Hypo with Hyper results!

[Revolut]

Hi All and good to meet you.

Had a thyroidectomy in 2022. Just had a blood test with

TSH - 0.2 miU/l

FT4 24.5 pmol/L

On levothyroxine 125mg for 4 days and 100mg for 3 days.

Any idea why this looks like hyperthyroid?

Thanks for any advice.

[SlowDragon Administrator]

welcome to the forum

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)

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

Do you always get same brand levothyroxine at each prescription

For full Thyroid evaluation you need TSH, FT4 and FT3 tested

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

Low vitamin levels are extremely common on levothyroxine

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...

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

[Revolut in reply to SlowDragon]

Thank you very much SlowDragon

I will will review and have more tests done as suggested. Thank very much.

[Starseed56 in reply to Revolut]

Not a lot to add after such a comprehensive response from slow dragon… but I will be interesting to see you new test results to see what your t3 is because maybe you are a poor convertor. 💜

[pennyannie in reply to SlowDragon]

 ShrimpFried42 - please see SDragons very detailed reply above re blood tests.

[pennyannie]

Hello Revolut and welcome to the forum :

Having had a thyroidectomy - you can't be hyper but you could be over or wrongly medicated.

What was the reason for your thyroidectomy please ?

The thyroid is a major gland responsible for full body synchronisation from your physical ability and stamina through to your mental, emotional, psychological and spiritual well being, your inner central heating system and your metabolism.

A fully functioning working thyroid would be supporting you on a daily basis with trace elements of T1, T2 and calcitonin + a measure of T3 at around 10 mcg + a measure of T4 at around 100 mg - with T3 said to be around 4 times more powerful than T4.

T4 - Levothyroxine is a pro-hormone that needs to be converted in your body into T3 the active hormone that runs the body - much like petrol runs the car - and you likely need a full tank to get you through the day and back home again.

Conversion of T4 into T3 can be compromised by non optimal levels of your core strength vitamins and minerals so suggest you get ferritin, folate, B12 and vitamin D run and we can advise where these need to be maintained to support optimum T4 to T3 conversion.

It is essential that you are dosed and monitored on your Free T3 and Free T4 blood test results and not a TSH - as without a thyroid your HPT axis - the Hypothalamus-Pituitary-Thyroid feedback loop on which the TSH relies on as working well - now does not work well -as there is no thyroid in situ and this circuit loop broken with the TSH a very unreliable measure of anything - especially so if your thyroidectomy was because of Graves Disease.

We generally feel best when taking Levothyroxine only when the T4 is up in the top quadrant of its range with the T3 tracking just behind at around 60/70% through it's range.

Some people can get by on T4 - Levothyroxine only :

Others find that T4 seems to stop working as well as it once did and that by adding in a little T3 - likely at a similar dose to that their thyroid once supported them with - their metabolism kicks in again, T3/T4 hormonal balance is restored and health and well being restored.

Some can't tolerate T4 and need to take T3 only - Liothyronine - as you can live without T4 but you can't live or function without a decent level of T3.

Whilst others find their health restored better taking Natural Desiccated Thyroid which contains all the same known hormones as that of the human gland and derived from pig thyroids, dried and ground down into tablets referred to as grains.

Since around 2000 thyroid hormone replacements have been systematically withdrawn from the primary care sector and currently your doctor can only prescribe T4 - Levothyroxine - the cheapest option -

and you need a referral to an endocrinologist to be assessed as to your needs if T4 doesn't resolve your health and well being - and it does appear to be a bit of a postcode lottery with financial constraints rather than medical need taking precedence in some ICB/CCG areas of the country.

Thyroid Uk - the charity who supports this patient to patient forum hold a list of recommended thyroid specialists - NHS and Private - so this might make sense to have - just email admin @ thyroiduk.org -

and although you may think this is all going over your head - it isn't - stuff does start to sink in and make sense the more you read on this forum and we have all been there before you - in one way or another - and why we come back on here again to give back and help others get better thyroid health.

You can read anybody's Profile and all they have ever written on the forum by just pressing the icon alongside their name - and if you get lost - simply press the Profile icon top right on this page facing me on my laptop alongside the My Hub - Chat - Post and Alert symbols and that takes you back to your Profile page and all you have written and all your replies.

So anyway - first off we need a full thyroid blood panel to include your TSH, Free T3 + Free T4 antibodies, inflammation and ferritin, folate, B12 and vitamin D as these can all effect ho well you absorb and convert T4 into T3 - and just post all these results along with the ranges in new post and you will be talked through everything and advise of your next best steps back to better health.

[Revolut in reply to pennyannie]

Thanks again, I received the results of the test as follows:

Ferritin 33.30 ug/L (Range: 30 - 264)

Folate - Serum 22.1 nmol/L (Range: > 7)

Vitamin B12 - Active 130.0 pmol/L (Range: 37.5 - 188)

Vitamin D 106.0 nmol/L (Range: 50 - 250)

TSH 0.344 mIU/L (Range: 0.27 - 4.2)

Free T3 4.0 pmol/L (Range: 3.1 - 6.8)

Free Thyroxine 19.5 pmol/L (Range: 12 - 22)

Thyroglobulin Antibodies 16.40 kIU/L (Range: 0 - 115)

Thyroid Peroxidase Antibodies 20.0 kIU/L (Range: 0 - 34)

Inflammation CRP HS 0.152 mg/L (Range: < 3)

Let me know your thoughts please. Thank you.

