help with test results

[Catlady125]

I had a thyroidectomy over 20 years ago, not been feeling great and having no luck with GP. Had private blood test done and results are TSH 0.03 and T4 28.9 T3 was within range and normal,

[PurpleNails Administrator]

please add FT3 results & ranges.

What was reason for thyroidectomy?

TSH unreliable but doctors tend to focus & will likely suggest reduction.

Your FT4 is quite high by most ranges but how is you FT3? Do you convert well?

Most importantly are you currently well?

Important to test folate, ferritin, B12 & vitamin D? When were they last tested?

[Catlady125 in reply to PurpleNails]

thanks for your reply

I had a goitre and T3 4.9

Feeling tired and gaining weight aching too

Not had vitamin D tested for around 6 years and the others you mentioned not sure when they were tested but will have been a long time ago

[PurpleNails Administrator in reply to Catlady125]

Assume it is free T3 (not total)? we need range to interpret accurately but it’s lowish by most ranges.

I think you need to have a complete set of blood test results, you may have some low nutrients affecting conversion.

Was you goitre removed as was causing obstruction? Was it hyper. TSH can be down regulated if you’ve previously been hyper?

Have you ever had thyroid antibodies tested?

[Catlady125 in reply to PurpleNails]

Not had thyroid anti bodies tested and was removed due to obstruction bloods were fine

[SlowDragon Administrator]

Just testing TSH and Ft4 is completely inadequate

Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Is this how you did your test?

Please add Ft3 result

What was reason for thyroidectomy?

Autoimmune or cancer or goitre

Were thyroid antibodies tested before thyroidectomy - TPO and TG thyroid antibodies tested at least once

For full Thyroid evaluation you need TSH, FT4 and FT3 tested

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins

List of private testing options and money off codes

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

Only do private testing early Monday or Tuesday morning.

Link about thyroid blood tests

thyroiduk.org/getting-a-dia...

Symptoms of hypothyroidism

thyroiduk.org/wp-content/up...

Tips on how to do DIY finger prick test

healthunlocked.com/thyroidu...

Medichecks and BH also offer private blood draw at clinic near you, or private nurse to your own home…..for an extra fee

[Catlady125 in reply to SlowDragon]

Hi, I have never been informed about what you mentioned regarding the day of having the blood test, I have always had meds and breakfast T3 was 4.9

[SlowDragon Administrator in reply to Catlady125]

So Ft4 is falsely high as you took levothyroxine before test

TSH would probably have been higher if tested fasting and early morning

FT3: 4.9 pmol/l (Range 3.1 - 6.8)

Ft3 only 48.65% through range

Most people when adequately treated will have Ft3 at least 60-70% through range

So probably poor conversion rate

Next step test correctly and get vitamin levels tested too

For good conversion of Ft4 to Ft3 we need GOOD vitamin levels

Once vitamin levels are at good levels if Ft3 doesn’t improve, like thousands of other thyroid patients you will need T3 prescribed alongside levothyroxine

List of thyroid specialists and endocrinologists who will prescribe T3

healthunlocked.com/thyroidu...

Extremely difficult/long wait to get T3 on NHS

Likely to need to go private initially …..then you might eventually get prescribed on NHS if you’re lucky (post code lottery)

All the more reason to sign this U.K. Gov petition for better treatment

petition.parliament.uk/peti...

[Catlady125 in reply to SlowDragon]

Thank you

I will do another test and also get vitamins tested too

[beh1]

Hello Catlady125. As Purplenails mentioned, please add ranges.

Eg FT4 28.9 (12-22).

This will give us an idea of where your values are.

Also, did you say you took your meds before test? What time took meds? What time test? This will have pushed up the results.

Then we can advise next move. Maybe a retest allowing 24 hours after meds, first thing in the morning, and test D, ferritin, folate, B12.

[Catlady125]

Hi

TSH 0.03 range 0.27 - 4.2

FT4 29.2 range 12-22 pmol

FT3 4.9 range 3.1 - 6.8

Took meds at 7.30 am and tested 11.30 am

[pennyannie in reply to Catlady125]

Hey there :

So following on from my more detailed reply yesterday - I see we now have some blood test results and ranges.

Since you took your Levothyroxine some 4 hours prior to the blood test this is showing a false high T4 reading as generally it's advised to take your daily T4 medication after the thyroid blood test.

The accepted conversion ratio when on T4 monotherapy is said to be 1 - 3.50 - 4.50 - T3/T4 and we generally feel best when we come in this ratio at 4 or under.

So if I divide your T4 by your T3 - I am getting your conversion coming in at 5.60 and way outside this range :

Optimal ferritin, folate, B12 and vitamin D will help support better T4 to T3 conversion but the logical solution is to reduce down your T4 dose BUT add in a small dose of T3 to rebalance these two vital hormones.

Thyroid UK - the charity who support this forum hold a patient to patient list of thyroid specialists - both NHS and private - maybe contact admin @ thyroiduk.org - obtain a copy as there might be someone there who you could ask to be referred to.

You haven't a thyroid and it's blatantly obvious that you need more than T4 monotherapy in order to regain your health and well being.

[Catlady125 in reply to pennyannie]

Thank you for your advice I will contact thyroid uk

[pennyannie]

Hello Catlady :

A fully functioning working thyroid would be supporting you on a daily basis with trace elements of T1. T2 and calcitonin + a measure of T3 at around 10 mcg + a measure of T4 at around 100 mcg.

The thyroid is a major gland responsible or full body synchronisation including your physical through to your mental, emotional, psychological and spiritual well being, your inner central heating system and your metabolism.

T4 - Levothyroxine is basically inert and stored in the body ready to convert into T3 which is the active hormone that runs the body, much like petrol runs the car.

Conversion of T4 into T3 can be compromised by non optimal levels of ferritin, folate, B12 and vitamin D and inflammation, any physiological stress ( emotional or physical ) depression, dieting and ageing can also down regulate the conversion of T4 into T3.

We generally feel at our best when our T4 is in the top quadrant of its range with the T3 tracking slightly behind at around 60-70% through it's range - at roughly a 1/4 ratio T3/T4.

Since you haven't a thyroid it is essential that you are dosed and monitored on your Free T3 and Free T4 readings and not your TSH.

The TSH relies on the HPT axis working well - but without a thyroid - this Hypothalamus - Pituitary - Thyroid feedback loop open ended as there is no thyroid any longer and this circuit loop not complete and closed as in nature.

Some people can get by on T4 only - Levothyroxine.

Some people find that at some point in time T4 seems to not work as well as it once did and that by adding in a little T3 - likely a similar dose that their thyroid once supported them with - their health is restored.

Some people can't tolerate T4 and need to take T3 Liothyronine - only.

Whilst others find their health and well being restored better taking Natural Desiccated Thyroid which contains all the same known hormones as the human thyroid and derived from pig thyroid, dried and ground down into tablets referred to as grains.

Up until 20 odd years ago all doctors in primary care had all these thyroid hormone treatments in their box of tricks to readily prescribed if a patient did not fully recover their health and well being on T4 monotherapy.

Currently, doctors in primary care can only prescribe T4 and you need a referral to an NHS endocrinologist to be assessed and sadly it has become a post code lottery where CCG/ICB financial restraints - rather than medical need - appear to be implemented.