Results out of range. Deal with high cholesterol

[sunbee]

Hello All.

I have an appointment with the Endo next week. Last week blood test shows both TSH and free T4 is out of range.

Serum TSH level Result: 0.04 mu/L * Normal range: 0.27 - 4.2mu/L

Serum free T4 level Result: 23.8 pmol/L * Normal range: 12 - 22pmol/L

I've been taking 125mg Levothyroxine since 26 October 2023.

Initially, I didn't feel an improvement on this dose. I continued to experience low mood/depression, brain fog, enlarged tongue, aching knees and hips/back, tinnitus occasionally, exhaustion. Constipation marginally better.

Main issue is Serum cholesterol 7 mmol/L and 7.9 mmol/L in October

(No familial cholesterol issue. )

However, over the last month, in addition to the above issues, x 2/3 daily I feel very warm/sweaty, similar to hot flushes, fluttering in chest and hyped up, mood fine. (I stopped HRT mid 2023. I understand hot flushes can continue after stopping HRT.) Apart from these changes I feel happier. No weight loss.

I may have become hyperthyroid? I take all the recommended minerals and vitamins.

My doctor wants me to start statins, which I have refused.

I would like Endo to lower dose of Levo to 100mg and put me on small dose T3 to help lower LDL.

Cholesterol has improved on 125mg.

Cholesterol issue is my and my doctor's main concern.

How realistic is my request, as I may be tipping over into hyperthyroid? Will T3 make hyperthyroid worse?

Apologies for the long complex post.

[Forestgarden]

I would like Endo to lower dose of Levo to 100mg and put me on small dose T3 to help lower LDL.. Yes, thats what you need! Whether you get it or not is another matter. What you also need is full thyroid blood test results with free t3...... Suspect you're not converting t4 to t3 very well. If you get your bloods done privately you'll have some evidence to present to the gp. I am similar (ft4 top of range, ft3 bottom of range) also with high cholesterol. I think you are right to refuse statins. You need to sort your thyroid hormones. The symptoms you are getting are also familiar. I had to reduce my levo slightly to stop feeling so awful, but of course, that dropped my ft3 too. I'm now waiting on a private endo appointment to try to get some t3. I think there are some symptoms directly attributable to too high levo, and at the same time some due to low ft3. But try explaining that to a gp!

[TiggerMe Ambassador]

Without knowing where your fT3 level is on this dose it is rather hard to say as we don't know how well you are converting... Is this result 24 hours after last dose?.... yes you need a small reduction in T4 perhaps drop to 100mcg 4 days a week and 125mcg the other 3?

As you say you have stopped HRT so you are going to be having a recurrence of some symptoms many of which cross over with thyroid symptoms

I'm not sure how your Endo can properly treat you without a full thyroid panel to look at??

If you have historic results that show you are a poor converter they would be worth flagging up and then T3 is more likely to be offered...

[SlowDragon Administrator]

Ideally BEFORE consultation you would have got FULL thyroid and vitamin testing

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

Is your hypothyroidism autoimmune?

[greygoose]

How realistic is my request, as I may be tipping over into hyperthyroid? Will T3 make hyperthyroid worse?

No, you can't do that. I imagine you've been diagnosed with hypOthyroidism and that's why you're taking levo, right? So, that means that your thyroid is incapable of making enough hormone to keep you well. It cannot suddenly revive and start making too much hormone, which is the definition of hypERthyroidism. Unfortunately, this is what doctors often say when they just mean you're over-medicated! (Someone buy that endo a dictionary!)

Your FT4 is slightly over-range, but not nearly high enough to be considered hyper. And, I imagine it's over-range because you're a poor converter and your FT3 is low, which is why your cholesterol is high. But, you can't know for sure without getting it tested. So, that should be your next step.

And, if your FT3 is low, then it is perfectly reasonable to ask for a lower dose of levo and added T3. The question is: is your endo a reasonable man? Time will tell.

Having said all that, 125 mcg levo is not a huge dose, so I'm wondering if you have Hashi's? In which case, your high level will have nothing to do with your dose of levo. Could be that you're just under-medicated but having a Hashi's 'hyper' swing. Have you had your antibodies tested? Both of them?

Looks like your next step should be to get full thyroid testing to know exactly what's going on here.

[sunbee]

thank you for your replies. I so value being able to contact this group!

I won't be able to get a T3 test before my appointment unfortunately. I'll have to wing it... 🤞

[TiggerMe Ambassador in reply to sunbee]

Whichever lab did your last test should hold onto your sample for 10days...

[sunbee in reply to TiggerMe]

You're a star Eeeyore100. ⭐

I didn't realise that labs kept blood test for 10 days... duh...

I phoned my surgery and unfortunately, the bloods are no longer available (taken 18th Jan) but I can get a T3 blood test tomorrow which should be available for Endo to view at my hospital appointment on Tuesday!

If you hadn't prompted me Eeyore100 I would have remained ignorant. This group is fab, loads of help and support.

👏👏Thank you all who replied and of course Eeyore100.

[TiggerMe Ambassador in reply to sunbee]

Well done! 👏 They really ought to do the full panel again from one draw... hide your Levo tonight so you don't take it on auto pilot 🤗

[humanbean]

You should find this link helpful :

nhs.uk/conditions/statins/c...

particularly this bit :

If you have an underactive thyroid (hypothyroidism), treatment may be delayed until this problem is treated. This is because having an underactive thyroid can lead to an increased cholesterol level, and treating hypothyroidism may cause your cholesterol level to decrease, without the need for statins. Statins are also more likely to cause muscle damage in people with an underactive thyroid.

The biggest factor in the relationship between cholesterol and thyroid hormones is how much much Free T3 you have. Cholesterol rises when Free T3 is low.

Just for info...

In decades gone by (1930s? 1940s? 1950s?) doctors used cholesterol levels as a diagnostic aid in diagnosing hypothyroidism. At the time there were no thyroid function tests but they could measure cholesterol.

[sunbee in reply to humanbean]

Thank you humanbean. I'm sure/hope the endo knows about this? I laboured the point at my doctor's visit, saying "my thyroid function must be optimised first" and thankfully she referred me.

I yearn to get back to better health like all people on this site.

[humanbean in reply to sunbee]

Although it hasn't happened to me, I have read anecdotes of thyroid patients mentioning to doctors that low T3 raises cholesterol. The doctors didn't know and in some cases completely dismissed the information. So, I would suggest not getting your hopes up.

*Sigh* Our situation is just insane!