🤷🏻‍♀️ Sudden jump up in T4

[Aslangal]

Morning all 😉

I have Hashimoto’s and have had radio active iodine treatment over 16 years ago so have been on Levothyroxine since. I’m familiar with all the testing and get regularly tested by my GP. I also private test occasionally to check my T3 as my local area do not test that on the NHS.

I take my Levo religiously in the correct manner.

Last Sept, my T4 was higher than was optimal so they reduced me from 175mcgs to 150mcgs per day. Check up last week has shown my T4 has shot up very high and GP rang me as she was concerned.

I was out in traffic at the time and it was a bad line but I’m sure she said it was 29 and she was concerned about my TSH too. They have a new facility to contact the Endo Consultant directly for advice so I’m waiting to hear. But she immediately asked me to reduce to 100mcgs till I picked up my new prescription.

Any ideas on the cause of the sudden leap up? 🤷🏻‍♀️. Could explain why I have felt breathless some days, out walking the dog.

Thank you in advance for responses 😉

[SlowDragon Administrator]

Request GP test full iron panel including ferritin

Low iron/ferritin will

A) cause breathlessness

B) reduce your ability to use your levothyroxine…..resulting in high Ft4 …..but likely low Ft3

ESSENTIAL to test folate, B12 and ferritin at least annually

Test vitamin D twice year when supplementing

What vitamin supplements are you taking

Strongly recommend you get FULL thyroid testing before dramatically reducing your dose Levo

How old are you

Pre or post menopause

[Aslangal in reply to SlowDragon]

62 post menopause

[SlowDragon Administrator]

post 2 years ago showed low folate and Vitamin D

healthunlocked.com/thyroidu...

Presumably you are still taking daily vitamin D and vitamin B complex

ALWAYS remember to stop vitamin B complex 5-7 days before all blood tests as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate folate supplement (eg Jarrow methyl folate 400mcg) and separate B12

[Sleepman]

No idea about breathlessness. How are you generally ?

Doctors should be asking about symptoms not just using blood numbers ?

I would ask them to retest the bloods, it's one result ?My blood results from doctor are finally on app on phone and I do not have to send a form in everytime to get them. I am getting round to saying ask them for blood results and the ranges.

Do you take a B complex with Biotin / vit B7 - this can alter the blood results.

When was blood test done - advice on here is 9AM / no levo for 24 hours

How long have you been on 175 mg ? Any change in brand ? Do you take with water and nothing else. Have you changed anything other supplements or meds that could have been stopping you absorb the levo ?

Or has you stomach improve and it is taking in more of the levo these days ?

Hope you are feeling well.

[Aslangal in reply to Sleepman]

Thanks. No biotin. No Levo day of testing. Yes I take it with a full glass of water and nothing else for an hour. I actually feel good. I was shocked when she called me. Take Vit D mouth spray.

[SlowDragon Administrator in reply to Aslangal]

so get full thyroid and vitamin testing before considering reducing dose

[Aslangal in reply to SlowDragon]

They called back and Endo said to reduce to 100mcgs but have booked me in for bloods next Wednesday - B12, Ferritin and Vit D

[SlowDragon Administrator in reply to Aslangal]

Well you should only ever reduce by 25mcg per day

Even 12.5mcg reduction will cause significant effects

Are they retesting thyroid on Wednesday too

[Aslangal in reply to Sleepman]

Sorry missed some of your questions … their opening question was ‘Do you feel alright?’ Before they told me T4 went up. No change in supplements. Was on 175mcgs for a long while - 2 yrs? Yes take with glass of water an hour before food.

[Sleepman]

Glad you are feeling good. I would stick not twist and reduce dose. Inexpert view.

Slow dragons advice on low iron is interesting and info wonderful as usual ... we are lucky. Also said get some new blood results.

Do you have blood pressure machine? I think I paid 30 for an Omron one some years ago. Tell doctor your heart rate and pressure, to help them feel less nervous.

Is you weight stable? Not going down?

[Aslangal in reply to Sleepman]

Yes have a machine. Weight going down but deliberately

[SlowDragon Administrator in reply to Aslangal]

So how much weight have you lost

Reducing approx 1.6mcg per kilo of weight lost

[Aslangal in reply to SlowDragon]

Sorry for delay. Just over 16lbs. Not a massive difference suddenly.

Coincidentally, I had a 6 month review last week, from a Randox Women’s Health check I took in August 23. I got the full report late last night:

TSH: 0.23 mlU/l

T4: 30 pmol/l

T3: 4.68 pmol/l

Anti TPO: 16 ku/l

Thyroxine binding globulin TBG: 18.86 ug/ml

Anti TG: very high at 639 IU/ml

Ferritin: Very high at 241.59 ug/l (it was 164 in Aug 23)

Insulin low at 14.2 pmol/l

It’s a 46 page report. I’m seeing GP tomorrow anyhow so will take it in. They’ve flagged ‘red’ areas of concern mainly liver and hyperactivity of the thyroid which I obviously know but querying cause. Functioning or non functioning rather of the pituitary gland is mentioned 2-3 times as possible cause. Liver function concerns. My blood pressure was up a bit and my pulse rate low.

Vit D was 96 and B12 725.

Other than that - other readings were optimal in other areas! 🤣

Any thoughts?

[SlowDragon Administrator in reply to Aslangal]

Well you definitely seem to be taking too much Levothyroxine

Reduce by 25mcg per day

Retest again in 6-8 weeks

request GP to do full iron panel test to check if only ferritin is high

Or wether iron is high too

Ferritin is frequently higher post menopause

Updated reference ranges for top of ferritin range depending upon age

healthunlocked.com/thyroidu...

Thank you for your incredible patience while you have been awaiting the outcome of our ferritin reference range review. We conducted this with Inuvi lab, which has now changed the reference ranges to the following:

Females 18 ≤ age < 40. 30 to 180

Females 40 ≤ age < 50. 30 to 207

Females 50 ≤ age < 60. 30 to 264l

Females Age ≥ 60. 30 to 332

Males 18 ≤ age < 40 30 to 442

Males Age ≥ 40 30 to 518

The lower limits of 30 are by the NICE threshold of <30 for iron deficiency. Our review of Medichecks data has determined the upper limits. This retrospective study used a large dataset of blood test results from 25,425 healthy participants aged 18 to 97 over seven years. This is the most extensive study on ferritin reference ranges, and we hope to achieve journal publication so that these ranges can be applied more widely.

[Aslangal in reply to SlowDragon]

Thanks for that. The GP said to reduce by 25mcg but the Endo advised to reduce by 50mcg immediately so I am now on 100.

[SlowDragon Administrator in reply to Aslangal]

Retest in 6-8 weeks

test early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test

make sure you keep vitamin levels optimal when reducing dose levothyroxine