Medicheck Dr's notes suppressed TSH with low T4

[66olives]

MEDICHECK - (7.45 am, pre-breakfast and no meds 24hr)

CRP HS 1.430 mg/L (Range: < 3)

Ferritin 168.00 ug/L (Range: 30 - 264)

Folate - Serum 21.6 nmol/L (Range: > 7)

Vitamin B12 - Active 124.0 pmol/L (Range: 37.5 - 188)

Vitamin D 60.9 nmol/L (Range: 50 - 250)

TSH X 0.050 mIU/L (Range: 0.27 - 4.2)

Free T3 4.0 pmol/L (Range: 3.1 - 6.8)

Free Thyroxine 12.5 pmol/L (Range: 12 - 22)

Thyroglobulin Antibodies X 329.00 kIU/L (Range: 0 - 115)

Thyroid Peroxidase Antibodies X 562.0 kIU/L (Range: 0 - 34)

Then daily medication Levo 75mcg, Liothyronine 10mcg, plus D with K2 , B12, B complex, Mg

Gluten free - not that it seems to make any difference.

Hi All,

I have pondered over these results and, more importantly, the Dr's analysis. I will go through it bit by bit, and see if any of you can provide any suggestions. Normally, I tick the box to forgo the Dr's comments, but brain fog ...

Your vitamin D level is now in the low normal range. If you are not already doing so, please consider taking 400 iu (10mcg) per day.

I take 4 squirts of D3000 with K2 per day (4 times his suggestion)and my levels have dropped since October. (It was only 73 nmol/L just three weeks after two weeks in Egypt, I expected it to be higher, as I deliberately didn't wear suncream 100% of the time.) I have now added two extra squirts. Is this too much K2? is there a quicker way to raise D levels? I have noticed I convert so much better when my Vit D is higher. (yes it is taken with an eggy breakfast.

You have a low thyroid stimulating hormone with a low normal thyroxine. Your thyroid results are contradictory or do not follow an expected pattern... It is also important to be aware that any significant illness including psychiatric issues can cause temporary changes in your thyroid results which usually return back to normal within 8 weeks.

There are many reasons this can occur. Firstly, some drugs ... It is also important to be aware that any significant illness including psychiatric issues can cause temporary changes in your thyroid results which usually return back to normal within 8 weeks.

I am not on any other medication, and I'm unaware of any other illnesses. Back in October, my white cell count was 3 (range 4-11 g/L) Haemotology Suggested this was investigated, a letter went to the surgery, but not to me, and not followed up.

Repeating your test to confirm the findings may be a good idea. If your results are still unusual, you may have specific antibodies which can confuse the laboratory tests — this is known as assay interference. Alternatively, it may be a unique presentation of thyroid disease. In this case, I recommend speaking to your GP, who may wish to arrange a further repeat test or refer you to an endocrinologist.

What are these antibodies and how do I test for them? My TSH is often suppressed and their response is to lower levo, despite T4 sitting near bottom of the range (which they don't test for). This constant exhaustion is ruining my life, I have quit two jobs and now work less than 10hrs a week.

My GP and endocrinologist have ignored my low T4 and kept lowering levothyroxine to bring up TSH. GP is refusing to issue another early script for levo, so I have had to drop back down to 50mcg a day. My next endo appointment is phone only in April.

Apart from many of the usual symptoms, tiredness, cold intolerance, dry skin and brain fog, etc, I have started to get dizzy regularly, and passed out on 19th when I got too hot, but not sweating.

Thoughts please.

[Forestgarden]

Hi there, I'm no expert but the low ft3, ft4 and suppressed tsh look like central hypothyroidism. If your pituitary isn't responding as it should it would explain your low tsh. You are obviously hypo from your ft3 and ft4 results, and symptoms. Your pituitary should be responding with a high tsh. Sounds like you need to see a different endo who knows something about thyroids. I can't answer your other questions, but you definitely need a meds increase.

[Forestgarden in reply to Forestgarden]

Just noticed you're on lio as well as levo.... Greygoose explains it below x

[66olives in reply to Forestgarden]

thanks

[greygoose]

I'm not surprised you still have symptoms with that low FT3. I would increase the T3 if I were you.

One thing to know about Medichecks' doctors is that they are not thyroid experts. They are just common or garden GPs with the usual lack of thyroid knowledge that all GPs have. Your results are not abnormal, they are perfectly normal for someone taking T3. Taking T3 suppresses the TSH and lowers the FT4. That is perfectly 'normal'. But doctors never seem to understand that.

Nor do they tend to learn by experience and learn that continually lowering the dose of levo is not going to raise the TSH when you are taking T3. It just ain't gonna happen - probably not even if you cut out the T4 altogether. But, they still keep trying. And, reducing the T4 is also going to reduce the FT3 level, so you need more T3, so the TSH stays suppressed. Talk about shooting yourself in the foot! 🤣

Nor do they understand that it doesn't matter! The pituitary has stopped making TSH because you don't need it anymore. TSH has nothing to do with bones or hearts, but they persist in this insane treatment. One has to wonder about their level of intelligence, sometimes. Sigh.

What are these antibodies and how do I test for them?

You can't test for them. Diogenes always referred to them as mouse antibodies - can't remember why - but they interfer with testing TSH. They are anti-TSH antibodies. Although usually, they cause the TSH result to be abnormally high.

But this has nothing to do with you because your TSH is where one would expect it to be given your dose. So, don't worry about them. And do check the box next time and save yourself all this worry.

[66olives in reply to greygoose]

Thanks for that. I'll try to stop stressing, but I'm frustrated.

These are my results since July last year. Why keep me on Lio when T3 and T4 are dropping on the medication?

The results in early October show my T3 higher than when on Liothyronine. I felt better too. This was just after 2 weeks of uninterrupted sun, so my Vit D was at its highest (still not optimum at 73nmol/L but I struggle to get it higher). This is why I think I need to increase my vit D as quickly as possible. I believe it helps conversion. It appears there was nothing wrong with my conversion at that point, whenever the T4 levels get high enough to start making a difference to my health the GP throws a wobble because my TSH is suppressed.

My meds went up to 100/125 alternate days when I went to see private endo and explained I was aware of the future risks, but thought them acceptable for quality of life presently.

The NHS endo prescribed the T3 before she did the test on 13th October but I did not start taking them until after the test. She is happier now because my TSH is not suppressed, just low.

I work a few hours, do a bit of writing and fall into exhausted vegetation. Something is not right but I can't even get an appointment to see the GP, they are too busy. Next time I faint, I may let them call an ambulance.

Maybe an email to the endo will move things along quicker.

Thyroid results

[greygoose]

It appears there was nothing wrong with my conversion at that point,

Do you have labs from that point: FT4 and FT3?

Why keep me on Lio when T3 and T4 are dropping on the medication?

T3 and T4 are dropping because your doctor keeps lowering your dose! It's all your doctor's fault, not the the fault of the T3.

Just refuse to reduce your dose. Never mind pussyfooting around about understanding the supposed risks (there aren't any!), just give and out-right, solid 'NO', I will not lower my dose any further.

Next time I faint, I may let them call an ambulance.

I doubt that will do any good. They'll just blame it on your low TSH. They know even less about thyroid in A&E than the average GP!