I’ve had a test recently and my results are
Tsh 2.34 mu/L (range 0.27-4.2 mu/L)
Ft4 19 pmol/L (range 12-22 pmol/L)
Ft3 4.8 pmol/L (range 3.1- 6.8 pmol/L)
Tpo antibodies 72 IU/mL
Can anyone help me interpret this? I’m on 25mcg Levothyroxin and I did the blood test early in the morning before I took my levothyroxine.
They could hardly be optimal with such a high TSH. Your FT4 is high but it can't be optimal by itself. It needs to correspond to your FT3, but that's low because you're a poor converter.
Why you're a poor converter is anybody's guess. Could be low nutrients, but it could be a lot of other things, too. Could just be because you have Hashi's, and there's nothing anyone can do about that.
So, the only solution - after having optimised your nutrients - is to obtain some T3, and that's not easy. You would need to be referred to a T3-friendly endo and hope he's willing to prescribe.
Sorry to be the bearer of bad tidings, but it's best to know exactly where you are.
thank you for replying, you’ve confirmed what I was thinking, it just sucks that the gp won’t refer me and doesn’t care about ‘optimal’ levels as long as I’m not clinically hypo
I got this private test as the first step before seeking help from a private endo who I know prescribes t3, I was unsure about going private but it does seem to be the only way forwards
The late, great Diogenes advised that poor conversion is indicated when fT4/fT3 is 4.5 or higher. Yours is still below 4: your fT3 would need to be 4.2 or lower with your current fT4 for there to be poor conversion, according to this rule.
With older patients, GPs often want to keep TSH within the upper part of the range, supposedly to avoid cardiac complications. That shouldn't be a factor against you asking for an increased dose.
I don't think requesting "optimal" values to some high degree of precision is a reasonable expectation. We're not world-beating athletes with access to frequent testing, and just about everything in the real world works within allowable tolerance ranges.
The late, great Diogenes advised that poor conversion is indicated when fT4/fT3 is 4.5 or higher
FT4 or(???) is 4.5 or higher. What does that mean?
It's fT4 divided by fT3, using SI units (pmol/L, as used by the NHS in the UK).
helvella - T4:T3 Ratios
Some notes and links about calculating T4:T3 ratios and what they mean.
helvella.blogspot.com/p/hel...
inthedoldrums
Me too, I would like to understand because I have the faulty gene for conversion and would like to have a deeper understanding of my test results. Best wishes.
So you think I should be happy sticking with the 25mcg?
No, your fT3 is 46% through the range, and a dose increase should take it over halfway through the range, which was one of the recommendations from diogenes and his colleagues. As you are young, that's one obstacle removed from many GPs' reluctance about having TSH in the lower part of the range. If you're on a restrictive diet there could be a negative impact on your nutritional status, which could affect your conversion of fT4 to fT3. Liver, including liver pâté, for example, for iron and vitamins B12 and A, but too much wouldn't be good for you.
An interesting reply from the author (an endocrinologist) to a comment at: hormonesdemystified.com/t3-...
"The first citation is a nice summary of the relationship between iron status and the thyroid, but it doesn’t support the assertion that subtle decreases of iron within the normal range will cause clinically meaningful changes to thyroid hormone metabolism. I think that’s important to note, given the propensity of alt med practitioners to recommend a host of vitamins, minerals, and nutraceuticals to “optimize” levels that don’t need optimizing. Now, if one has a tendency to develop iron deficiency anemia for some reason, I am all for eating iron rich foods to be proactive. But if one has a normal hemoglobin and hematocrit, with no history of anemia, and low-normal iron levels, I would say it is highly unlikely that boosting iron levels would cause a clinically meaningful improvement in thyroid levels."
Incidentally, I found the link above just now, after suggesting to you that seeking some idea of optimal values is unreasonable.
How long have you been on 25mcg
Which brand
Next step retest again in another 6 weeks INCLUDING vitamin levels
I’ve been on them for 12 weeks, and have had two test in that time, including vitamins which they say are adequate
Can you add actual vitamin results
Adequate means “Within range” which is not the same as optimal
The didn’t give me any information, just all the vitamins they tested were ‘normal’
This is why I’m so frustrated, the gp gives me next to no information
You are legally entitled to printed copies of your blood test results and ranges.
The best way to get access to current and historic blood test results is to register for online access to your medical record and blood test results
UK GP practices are supposed to offer everyone online access for blood test results. Ring and ask if this is available and apply to do so if possible, if it is you may need "enhanced access" to see blood results.
