latest results, confused, please advise!

[Benjipuss]

My last results a month ago before treatment with 50 mcg were :

Serum free t4 level. 10.2 pmo/L

TSH level 7.28 IU/mL

After a month of Levothyroxine my results are now:-

serum free t4 level. 15.6

TSH 2.87

I asked for, and was told my T3 would be checked but I can’t see it on printout unless it is down under something else or may be the result is not back yet from last Thursday?

No antibodies have been checked , on initial test they were 298 . I had had a lot of infections, psoriasis , including covid and suffering long covid . A scan had revealed I had inflamed thyroid so blood tests were done. I did read some research that said if antibodies below 500 could often be resolved.

Is this normal for results to change to normal so rapidly? I know this should be good (I think) but it’s just making me query whether diagnosis is correct? All my other results were normal , potassium slightly high but says could be dehydration? hbac1 a little over too.

Cholesterol confusing as six different results so not sure what is what, though overall 5.2, two different readings for HDL so flummoxed …

Receptionist typed out quickly though I had requested print out last Friday to be picked up Monday. But hopefully no errors . Will make appointment with dr but any thoughts please?

[TiggerMe Ambassador]

You'd need to add the ranges for these results but these would suggest you are ready for an increase aiming to get your TSH around 1 for starters, if fT4 is 12-22 then you are only around 36%

Cholesterol at 5.2 is ok

[Benjipuss in reply to TiggerMe]

Thank you! The ranges for T4 were 11-26. Ranges for TSH were .27-4,2. So results are within range, does this not mean they are now normal?

[TiggerMe Ambassador in reply to Benjipuss]

Excellent answers from greygoose can't really add 🤗

[greygoose]

I did read some research that said if antibodies below 500 could often be resolved.

Oh yes? And how did they suggest that might happen? Antibodies fluctuate all the time so they might be 499 today, but 650 next week. That sounds highly unlikely to me, but can you link to that research and let's have a look, please?

Is this normal for results to change to normal so rapidly? I know this should be good (I think) but it’s just making me query whether diagnosis is correct?

With a TSH over 7 plus high antibodies, it's pretty certain that your diagnosis is correct.

The speed with which results change is a very individual thing, complicated by having Hashi's. Because with Hashi's, levels can jump around quite a lot due to the continual attacks on the thyroid.

It's possible that the lab blocked your doctor's request for T3 to be tested. They have the final say in what tests are done and what aren't, I'm afraid.

[Benjipuss in reply to greygoose]

Thank you! I shall have rummage and post research when found . I shall check re T3 because dr said would do and I also checked with nurse taking bloods who also said it was on the form to be checked . How can a lab block drs request and why would they?

[greygoose in reply to Benjipuss]

How can a lab block drs request and why would they?

That's a very good question. Another good question is: why do doctors put up with it?

Why they do it is to save money - false economy, I know. But when have those in-charge ever been good at economics? They can only see the short-term and have no idea how these measures can affect the long-term.

How can they do it? The NHS tells them they can, that's how.

The ranges for T4 were 11-26. Ranges for TSH were .27-4,2. So results are within range, does this not mean they are now normal?

Nope. 'Fraid not. Just being any old where within the so-called 'normal' range, does not make them normal. Besides, we're not after 'normal', we're after optimal. Not the same thing.

serum free t4 level. 15.6 (11-26) 30.67%

TSH 2.87

A 'normal' (euthyroid) TSH is around 1, but hypos usually need it lower, because they need their thyroid hormone levels higher than euthyroid.

A euthyroid FT4 would be around 50% through the range. Yours is only 30.67% through the range. And, it's only that high because you are taking exogenous T4 (levo). But, you need an increase in dose because you probably need your FT4 up around 75% through the range. And, even when it gets to be where you need it, you still have to carry on taking the levo because if you stop, the level will drop again.

[Benjipuss in reply to greygoose]

Thanks! I would like to know what my T3 is doing , should I try drs again? Please can you explain why my thyroid needs to be higher than euthyroid?

