Advice on referred blood tests

[CornishChick]

As per my recent post, a GP (not my usual) is on the band wagon to reduce my levothyroxine due to a suppressed TSH. This became suppressed a few years ago when I tried T3, although I've always been towards the top of range (until now it seems) and it made no difference, so I stopped it.

My usual GP has always turned a blind eye, but this other GP is determined to reduce my dose. She sent my test results off for further investigation, I'd like to know what this means and why they're so different from the usual lab results please. Just to say I'm not trying to get T3, I am trying to fight against reducing my levo. I've had all the other vitamins tested numerous times and everything is usually fine except ferritin which I struggle to get above about 45 from memory. I'd really just like help with fighting this GP, I take all the recommended supplements. I am incredibly stressed and upset with this battle and need all the help I can get please. Thank you.

27/9/23

FT4 16.5 (9-19)

TSH 0.004 (0.35-4.94)

I am aware that my FT4 isn't high enough, and if anything I should be getting a levo increase.

The GP then sent my results away to be re-examined by a different lab, and they came back as follows:-

27/9/23

CHMSA (3) >>> LTGQ - what does this mean???

TSH 0.01 (0.27-4.2)

Free thyroxine (S) 24.3 (12-22)

FT3 4.7 (3.1-6.8)

Please can someone explain why my TSH is different when re-rested. Why is FT(S) tested and not FT4? What's the difference please?

Also, any further evidence I can throw at this dreadful GP not covered in my previous post, who is causing me so much unnecessary stress and upset at a time in my life when I'm dealing with a huge amount of stress elsewhere.

Just to add I do take LDN and am wondering if this could be suppressing my TSH?

[tattybogle]

'Free Thyroxine' is fT4

in this latest test it is over range .

Don't know what the other codes and the (s) stand for . you'd have to ask GP to clarify.. but it's probably nothing important.

Can't say why the fT4 result are so much higher, except that it is well known that different test methods at different labs will give slightly different results. You are stuck now ..the GP won't be happy to ignore the over range fT4 now they have it in print , but you can argue strongly that the active hormone (fT3) is well within range , therefore this suggests you are not actually overmedicated.

based on the over range fT4 (and the low TSH) , you may be best to agree to 'trial a small reduction in levo for 3 mths to see how you feel'. eg negotiate a 12.5mcg reduction rather than 25mcg .

if you do agree to try it , do give it at least 6 wks before you start to make your mind up how it feels ..... in my experience , i have found that the first 5 ish weeks of a reduction may well feel undermedicated but things can improve from then on ... i have found i was ok and in fact better in some areas by about 2/3 months ... but if you'd asked me at week 5 i would have been absolutely adamant that the dose was too small.

if the current time is very inconvenient for you to be 'rocking the boat' by trialing a lower dose , you could try 'i have a lot on at the moment and can't afford to risk becoming unwell can we retest in 3 mths and if fT4 is still over range , then i would be prepared to try a small reduction then'

[CornishChick in reply to tattybogle]

Thank you for your help.

My previous FT4 results are

16.8

14.5

11.7

Range 9-19.

So it seems very strange to me how this extra test on the same sample has come back 24.3 (12-22). How can that be?!

[tattybogle in reply to CornishChick]

it has clearly been rising ... it's up to about 70% at your usual lab.

My fT4 went higher after the menopause .. and i become overmedicated .. dose has needed to be reduced twice .. i was previously on 150mcg for 15 yrs then became overmedicated post menopause , reduced to 125mcg , then 3 yrs later fT4 went over again, so now on 112.5mcg .... it's not uncommon for changes in menopause etc to lead to needing a bit less levo.

a difference in fT4 test methods does always give slightly different results anyway . ( separating the 'free' bit in order to measure it is feindishly complex , and you are talking about miniscule amounts , so tests using different methods are not properly comparable ... so don't spend too much time scratching your head about the difference between :

16.8[9-19] roughly 70%

24.3 [12-22] roughly 120% .

... the fact is they are both indicating your fT4 level is in the region of ' highish not lowish '

look more for 'trends' in result (from results using same lab / test method) rather than one off results, or differences in tests using different methods.

[CornishChick in reply to tattybogle]

Thanks Tattybogle.

Could the LDN be affecting my TSH please?

[tattybogle in reply to CornishChick]

i don't know anything about ldn, soz

x

[greygoose]

How long was the gap between your last dose of levo and the blood draw for this latest test? And what time was the blood draw?

[CornishChick in reply to greygoose]

I left 24 hours between my last levo dose and my blood test. It was at 9am.

[greygoose in reply to CornishChick]

OK, so very strange that the readings are so different. Do you have Hashi's?

[CornishChick in reply to greygoose]

Yes I do.

[greygoose in reply to CornishChick]

Well, that could account for it, then. Levels do fluctuate with Hashi's. But I wouldn't expect an ignorant GP like yours to know that.

[CornishChick in reply to greygoose]

😂Yes although she calls herself a hormone specialist GP!

The two lab results were taken from the same sample, so can Hashis account for that? One went off to the usual GP’s lab, but then this particular GP decided to send it elsewhere afterwards for more detailed analysis to obtain further proof that my TSH is dangerously suppressed. They came back as

TSH 0.004 (0.35-4.94) usual lab

TSH 0.01 (0.27-4.2) second lab

Seems like a big difference, same with my FT4 in the post above.

[greygoose in reply to CornishChick]

Yes, well, she could call herself Donald Duck, but it wouldn't make her a Disney character.

If the blood came from the same sample for both tests then no, Hashi's couldn't account for that! And, being a confirmed cynic, I would suspect foul play! For some unknown reason - pigheadedness? - she has decided she wants your TSH higher. How far is she prepared to go to get it?

But there is no such thing as a 'dangerously' low TSH. If your TSH is low it's because your pituitary has decided you don't need it anymore. I don't think the body would work like that if it were dangerous to have a low TSH.

But, quite honestly, the difference is not that much for the TSH. Once it gets below 1 it doesn't mean much anymore, anyway. The surprising difference is with your FT4. And, if I were you, I would demand a recount - or retest, whatever - because that is just not possible. Something is wrong.

[CornishChick in reply to greygoose]

Thank you so much for confirming exactly what I suspected. I will get on the case. Just the stress I don’t need!

[greygoose in reply to CornishChick]

You're welcome.

[Bearo in reply to greygoose]

But the two samples came from the same blood draw, didn’t they, Cornish Chick?

[Bearo in reply to Bearo]

Oh, sorry, I see this was addressed in the next reply!

[CornishChick in reply to Bearo]

Yes they did thank you for replying.

[SlowDragon Administrator]

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

What vitamin supplements are you taking

Low vitamin levels results in poor conversion/low TSH

[CornishChick in reply to SlowDragon]

Ferritin is always dire, latest 30/6/23 - 39. I have tried eating liver pate until I am sick of the sight of it, and 46 is the highest I could ever get it.

B12 30/6/23 - 559.

Vitamin D 16/3/23 - 114. Very proud of this, bringing it up from 22 when I could barely walk, discovered this forum, went gluten free, take a large dose which made the endo fall off her chair in horror, but I am super pleased.

Folate 30/6/23 15.9 (3.1-20). Increased this from 9.9 in the last five years from supplementing.

I take high dose D and C, magnesium, K2 mk7, selenium, B complex, I think that's it, it's what has been recommended on here. Oh also been taking iron recently, obviously all hours away from levo.

Hoping you can help SlowDragon