Worried about over-range fT4: Hi everyone. I’m a... - Thyroid UK

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Worried about over-range fT4

Ukie profile image
Ukie
18 Replies

Hi everyone. I’m a bit confused by recent Medichecks result. In myself I’ve been feeling great (re tiredness, brain fog etc) but I have had a couple of migraines recently and have put on a couple of pounds. I should mention I’ve had some stomach problems going back a few months as well (reflux and allegedly high stomach acid, though I know low acid is more typical). I was on PPIs for 6 weeks last autumn, but when stomach symptoms returned in the spring I didn’t do that, I just took Gaviscon at bedtime and it seemed to settle.

I’m taking 3 x 100mcg & 4 x 87.5mcg levo per week. This is my result, taken Monday, early morning on an empty stomach.

TSH 0.169 mIU/L (0.27 - 4.2) -2.6%

Free T4 (fT4) 25.2 pmol/L (12 - 22) 132.0%

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

T4:T3 Ratio 6.462 

In January fT3 was only 10% through range, now 21.6, but I’m a bit worried about fT4 being over range.

Also some surprising vitamin results:

B12 = 59.2 pmol/L [37.5 - 188]

Vitamin D = 119 nmol/L [50_250]

Ferritin = 182ug/L [30 - 650]

I have been taking 50mcg of D all through the summer, as well as out in the sun quite a lot.

B12 has dropped from 91 pmol/L in January

I don’t know what to do now really. If I speak to the Dr she is likely to reduce my levo, so I don’t want to risk that. I think I need T3.

I’ll increase my vitamin D, and please advise what B12 is best. Any other suggestions welcome.

Thank you

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Ukie
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18 Replies
DippyDame profile image
DippyDame

Over range FT4 is not advised....potential cancer risk if long term

Your T4 to T3 conversion is very poor.

AskGP to refer you to an endo who should prescribe T3

We normally start with 5mcg T3 increased by 5mcg after 2 weeks.....repeat until 10mcg then test after 6 weeks

Monitor symptoms.....test results will point to the way forward

FT3 at 21.6% thro' ref range is too low

Both Frees should (approx) be approaching 75%

You need to slowly introduceT3.

T3 will lower FT4 and TSH

You may need to reduce Levo along the way.

At the same time work on essential nutrients

Optimal nutrients

Vit D: 100-150nmol/L

B12: top of range for Total B12

Active B12 if tested .... 100 plus

Folate: at least half way through range

Ferritin: optimal ferritin level for thyroid function is 90-110ug/L

You are clearly not symptom free on current dose.

Good luck!

Ukie profile image
Ukie in reply toDippyDame

Thanks DippyDame, a lot to take on board.

SlowDragon profile image
SlowDragonAdministrator

Was test done as recommended

Early morning, ideally just before 9am, only drinking water between waking and test and last dose levothyroxine 24 hours before test

do you always get same brand levothyroxine at each prescription

Exactly what vitamin supplements are you currently taking

No folate result

B12 is too low

Low B12 symptoms

b12deficiency.info/signs-an...

methyl-life.com/blogs/defic...

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

B12 drops

natureprovides.com/products...

Or

B12 sublingual lozenges

uk.iherb.com/pr/jarrow-form...

cytoplan.co.uk/shop-by-prod...

B12 range in U.K. is too wide

Interesting that in this research B12 below 400 is considered inadequate

healthunlocked.com/thyroidu...

Low folate

supplementing a good quality daily vitamin B complex, one with folate in (not folic acid)

This can help keep all B vitamins in balance and will help improve B12 levels too

Difference between folate and folic acid

healthline.com/nutrition/fo...

Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid.

thyroidpharmacist.com/artic...

B vitamins best taken after breakfast

Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule)

Thorne currently difficult to find at reasonable price, should be around £20-£25. iherb.com often have in stock. Or try ebay

Other options

healthunlocked.com/thyroidu....

Igennus B complex popular option too. Nice small tablets. Most people only find they need one per day. But a few people find it’s not high enough dose

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

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

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

healthunlocked.com/thyroidu...

Ukie profile image
Ukie in reply toSlowDragon

Thanks SlowDragon. Test was 7:30 a.m. and last levo was about 27 hours before. Only water before the blood draw. I don’t always get the same brand of levo, but it doesn’t seem to make any difference to me. They most often give me Teva.

Supplements:

- 1000mg Omega 3

- 400mcg Folic acid (I’ll try to find Folate from now on)

- 1000mg Vitamin C

- 50mcg Vitamin D (summer dose, I take more in the winter)

- Probiotic tablet

- 700mg Glucosamine with 300mg Chondroitin (for arthritis)

This last one only recently. I take all supplements after breakfast, at least 3 hours after levo, usually longer.

I didn’t respond yesterday because I have yet another migraine, still in post-drome now. I will work through all your info when I’m feeling better. Thank you so much for your help.

SlowDragon profile image
SlowDragonAdministrator in reply toUkie

Currently very poor conversion rate of Ft4 to Ft3

you’re likely to need addition of T3 prescribed alongside (slightly reduced) dose levothyroxine

So looking at previous posts

You have Hashimoto’s…high thyroid antibodies

Are you on gluten free diet or dairy free diet?

