Satisfactory Serum free T4?: Hi everyone, First... - Thyroid UK

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Satisfactory Serum free T4?

BeePurple profile image
13 Replies

Hi everyone, First time posting anything but my latest results say satisfactory T4 result, as a comment from the health professional. The result is out of the range so I am wondering if I am being fobbed off.

Results as follows:

TSH - 1.64 mIU/L (0.38-5.33)

Serum free T3 - 4.8 pmol/L (3.8-6.0)

Serum free T4 - 15.3 pmol/L (7.9-14.4)

This was a fasting blood test taken at approximately 8:30 am.

I have been on a 75 microgram dose since 2017 after a partial thyroid removal in 2016 due to a nodule/goitre that they couldn't determine was cancerous until removed. It wasn't cancer. From what I have read on here, that dose seems quite low due to NICE guidelines.

I am aware that I haven't filled iny profile so here is some background. I'm approaching 50 so symptoms like brain fog, weight gain, muscle aches, sleeping problems can be common with both perimenopause and hypothyroidism. I have always felt a bit rubbish most of my adult life with extreme tiredness, generally I have learned to live with it. I follow a strict gluten free diet which helps a bit.

Sorry for the long post. Any advice, thanks in advance.

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13 Replies
BeePurple profile image
BeePurple

Should add, dose is levothyroxine and last took 24 hours before the blood test as I see recommend here.

greygoose profile image
greygoose

In a way, you are being fobbed off, yes. They are ignoring the fact that you are a poor converter and need your FT4 well over-range in order to get enough T3 to keep you alive - and even then it's not quite mid-range!

But either they don't understand how these things work. Or else they're avoiding the quetion of prescribing T3, which they really don't like doing.

BeePurple profile image
BeePurple in reply to greygoose

Thank you. Would my next step be trying to get them to prescribe T3? Or perhaps order a more in depth test with vitamins like SlowDragon is suggestions below before making that step?I know this will most likely be private test from what I have read previously on the forum.

greygoose profile image
greygoose in reply to BeePurple

Well, you do absolutely need optimal nutrients, so getting them tested is essential. But, even with optimal nutrients I doubt your conversion would improve enough to keep you well. So, you do also need to start investigating the possibility of obtaining T3.

BeePurple profile image
BeePurple in reply to greygoose

Thank you for your help. I will start looking into that.

greygoose profile image
greygoose in reply to BeePurple

You're welcome. :)

SlowDragon profile image
SlowDragonAdministrator

Suggest you get vitamins tested next

Vitamin D, folate, ferritin and B12

Did you have full thyroidectomy or hemi thyroidectomy

Plus need thyroid antibodies if never been tested

What vitamin supplements are you currently taking

BeePurple profile image
BeePurple in reply to SlowDragon

It was a hemi thyroidectomy. I take a spray vitamin D in the autumn/winter because I spend as much time outside as I can to feel better. I should really take something else but have never been able to get myself in a good routine. I have never had B12 or my antibodies tested.

My iron is tested every 4 months when I donate blood so that must be fine.

I'm assuming the vitamin and antibody test is a private one?

SlowDragon profile image
SlowDragonAdministrator in reply to BeePurple

Many thyroid patients need to supplement vitamin D all year and at higher doses than typical for other people

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

Also both TPO and TG thyroid antibodies tested at least once

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

Test vitamin D twice year

About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high thyroid antibodies

Autoimmune thyroid disease with goitre is Hashimoto’s

Autoimmune thyroid disease without goitre is Ord’s thyroiditis.

Both are autoimmune and generally called Hashimoto’s.

Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease

As you have found gluten free diet beneficial, likely you have autoimmune thyroid disease

20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis

In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)

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)

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

Testing options and includes money off codes for private testing

thyroiduk.org/testing/

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/testing/thyro...

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

Symptoms of hypothyroidism

thyroiduk.org/signs-and-sym...

Tips on how to do DIY finger prick test

See detailed reply by SeasideSusie

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

BeePurple profile image
BeePurple in reply to SlowDragon

I have often wondered about Hashimoto's because I had a goitre. It is very frustrating because the Drs do limited blood tests and they always came back "normal" until now. It was the first one I managed to book following your recommendations above too 8:30, no levo for 24hrs, just water) and I felt pretty rubbish. Thanks for all the links and recommendations, I will get reading. The vit D is the highest they sell and what was recommended. I will be more diligent with taking it throughout the year.

Autoimmune conditions are quite common in my family. I have asthma and allergies and gluten intolerance.

Thank you for all your help.

SlowDragon profile image
SlowDragonAdministrator in reply to BeePurple

With gluten intolerance you’re virtually guaranteed to have Hashimoto’s

Essential to test folate, B12 and ferritin at least annually

Vitamin D twice year …ideally August and January

The vit D is the highest they sell

So what dose is your vitamin D

NHS Guidelines on dose vitamin D required

ouh.nhs.uk/osteoporosis/use...

GP will often only prescribe to bring vitamin D levels to 50nmol.

Some areas will prescribe to bring levels to 75nmol or even 80nmol

leedsformulary.nhs.uk/docs/...

GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)

mm.wirral.nhs.uk/document_u...

But with Hashimoto’s, improving to around 80nmol or 100nmol by self supplementing may be better

pubmed.ncbi.nlm.nih.gov/218...

vitamindsociety.org/pdf/Vit...

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

Test twice yearly via NHS private testing service when supplementing

vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function.

There’s a version made that also contains vitamin K2 Mk7.

One spray = 1000iu

amazon.co.uk/BetterYou-Dlux...

It’s trial and error what dose we need, with thyroid issues we frequently need higher dose than average

Vitamin D and thyroid disease

grassrootshealth.net/blog/t...

Vitamin D may prevent Autoimmune disease

newscientist.com/article/23...

Web links about taking important cofactors - magnesium and Vit K2-MK7

Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Interesting article by Dr Malcolm Kendrick on magnesium

drmalcolmkendrick.org/categ...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

BeePurple profile image
BeePurple

It is 75. It is an oral spray from better you called D3000

BeePurple profile image
BeePurple

I try to include nuts, red meat, offal, greens and dark chocolate in my diet to help with vitamins. I often crave things like steak or Brazil nuts probably because I am lacking in the vitamins I need.

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