[greygoose in reply to Benjipuss]

It's essential to know what your T3 is doing because it's the active hormone that causes symptoms when it's too low or too high. But, the labs don't see it that way and usually refuse to test it. Even your doctor probably won't know why it's important.

Please can you explain why my thyroid needs to be higher than euthyroid?

It's not your thyroid that needs to be higher, it's your thyroid hormones: T4 and T3. So important to use the right words/phrases when talking to doctors if you want them to take you seriously. (Not that I'm a doctor! Heaven forbid! 🤣🤣🤣 But you know what I mean.)

So, why? I imagine because when you have a healthy, working thyroid, it will make hormone on demand. We only have what we take once or twice a day, so we need larger reserves.

[SlowDragon Administrator]

Really tested too soon, should be 6-8 weeks

They won’t test thyroid antibodies again

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)

You need to test vitamin D, folate, ferritin and B12 at least once year minimum

Which brand of levothyroxine are you currently taking

Try to stay on same brand as you increase to 75mcg daily

Bloods will need retesting again 6-8 weeks after moving up to 75mcg daily

[Benjipuss in reply to SlowDragon]

My first test was done midday after eating and drinking , also I’d taken B and D vitamins . I wonder how much this could have skewed the results and in what direction? My second bloods I followed the above advice. All the other bits you mention above are well within range so no issues there. I’m taking liquid teva levothyroxine 50. I wonder if I should stay on this dose for another four weeks ?

[FallingInReverse in reply to Benjipuss]

One opinion, not having read every detail above.

If I were you, I would stay on the 50 for the next two weeks (so you are on that dose for a full 6 weeks total. At that point you could try to get another TSH/FT4/FT3 test, but even if you can't, that would be a good time to titrate to 75. To do that, you could choose to go to 62.50 for a week or two, then round up to 75 for the 4-6 weeks after that. Did you already determine your target dose is probably 100+ I'm guessing.

The wisdom that you should always apply to titration is LOW and SLOW. One change in any 6-8 week period. If you are titrating T4 and/or T3, 6 weeks is minimum and 8 weeks is better. If titrating Levo, never more than 25 mcgs at a time, and usually not a bad idea to go even slower. Especially as you near your full replacement dose, it is far too easy to overshoot your sweet spot.

Thyroid hormones tip off a long, complex chain reaction of things in our body... there are ups and downs, while your body settles into the new dose. Which is why testing any sooner than 6 weeks is not recommended or reliable for titration decisions.

Personally, I planned to take 6 weeks - but ended up taking the 8 full weeks to go from Levo 50 to 62.50. The difference between weeks 5-8 was night and day. Now I am taking the next full 8 weeks to settle at 75. 6 weeks minimum. 8 weeks is indeed better.

[Benjipuss in reply to FallingInReverse]

Thank you. I shall stay on this dose for another four weeks and maybe get tested again and ask dr to increase slowly thereafter . What was the difference between weeks 5-8 please?

[FallingInReverse in reply to Benjipuss]

Well here I was at 4 weeks:

healthunlocked.com/thyroidu...

It doesn’t sound like your symptoms are too crazy, but it’s pretty common for people to get antsy through the 6 weeks periods and want to change, go faster, switch things up. Patience is hard when we are going through it.

Edit:

And here’s one at 5 weeks : ) where I picked up on an older thread by searching the term “5 weeks” on this board- because I was so fed up with needing to be patient through the full 6 weeks:

healthunlocked.com/thyroidu...

You can see the original poster was noting that she actually felt great at 6 weeks, but then by 8 things would settle differently.

[Benjipuss in reply to FallingInReverse]

Thanks

[FallingInReverse in reply to Benjipuss]

Hi! And 5 months later I’m now in between 87.5 and 100…. Gosh what a long 5 months it’s been : ) loooww and so slowwwww!! But I would do it that way all over again - the ups n downs are the worst !

[Benjipuss in reply to FallingInReverse]

Glad you’re feeling much better. I’m still on fifty! It was slowly moving in the right direction but then got a different condition which has involved medication where I couldn’t be tested. Was tested last week, as a sudden appointment when I just happened to be at the surgery I jumped at it, forgetting I’d had my leva in the morning, so inaccurate result!