Help with Labs?

[Dollyrocker000]

I had been seeing a Functional doctor privately but lost job and cannot really afford a consultation at the moment. secersl years ago a Bluehorizon test showed high RT3 and I was put on liothyronine 50mcg per day and 50 Levo which I have remained taking to present. My gynae just ran some bloods which now show low TSH and low T4. I’m aware I’ll need to see either a dr or a good endo on husbands insurance but what do low TSH and low T4 usually indicate? I have had low iron and b12 several times in past but am taking iron and vit c as well as b12 shots. Tests also showed high SHBG.

[TiggerMe Ambassador]

Not unusual to have low fT4 when on a low dose, generally any dose of T3 will lead to a very low TSH.... how are you feeling?

What you really need is a fT3 result

High SHBG could mean you are on too much T3? But it effects your testosterone levels as it binds to them

[Dollyrocker000 in reply to TiggerMe]

Thank you and apologies for late reply, I was sidetracked investigating a breast lump.

I think my T3 might indeed be too high, I have lost some weight but not re-tested

I will probably go ahead an do another BlueHorizons test

[SlowDragon Administrator]

you need full thyroid and vitamin testing with correct timings

Taking almost any dose of T3 will result in very low or suppressed TSH

And taking 50mcg of T3 per day is quite a high dose

As you are only taking a very low dose of levothyroxine (Ft4 ) it’s not surprising that Ft4 is low

Wether you might be better with slightly higher dose levothyroxine and slightly lower dose T3 ……that would take some careful experimentation

Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine or T3

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

About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high TPO and/or high TG thyroid antibodies

Autoimmune thyroid disease with goitre is Hashimoto’s

Autoimmune thyroid disease without goitre is Ord’s thyroiditis.

Both are autoimmune and generally called Hashimoto’s.

Significant minority of Hashimoto’s patients only have high TG antibodies (thyroglobulin)

20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis

In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)

Recommended that all thyroid blood tests 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

Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins

Post all about what time of day to test

healthunlocked.com/thyroidu...

Testing options and includes money off codes for private testing

thyroiduk.org/testing/

Medichecks Thyroid plus BOTH TPO and TG antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes BOTH TPO and TG antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

Only do private testing early Monday or Tuesday morning.

Link about thyroid blood tests

thyroiduk.org/testing/thyro...

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

Symptoms of hypothyroidism

thyroiduk.org/signs-and-sym...

Tips on how to do DIY finger prick test

support.medichecks.com/hc/e...

Medichecks and BH also offer private blood draw at clinic near you, or private nurse to your own home…..for an extra fee

[Dollyrocker000 in reply to SlowDragon]

Thank you, yes I have tested vitamin D, folate, ferritin and B12 and have followed the suggested timings.

I did change brand of t3 and will need to a more comprehensive re-test of everything .

[SlowDragon Administrator in reply to Dollyrocker000]

Make sure you test as recommended

all thyroid blood tests 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

stop any supplements that contain biotin 5-7 days before test

[Dollyrocker000 in reply to SlowDragon]

Thank you, I always follow these guidelines prior to testing just need a new endo that accepts Axa PPP insurance, I have an authorisation for initial diagnostics, bloods, scans etc.

[greygoose]

what do low TSH and low T4 usually indicate?

If you're hypo and taking thyroid hormone replacement, it usually indicates that you're taking a high dose of T3. But you need that FT3 tested to know if you're taking too much. Although do you feel you're taking too much?

years ago a Bluehorizon test showed high RT3 and I was put on liothyronine 50mcg per day and 50 Levo

An endo did that? Sigh. No point in testing rT3, it doesn't give you any information that you can't get from testing FT4 and FT3 at the same time. If your FT4 was right up the top of the range, and your FT3 low, then obviously you were going to have high rT3. That's a given. And all you do is reduce the levo slightly and add a small amount of T3, and titrate it until you reach your sweet spot.

But if your FT4 wasn't high, then a high rT3 would have had nothing to do with your thyroid. There are many, many reasons why people have high rT3 and very often there's no way of finding out why, but it has nothing to do with your thyroid. So putting you on a high dose of T3 wasn't going to help.

Not that rT3 is a problem, anyway. Symptoms are caused by low T3 if you're a poor converter, not high rT3. But, you do need that FT3 tested to know where you are.