Would appreciate some help on some blood test results please. I’m asking on behalf of my niece who was diagnosed with ME when she was a teenager. She is in her forties now and has had a range of health issues over her life. She has suffered many tummy issues and she believes she now has Cmuse, (multi focal ulcers & strictures to the small bowel.) She still struggles with eating and finds it difficult to keep food down so her diet is very restricted and she is on quite a lot of medications and takes vitamins. She has been on levothyroxine for many years also and I was interested to know her blood results on that issue as some of her symptoms sounded as though she might be under medicated. The blood test was taken at 9.35 am but she had taken her thyroxine before the test unfortunately. However the results were:-
she is aware of her anemia and she has regular b12 injections and I believe she is on an iron supplement. But why is her TSH in good range and free t4 level low? She is 17 stone and 100 mcg of thyroxine.
Many thanks in advance for any advice or observations 😊
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Bookworm63
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She took her levo before the blood draw and her FT4 is still under-range?!? How long before the blood draw?
TSH is not a very reliable indicator of thyroid status. And it's a shame she didn't have FT3 tested to give us more of a clue. But, at a rough guess it rather looks like a pituitary problem. The pituitary is just not reacting correctly to the thyroid hormone levels in the blood.
What does her doctor say about these results? Please don't tell me he says she's 'fine' because her TSH is in-range! If he did, I'd shoot him and get another one!
Thank you for replying Greygoose, not sure what time she took her thyroxine, I’ve just text her to find out. I did mention to her not to take it beforehand but she forgot bless her. She has had a lot of problems of late and she has to take quite a lot of meds. She likes her dr and I have to say they have been very good to her with her various problems over the years and she says is very open to discussion about her treatment. I was thinking she should ask to have t3 tested as it could be a conversion issue? She didn’t even know she was supposed to take her thyroid medication separately and away from food until I told her a couple of years back. They just put all the meds in one of those daily sectioned containers. She did pull him up on that and now she takes it first thing away from food and other meds.
Well, there's something seriously wrong, there, but we don't have enough information to try and work out what it is. Hopefully she will give you more information soon.
OK, well, that's really not good, then. She would have been at peak level. And if her peak level is below-range then she is seriously in need of an increase in dose. How much is she taking at the moment?
How can one know? She doesn't have any T4 to convert! Once her FT4 gets up to over mid-range then you'll be able to judge her conversion but at the moment it's far too low.
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
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.
Some people need a bit less than guidelines, some a bit more
TSH should be under 2 as an absolute maximum when on levothyroxine
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).
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Blood test results help PLEASE. 
Please help with blood test results. 
Help understanding blood tests results please. 
Please help with blood test results
Blood test results help please