Link re access
patients-association.org.uk...
healthunlocked.com/thyroidu...
In reality some GP surgeries still do not have blood test results online yet
Alternatively ring receptionist and request printed copies of results. Allow couple of days and then go and pick up.
Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine
For full Thyroid evaluation you need TSH, FT4 and FT3 tested
Also both TPO and TG thyroid antibodies tested at least once to see if your hypothyroidism is autoimmune
Very important to test vitamin D, folate, ferritin and B12 at least once year minimum
Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease
Optimal vitamin levels
Vitamin D at least over 80nmol minimum
Serum B12 at least over 500
Folate at least over 20
Ferritin at least over 70
Likely many are scraping along bottom of range
Come back with new post once you get results
My gp is not going to test all that just because I request it, they do not listen to me, constantly gaslight me and just overall don’t really care/ think I’m making a big deal over nothing
That’s why thousands of U.K. patients test privately to make progress
(Myself included…..only made progress after 25 years left inadequately treated on NHS - more on my profile)
High Ft4 suggests possible Hashimoto’s flare
Early stage hashimoto’s levels can go up and down quite a lot until on or near full replacement dose Levo
That’s why many hashimoto’s patients feel best with TSH below 1 as this will stop your own variable thyroid output
You’re on a very low dose of levo, how long have you been on 25mcg?
Yeah the doctors refuse to increase, they said it will cause more harm than good
Levothyroxine doesn’t “top up” failing thyroid, it replaces it.
Even if we frequently start on only 50mcg, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near full replacement dose
pathlabs.rlbuht.nhs.uk/tft_...
Guiding Treatment with Thyroxine:
In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months.
The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).
The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range.
……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.
The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.
TSH should be under 2 as an absolute maximum when on levothyroxine
gponline.com/endocrinology-...
Graph showing median TSH in healthy population is 1-1.5
web.archive.org/web/2004060...
Comprehensive list of references for needing LOW TSH on levothyroxine
healthunlocked.com/thyroidu....
onlinelibrary.wiley.com/doi...
If symptoms of hypothyroidism persist despite normalisation of TSH, the dose of levothyroxine can be titrated further to place the TSH in the lower part of the reference range or even slightly below (i.e., TSH: 0.1–2.0 mU/L), but avoiding TSH < 0.1 mU/L. Use of alternate day dosing of different levothyroxine strengths may be needed to achieve this (e.g., 100 mcg for 4 days; 125 mcg for 3 days weekly).
I know this but if my doctor refuses to prescribe what can I do?
Get hold of vitamin test results as first step
How long ago were vitamin levels tested?
Are you vegetarian or vegan?
which brand of levothyroxine are you taking
Approximately how much do you weigh in kilo
Has GP done coeliac blood test yet ….if not get tested
nice.org.uk/guidance/ng20/c...
1.1 Recognition of coeliac disease
1.1.1 Offer serological testing for coeliac disease to:
people with any of the following:
persistent unexplained abdominal or gastrointestinal symptoms
faltering growth
prolonged fatigue
unexpected weight loss
severe or persistent mouth ulcers
unexplained iron, vitamin B12 or folate deficiency
type 1 diabetes, at diagnosis
autoimmune thyroid disease, at diagnosis
irritable bowel syndrome (in adults)
first‑degree relatives of people with coeliac disease.
Try to see another doctor! This one is a disaster!!
Complain to your Practice Manager that despite your lab results showing that your T4 to T3 conversion is impaired and despite having symptoms of hypothyroidism your GP insists on keeping you on 25mcg levo which is less than the usual starter dose of 50mcg....and is not resolving your symptoms or improving your health.
You need T3....but they fear it because of their lack of knowledge. This one is obviously afraid of T4 too!!
Increasing your levo will absolutely not do more harm than good...that would only be a possibility if your FT3 were over range. But they won't know that because they cling to TSH which research proves is not a reliable marker
Your conversion isn't at rock bottom so Initially increasing your T4 dose might provide some extra needed T3 . You have room to increase to 50mcg....maybe more. Testing will show the way forward
It's a start....but ultimately you are likely to need exogenous T3
The ignorance and lack of empathy showed by this GP is astounding....accept it and suffer or complain and try to achieve appropriate treatment.....or look elsewhere!
How many other patients is s/he failing to treat correctly....it's a scandal
High TSH but FT4 and FT3 normal
Advice re inconsistent and above range FT4 please.
Stress and Anxiety 
Recording FT3 and FT4 reference ranges