If not, get coeliac blood test BEFORE cutting gluten out as 3-6 months trial

Meanwhile start on daily B12

Then after 2 weeks, change daily folate for a daily vitamin B complex

Ukie profile image
Ukie in reply toSlowDragon

Thank you so much for your comprehensive replies! I’ve ordered B12, B complex and folate. B12 first as advised, then B complex. How long do you think I should leave it before getting another blood test?

SlowDragon profile image
SlowDragonAdministrator in reply toUkie

I think I would also reduce dose levothyroxine very slightly as Ft4 is over range

100mcg 2 days and 87.5mcg 5 days

Retest in 6-8 weeks

Are you gluten free?

Dairy free?

Ukie profile image
Ukie in reply toSlowDragon

I’m not gluten or dairy free atm. I thought I would see how I get on with the new supplements first. One of the main symptoms that bothers me is constipation, and I find it helps to eat Weetabix every morning, with flax seeds and chia seeds. I have just started to have oat milk with my Weetabix though, because I probably do have too much dairy tbh. When I’m settled in the new supplement regime I’ll give gluten free a try. Thanks

SlowDragon profile image
SlowDragonAdministrator in reply toUkie

There are gluten free weetabix ……not tried them myself

sainsburys.co.uk/gol-ui/pro...

I make my own muesli with certified GF oats. (Waitrose GF oats are the best) ……

1/2 of a 1kg bag per mix

Adding wide selection of seeds, nuts and dried fruits

Usually

seeds - chia, sunflower, pumpkin, flax, linseed

Chopped Nuts - almonds, Brazil, walnuts

Dried fruit - figs, dates, apricots, raisins

Mix whole lot in large bowl. Put in storage jar. Makes about 20 -26 portions.

I have with fresh banana, few strawberries and blueberries and oat milk

Ukie profile image
Ukie in reply toSlowDragon

That’s great thanks, we sometimes go to Sainsburys. I may try the muesli too 🙂

Ukie profile image
Ukie in reply toUkie

But not yet if I’m having a celiac test!

SlowDragon profile image
SlowDragonAdministrator in reply toUkie

That’s true

When is that being done?

Ukie profile image
Ukie in reply toSlowDragon

I’ll organise it soon. Thanks

SlowDragon profile image
SlowDragonAdministrator in reply toUkie

you can get that GF weetbix in most supermarkets, in the “free from “ section

radd profile image
radd

Ukie,

If you left 24 hours between your last dose and the blood draw, then you are over medicated and need to reduce your dose.

As DD has said over-range FT4 isn’t recommended as thought to be a cancer risk, but it also stops working so positively when you exceed your sweetspot, eg T3 conversion reduces the higher you go, and you might find you achieve better FT3 levels with FT4 a bit lower.

Also regarding gut issues, many hypos suffer from low gastric acid that doctors don’t recognise. If you haven’t got stomach ulcers, you could try betaine + pepsin to help with nutrient absorption and this might make thyroid hormones meds work a bit better also.

Ukie profile image
Ukie in reply toradd

Hi Radd, thanks for response. In January 2023 I was on 2 x 100mcg & 5 x 75mcg per week, and T3 was only 10% through range. T3 has apparently improved on the higher T4 dose. As you say though, it’s not good to be over range on T4, so I probably do need to reduce it again. Going forward I think I need to increase my vitamin levels, then maybe try to source some T3. SlowDragon has given me a lot of info which I plan to work through when I’m feeling better (another migraine). Thanks for gut suggestions as well.

radd profile image
radd in reply toUkie

Ukie,

Optimising iron and nutrients give Levothyroxine very best chance of working well, and then should FT3 drop and remain low with a Levo reduction, that's the time to consider adding a little bit of T3 meds.

SlowDragon profile image
SlowDragonAdministrator

Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels

Low vitamin levels affect Thyroid hormone working

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common.

A trial of strictly gluten free diet is always worth doing

Only 5% of Hashimoto’s patients test positive for coeliac but a further 81% of Hashimoto’s patients who try gluten free diet find noticeable or significant improvement or find it’s essential

A strictly gluten free diet helps or is essential due to gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and may slowly lower TPO antibodies

While still eating high gluten diet ask GP for coeliac blood test first or buy test online for under £20, just to rule it out first

Assuming test is negative you can immediately go on strictly gluten free diet 

(If test is positive you will need to remain on high gluten diet until endoscopy, maximum 6 weeks wait officially) 

Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse

chriskresser.com/the-gluten...

amymyersmd.com/2018/04/3-re...

thyroidpharmacist.com/artic...

drknews.com/changing-your-d...

Non Coeliac Gluten sensitivity (NCGS) and autoimmune disease

pubmed.ncbi.nlm.nih.gov/296...

The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported

nuclmed.gr/wp/wp-content/up...

In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned

restartmed.com/hashimotos-g...

Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.

Similarly few months later consider trying dairy free too. Approx 50-60% find dairy free beneficial

Hashimoto’s and leaky gut often occur together

Post discussing gluten

healthunlocked.com/thyroidu...

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