Hi, I’m new and I’m hopi g you can offer some advice and help interpreting these results. I’m 33F and generally healthy but have been struggling with a very low Free T4 and an elevated TSH.
My recent result on 13/11/2023 shows TSH 5.50 and T4 -3, and my recent test on 20/12/2023 shows TSH-27.60 & T4 -2.
My current doze is on 10mg carbimazole.
Please any advice on this to me would be much appreciated
Thanks
Welcome to forum,
When were you diagnosed with Graves? & how long have you been on carbimazole? Is the dose adjusted?
You are currently taking too much & it is causing your FT4 & FT3 to drop to hypothyroid levels (this makes TSH rise).
Always add lab range - ranges vary between labs.
Your doctor needs to reduce your dose, most consider 5mg per day the lowest dose, but even that might be too high. Some take a half pill per day or every other day.
What were your TSI or TRab antibodies levels when diagnosed? Sometimes doctors assume you have Graves if TSH is low, but there’s many reasons for low TSH or transient hyper. Was it correctly confirmed?
Are you treated in Canada?
Thanks for your feedback.
I was diagnosed with Hyperthyroidism (Grave's disease) in May 2023 when I was in Ghana. I.e. from May-October 2023. I have been on carbimazole since from 20mg dozes (May-July) to 15mg (Aug-Oct) and when I arrived in Canada on Nov. 8, 2023, has been reduced to 10mg (morn (5mg) & eve (5mg)). Below is a breakdown of my history by far,
May 17, 2023-TSH was 0.005 (Range 0.38-5.33), S-FT3 direct was >46.1 (3.5-7.8) & S-FT4 (Thyroxine) was 78.6- (7.9-18.5)
June 13, 2023 - TSH was 0.005 (Range 0.38-5.33), S-FT3 direct was 11.3 (3.5-7.8) & S-FT4 (Thyroxine) was 12.5 (7.9-18.5)
July 27,2023- TSH-<0.05, (Range 0.38-5.33) S-FT3 - 12.2, (3.5-7.8) S-FT4-8.7 (7.9-18.5)
Sept. 5 - TSH-Anti -TG 42.20 (H1000.00 (H<5.61)
Oct.19- TSH-10.102 (Range 0.38-5.33) , S-FT3 - 4.1 (3.5-7.8), S-FT4- <5.1 (7.9-18.5)
On November 8, 2023, I moved to Canada to continue my medical treatment and the current results were what I sent earlier.
13/11/2023 shows TSH 5.50 (Range 0.35-5.00) and T4 -3 (11-23), T3 -4.5 (3.5-5.9) and my recent test on 20/12/2023 shows TSH-27.60 (Range 0.35-5.00) & T4 -2. (11-23) , T3 5.2 (3.4-5.9)
Thank you.
TGab can be positive with Graves but also with Hashimoto’s (autoimmune thyroiditis) where the hyper levels are transient & level ultimately drop.
They were high thyroid levels which make Graves likely, hashi thebd to be less elevated. However you were not started on a high dose (60 is the max) so the drop has been quite fast.
Arrange for TSI or TRab to be tested these are markers for Graves.
TPOab (Thyroid Peroxidase antibodies) autoimmune - Hashimoto’s (& Graves)
TGab (Thyroglobulin antibodies) autoimmune- Hashimoto’s (& Graves)
Thyroid-Stimulating Immunoglobulin (TSI) Graves
TSH receptor antibodies (TRAb) Graves
If negative you’ll need to stop carbimazole completely and you may require replacement.
If positive you need to reduce carbimazole to a level which allows FT4 & FT3 to be in range or take carbimazole & replacement T4 (levothyoxine). This is called block & replace or add back therapy to stabilise levels. You may need to consider B&R as your FT3 is disproportionately high, the FT4 will fall below range while FT3 remain high. B&R helps balance this.
In Canada they tend to prescribe Tapazole which is the equivalent to carbimazole. They are both the same & metabolise to methimazole.
Gluten issues common with thyroid autoimmune ask for gluten allergy test & nutrients can be affected test folate,ferritin m B12 & vitamin D most need to be in upper part of range to be optimal.
Many thanks for the clarification and recommendations on the tests I need to undertake. Will propose to my doctor and pick from there.
If he says otherwise, will do it on my own 🤝
I really appreciate this. 😍
Can this affect my fertility also?
Having thyroid issues once under control should not cause fertility issues. However you do need levels well under control & optimal levels (& optimal nutrients). Usually this is when TSH in lower part of range & FT4 in upper part of range & FT3 mid range.
Patients are advised not to try to conceive whilst on carbimazole & if anti thyroid must be taken whilst pregnant it should be PTU.
Many doctors will advise waiting until you are off carbimazole and not showing sign of relapse.
Hello Lynbuity and welcome to the forum :
The Carbimazole is an Anti Thyroid drug and semi-blocks your new daily thyroid hormone production and slowly your T3 and T4 should fall back down into the ranges and hopefully your symptoms relieved.
Some people are prescribed a measured dose of T4 thyroid hormone as well as Carbimazole so that their T3 and T4 do not fall too far too far through the ranges and then suffer the equally disabling symptoms of hypothyroidism -
Alternatively your dose of Carbimazole needs reducing further to allow more of your own natural daily thyroid hormones T3 and T4 to be released into your blood stream.
The TSH is a signal / marker of the level of thyroid hormones - T3 and T4 - circulating in your blood -
currently there are not enough T3 and T4 circulating in your blood and when optimally medicated - your TSH should be in the range - as should your T3 and T4 readings.
When metabolism runs too fast as in hyperthyroidism or too slow as in hypothyroidism core strength vitamins and minerals can nose dive through the ranges causing addition, unnecessary health issues - do you have any current results/ranges for ferritin, folate, B12 and vitamin D?
Your TSH is now way over range at 27.60 - your T3 in range but your T4 under range -
when do you next see a doctor ?
Many thanks for your feedback and clarification
I have not taken any test for these: ferritin, folate, B12 and Vitamin D
Will see my doctor this Thursday, January 11, 2024.
Thanks
hi Lynbuity
I cannot offer advice on your test readings as this should be only done by qualified medics. But a word of caution.
I was feeling dreadful last year and posted on here about this with my test results, and many replies said I needed to greatly up my dose, which I did. Over 6 months. This turned out to be completely the wrong advice. I lowered my dose substantially and am now very well. A GP figured out that I was over medicated. So please talk to your doctor.
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