening . by the time late evening comes my eye starts to get sore and i just go to sleep and the rest sort it’s . if i don’t take the propanolol , the eye pain kicks off around midday . i’m not keen on trying the replacement they mentioned because it has more side effects . any recommendations for replacement of propanolol that manages head pain would be welcomed but i’ll talk it through with gp .

[pennyannie in reply to WeeB]

Hello WeeB :

Just a thought - there are specialist clinics , mainly attached to larger teaching hospitals, I believe, throughout the country where both endos and ophthalmologists work together in this specialist field to optimise your health care.

If you contact the Thyroid Eye Disease Charitable Trust - tedct.org.uk - they can signpost you to your nearest clinic which might be another way of seeing specialists in the sector.

[TiggerMe]

Seems that you used to convert T4 a whole lot better before adding the propranolol... which I thought they use to treat hyperthyroid patients, it has certainly lowered your fT3 level? Did you feel better in Jan 2019 with decent fT3 levels?

How are your ferritin, folate, Vit D and Vit B levels as they are essential for conversion?

With your latest results it shows that you are overdoing the T4 and not converting it to fT3 (the active form) you need to ask for a referral to an Endo to get some T3 prescribed

TSH 1.66 mIU/L (0.27 - 4.2) 35.4%

Free T4 (fT4) 25.4 pmol/L (12 - 22) 134.0%

Free T3 (fT3) 3.9 pmol/L (3.1 - 6.8) 21.6%

T4:T3 Ratio 6.513 

[WeeB in reply to TiggerMe]

I can’t really remember how i felt in 2019 but if i did a private blood test at the time then it’s likely i was pretty ill at the time . so confusing

[WeeB in reply to TiggerMe]

Thanks for this , wish me luck trying to get endo referral .

[TiggerMe in reply to WeeB]

It certainly looks like propranolol is the big issue here... SlowDragon being the experienced one... possibly getting off it would save you the headache of trying to get T3 🤷‍♀️

[SlowDragon Administrator in reply to TiggerMe]

T3 won’t work if on propranolol

[WeeB in reply to SlowDragon]

Wow , did not know this , so i need to focus on getting my headaches under control and off propanolol before anything else then .

[WeeB in reply to SlowDragon]

i’m curious to know why the t3 won’t work if on propanolol , i thought it just messed with the conversion for t4 to t3 . do you have any more info on this before i get into any of my issues with gp

[SlowDragon Administrator in reply to WeeB]

Propranolol affects more than just conversion of Ft4 to Ft3

pubmed.ncbi.nlm.nih.gov/168...

[TiggerMe in reply to SlowDragon]

Ah, I thought it just hampered conversion... surely there must be better ways of treating headaches... likely starting with appropriate thyroid replacement hormones? 🙄

[SlowDragon Administrator in reply to TiggerMe]

Yes exactly…..headaches hypo symptom

[SlowDragon Administrator]

I was stuck on 4 x 10mg propranolol almost 20 years

Unbelievably no GP or endocrinologist saw it was an issue

Getting replacement thyroid hormone and especially vitamins optimal was essential…..propranolol lowers magnesium levels

but also for me…..a strictly gluten free diet…..then I was able to get off propranolol

More on my profile

[WeeB in reply to SlowDragon]

I was wondering what your thoughts were on food intolerance tests , are they worthwhile or not

[SlowDragon Administrator in reply to WeeB]

Coeliac test yes, but only 5% Hashimoto’s patients test positive, yet further 81% find gluten free reduces symptoms, improves absorption of levothyroxine and is either beneficial or absolutely essential

Similarly Approx 50% find dairy free beneficial

Only way to know is to try them

Try Gluten free at least 6 months. Assuming beneficial, then also try dairy free

Personally they were both life changing