[SlowDragon Administrator in reply to Revolut]

So was test done as recommended - early morning and last dose levothyroxine 24 hours before test

Was dose day before test 100mcg or 125mcg

Do you always get same brand levothyroxine at each prescription

Free T4 (fT4) 19.5 pmol/L (12 - 22) 75.0%

Free T3 (fT3) 4 pmol/L (3.1 - 6.8) 24.3%

Assuming tested correctly

Currently poor conversion of Ft4 (levothyroxine) to Ft3 (active hormone)

Ferritin is a significant issue and needs improving

This frequently increases conversion rate of Ft4 to Ft3

Next step get full iron panel test

cks.nice.org.uk/topics/anae...

Serum ferritin level is the biochemical test, which most reliably correlates with relative total body iron stores. In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency.

Never supplement iron without doing full iron panel test for anaemia first and retest 3-4 times a year if self supplementing.

It’s possible to have low ferritin but high iron

Test early morning, only water to drink between waking and test. Avoid high iron rich dinner night before test

Stop iron supplements 5-7 days before testing

Medichecks iron panel test

medichecks.com/products/iro...

Meanwhile

Look at increasing iron rich foods in diet

Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption

List of iron rich foods

dailyiron.net

Links about iron and ferritin

irondisorders.org/too-littl...

davidg170.sg-host.com/wp-co...

Great in-depth article on low ferritin

oatext.com/iron-deficiency-...

drhedberg.com/ferritin-hypo...

This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.

healthunlocked.com/thyroidu...

Posts discussing Three Arrows as very effective supplement

Great replies from @FallingInReverse

re ferritin and Three arrows

healthunlocked.com/thyroidu......

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Great reply by @fallinginreverse

healthunlocked.com/thyroidu...

Iron patches

healthunlocked.com/thyroidu...

Thyroid disease is as much about optimising vitamins as thyroid hormones

healthunlocked.com/thyroidu...

restartmed.com/hypothyroidi...

Post discussing just how long it can take to raise low ferritin

healthunlocked.com/thyroidu...

Iron and thyroid link

healthunlocked.com/thyroidu...

Posts discussing why important to do full iron panel test

healthunlocked.com/thyroidu...

Good iron but low ferritin

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Chicken livers if iron is good, but ferritin low

healthunlocked.com/thyroidu...

Shellfish and Mussels are excellent source of iron

healthline.com/nutrition/he...

Iron deficiency without anaemia

healthunlocked.com/thyroidu...

Ferritin over 100 to alleviate symptoms

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Great research article discussing similar…..ferritin over 100 often necessary

ncbi.nlm.nih.gov/pmc/articl...

Low Iron implicated in hypothyroidism

healthunlocked.com/thyroidu...

Really interesting talk on YouTube, link in reply by Humanbean discussing both iron deficiency and towards end how inflammation can also be an issue

healthunlocked.com/thyroidu...

Inflammation affecting ferritin

healthunlocked.com/thyroidu...

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.

[Revolut in reply to SlowDragon]

Thank you for the reply with advice and links. I am on the case with getting Ferritin sorted.

[pennyannie]

Hey there again :

OK - no thyroid hormone replacement woks well until the core strength vitamins and minerals are up and maintained at optimal levels and you have good levels of all but for your ferritin reading of just 33 - and barely in the range - let alone optimal.

Everywhere I researched when my ferritin came in at 22 - suggested that no thyroid hormone works well until ferritin is at least 70 - I now aim for around 100.

So first off - we need this supplementing - but only after an iron panel has been run to rule out if anything else is going on - I was referred for a colonoscopy and an endoscopy.

So - your T3 is at 25% through its range with your T4 coming in at 79.50% through its range - so whilst we recommend the T4 being up in the top quadrant -

your T3 is not responding and presenting with an equally high in range percentage through it's range - so showing poor conversion of the T4 thyroid hormone replacement- Levothyroxine.

The accepted conversion ratio when taking T4 only - once T4 is up in the top quadrant is said to be 1 - 3.50 - 4.50 T3/T4 - with most people feeling at their best when they come in this little rtio at 4 or under -

so if I divide your T4 result 19.50 by your T3 result 4.00 I'm getting your conversion coming in at 4.87 - so wide of the centre and showing you struggling to convert the T4 into T3.

So - first off you need to speak with your doctor about this very low, though in range, ferritin result and ask for an iron panel- before starting to supplement.

I couldn't tolerate the NHS tablets and purchased Gentle Iron - as it was less harsh on my stomach and did't constipate me further - and there are several iron bisglycinate options you can choose from if you experience issues.

Was you thyroidectomy due to Graves ?

If it is was your TSH will likely remain low suppressed for years - and just be aware - since some doctors dose and monitor on just TSH readings - and this may cause you to be under medicated - though you are not under medicated at the moment :

It could be suggested that you add back in some T3 now to rebalance your T3/T4 thyroid hormones - but you really should build back up your ferritin first so your core strength strong and able to support you better longer term.

[pennyannie in reply to pennyannie]

P.S. New blood tests really do deserve a new post/question so all forum members can reply to you - all opinions are good - we are all different -

You could re-post the above as a new question so it gets a wider notification to all forum members - as we can all look back at what has already been written.

[Revolut in reply to pennyannie]

Thank you very much. Yes - I will post this to the group now (did not realise this came only to you! I appreciate your response and will get on with next steps. Meanwhile, yes - the TT was a from Graves. Thanks again.

[SlowDragon Administrator in reply to Revolut]

Graves is autoimmune

So it’s worth trying strictly gluten free diet as well