test results . help please? just received but appt this morning with endo

[lauriegraham]

hi

I have just had the following results and also a note from GP wanting to talk about my 'worrying' thryoid (I assume TSH) results

My cholesterol has been high and he wanted me on statins but i have been hoping if I get my thyroid going the cholesterol would come down (endo thinks that is not possible!)

He allowed a trial of 20 mcg T3 for 2 months with 75 of levo

Results below. Any idea how to argue the case and indeed, what case?

thanks as ever

TSH 0,06 (.27-4.2

Free t4 12.7 (11.9-21.6) 75 levo

Free t3 4.3 (3.1-6.8) 20 mcg trial prescription

Iron 17.1 (10.5-28.3)

Unsaturated iron binding 37.3 (27.3-61.7)

Total iron binding 54 ( 41-77)

Iron binding saturation 32 (20-50)

Vit d 105 (25-120) nb I spray twice better you daily

Bone profile

Alkaline phosphate 97 (30-130)

Albumin 45 (34-50)

Calcium 2.47 (2.2-2.6)

Calcium albumin adjusted) 2.48 (2.2-2.6)

Phosphate 1.15 (.8-1.5)

[TiggerMe]

Well, hopefully they are going to pick up on your worryingly low fT3 & 4 and suggest an increase BUT the chances are they are going to bang on about your low TSH and try and force you to reduce which would be detrimental to your health!

How have you been feeling on this dosing? (early days I know)

Free T4 (fT4) 12.7 pmol/L (11.9 - 21.6) 8.2%

Free T3 (fT3) 4.3 pmol/L (3.1 - 6.8) 32.4%

T4:T3 Ratio 2.953 

[lauriegraham in reply to TiggerMe]

thanks, so poor conversion here?

[TiggerMe in reply to lauriegraham]

Once you start taking T3 conversion doesn't really come into it as you are replacing both, just not enough of either

[SlowDragon Administrator]

was test 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)

T3 ….day before test split T3 as 2 or 3 smaller doses spread through the day, with last dose approximately 8-12 hours before test

Do you normally split your T3

Ft4 is very low

Many thyroid patients on levothyroxine plus T3 find they need BOTH FT4 and Ft3 at least 60-70% through range

How much levothyroxine were you taking BEFORE T3 was added

75mcg is low dose, especially for a bloke

Approximately how much do you weigh in kilo

There’s no vitamin D, folate, B12 and ferritin results

When were these last tested

What vitamin supplements are you taking

[lauriegraham in reply to SlowDragon]

thanks.yes all after 24 hours of t4 and 3.

I take b vits now and magnesium and calcium sometimes and other sleep things like reishi mushrooms and vit c and a few others

I will ask about ferritin (mine usually low), and there is d there, no b12 or folate true .. he didnt even test cholestorol this time

thanks again

[SlowDragon Administrator in reply to lauriegraham]

So Ft3 is falsely low

Always split the dose

Looking at previous posts

Possibly central hypothyroidism

Have you had BOTH TPO and TG thyroid antibodies tested and ultrasound scan of thyroid

150lb = 68 kilo

If on ONLY Levo guideline dose would be

68kg x 1.6mcg per kilo per day = 109mcg per day

Approx 775mcg per week

100mcg 4 days and 125mcg 3 days

Adding T3 …..usually dose reduced by 25mcg per day

All this is only a guide, some need more, some less

with very low Ft4 it currently looks like you need 100mcg daily

Conversion is affected by low iron

Aiming for ferritin at least 100

[SlowDragon Administrator]

Results from 3 months ago

FERRITIN 71 (30 - 400 R)

FOLATE -16.4 (2.9 -16.98)

VITAMIN B12 - 163 (25.1 - 165)

VITAMIN D 70 ....50 - 200 R

TSH 0.98 (0.27 - 4.2)

FREE T3 3.8 (3.1 - 6.8)

FREE THYROXINE 17.1 (12-22)

Free T4 (fT4) 17.1 pmol/L (12 - 22) 51.0%

Free T3 (fT3) 3.8 pmol/L (3.1 - 6.8) 18.9%

Shows you needed 25mcg dose increase in levothyroxine as Ft4 too low

Terrible conversion rate

Very low ferritin especially for a bloke

Vitamin D better at least over 100nmol

[lauriegraham]

Thanks. Weight is a bit under 170kgs I think So I should be asking for increased t4? Even though barely converting? New ferritin etc tests? T3?

Thanks

[SlowDragon Administrator in reply to lauriegraham]

Assume You mean 170lbs

Not 170 kilo

[lauriegraham in reply to SlowDragon]

Lol yes!

[SlowDragon Administrator in reply to lauriegraham]

170lbs = 77kg

77kg x 1.6mcg = 123mcg per day likely dose

(if on levothyroxine ONLY)

So 100mcg levothyroxine per day plus 20mcg T3 per day likely nearer your requirement

Try as 3 small doses of T3 at roughly equal 8 hour intervals

Or 4 x 5mcg (I find this smoothest option)

5mcg at 6.30am, 11.30am, 5.30pm and 11pm approx

[lauriegraham in reply to SlowDragon]

thanks, in fact 155 ibls, so a bit less (should have said 70kg)

[SlowDragon Administrator in reply to lauriegraham]

So I should be asking for increased t4? Even though barely converting?

Yes …..always try optimising Ft4 first

Request increase to 100mcg daily

Which brand of levothyroxine are you currently taking

Do you always get same brand

Which brand T3?

And try splitting T3 everyday as either 2 x 10mcg or 3 doses - 10mcg and 2 x 5mcg

[tattybogle]

GP will be concerned about the low TSH level.

these two posts explain the issues involved and provide evidence you can use in discussions with GP/Endo to argue that TSH 0.06 is not necessarily too low :

This one is basically showing that anything over 0.04 on levo is not a problem:

healthunlocked.com/thyroidu... useful-evidence-that-tsh-between-0.04-0.4-has-no-increased-risk-to-patients-on-levothyroxine-updated-new-study-does-show-small-risk

and this one explains why TSH is going to be 'relatively' lower in all patients once they are taking Levo and / or T3, and therefore their 'low' TSH does not indicate the same risks as it would in people who are not taking Levo / and or T3 :

healthunlocked.com/thyroidu.... tsh-is-just-the-opinion-of-your-pituitary-about-your-dose-but-your-pituitarys-opinion-is-a-bit-warped-once-you-take-thyroid-hormone.

[lauriegraham in reply to tattybogle]

That's very helpful thank you

[lauriegraham]

Thanks everyone .. so endo has the usual belief.. tsh too high (risk of bone density, heart issues etc) and insisted on reducing to 10 of t3 but at least increased t4 to 100

i guess i am stuck with that

[TiggerMe in reply to lauriegraham]

I'm thinking you mean 'TSH to low blah, blah, blah'

Looks like you'll need to re-educate this one as you go along... anyway good thing that you have an increase in T4, it's an odd thing that even when we convert badly most of us feel better with a fT4 somewhere above 50%

Dropping your T3 by 10mcg is excessive, do you have enough in stock that you can drop to 15mcg first for a couple of weeks? Of course your TSH will still be low next time and for as long as you are on T3 🙄

[lauriegraham in reply to TiggerMe]

Good thinking