Test results - can anyone help?

Hi all, Can anyone help interpret my test results and advise on whether I need to work on any of my vitamin levels. Would also be grateful for any advise on thyroid meds so I know what to push for at endo appointment.

Results from March (on no medication):

Thyroid-stimulating hormone (TSH) 1.930 mIU/L ref range: 0.270 - 4.200 Serum

Free triiodothyronine (fT3) ↓ 3.64 pmol/L ref range: 3.66 - 6.72 Serum

Free thyroxine (fT4) 12.6 pmol/L ref range: 12.4 - 20.4 Serum

Triiodothyronine (T3). ↓ 1.06 nmol/L ref range: 1.30 - 3.10 Serum

Thyroxine (T4) 77.6 nmol/L ref range: 66.0 - 181.0 Serum

Thyroid peroxidase antibodies (anti-TPO) ↑ 317 IU/mL ref range: < 34 Serum

Thyroglobulin antibodies (anti-TG) 19 IU/mL ref range: < 115 Serum

Since then I have been put on SR T3 by FMD and have been on 45 mcg (and feeling pretty awful) for 2 months. Blood tests last week following all testing guidance:

TSH 3.53 ref range: 0.27 - 4.20 mIU/L

Free T4 16.1 ref range: 12.0 - 22.0 pmol/L

Free T3 3.8 ref range: 3.1 - 6.8 pmol/L

T4 Total. 79.5 ref range: 66 - 181 nmol/L

Anti-Thyroglobulin Abs 20 ref range: <115 IU/mL

Anti-Thyroidperoxidase abs H 281.0 ref range: <34 IU/mL

Vitamin D (25 OH) 88 ref range: 50 - 200 nmol/L

* HbA1c 31 ref range: 20 - 42 mmol/mol

Magnesium 1.0 ref range: 0.7 - 1.0 mmol/L

CRP. 0.97 ref range: <5.0 mg/L

Iron 16.6 ref range: 5.8 - 34.5 μmol/L

UIBC 33.9 ref range: 24.2 - 70.1 μmol/L

* TIBC 51 ref range: 45 - 81 μmol/L

* Transferrin Saturation 32.9 ref range: 20 - 50 %

Ferritin 108.00 ref range: 13 - 150 μg/L

Serum Folate 25.50 ref range: 8.83 - 60.8 nmol/L

Vitamin B12 382 ref range: 145 - 569 pmol/L

Active B12 90 ref range: 37.5 - 150 pmol/L

[RedApple Administrator]

Olives201 'Since then I have been put on SR T3 by FMD and have been on 45 mcg (and feeling pretty awful) for 2 months.'

I wasn't aware that there is such a thing as genuine Slow Release T3. Can you tell us more about what it is you're actually prescribed?

TSH 3.53 ref range: 0.27 - 4.20 mIU/L

Free T4 16.1 ref range: 12.0 - 22.0 pmol/L

Free T3 3.8 ref range: 3.1 - 6.8 pmol/L

Whatever it is, with those results, it's no surprise you don't feel good.

[Hidden in reply to RedApple]

Thanks so much for your reply. I really don’t know much about it. I’m really new to everything and am waiting to be referred to an endo as not sure about the medication I am currently being prescribed. I’ve had a lot of side effects and been feeling more ill than I did off medication and looks like it hasn’t really brought my T3 levels up much at all!

From what has been explained to me is that it is slow release compared to normal T3. It was prescribed through a functional medicine doctor who used a private pharmacy.

Was hoping to gain some more insight into my results as I am really unsure what I’m supposed to be looking for and where my vitamin levels should be at as I have been supplementing for a couple of years now but has been guess work.

[RedApple Administrator in reply to Hidden]

'prescribed through a functional medicine doctor who used a private pharmacy.'

Can you message me with the details of this FMD and pharmacy please?

[helvella Administrator]

TSH rising from 1.930 to 3.53 despite starting to take 45 micrograms of T3 seems somewhat odd.

And Free T3 rising minimally from 3.64 to 3.8 implies little real change - that difference is so small that it could be within the lab's sample to sample variations. Though the change in reference interval (range) makes me even more cautious in making any inferences.

What you are taking as a Sustained Release formulation actually looks closer to Zero Release than Sustained Release.

Given that there are no properly trialled Sustained Release formulations of T3, I'd be very wary of taking it at all.

I'd much rather take split doses of ordinary release T3. Even if this requires awkward tablet splitting and reminders, etc.

[Hidden in reply to helvella]

thank you for your reply. I am newly diagnosed and had no knowledge so did what the doctor told me at the time. Having researched I can see that like you say it’s not properly trialled. I’m waiting for a referral from my GP to an endo so was just looking for some advice in the meantime as I am still very new to all of this but looks like the results aren’t much to go on.

[helvella Administrator in reply to Hidden]

If you read many posts here, it can appear that levothyroxine (L-T4) is highly problematical. But the truth is that many, many people do fine on just L-T4.

Allow them to consistently take the particular formulation that best suits them and that resolves many problems.

Allow them to take some liothyronine (L-T3) alongside in some combination, and even more do well.

Only a small number of people seem to need L-T3 only.

I really cannot understand on any rational basis why anyone would start your treatment on L-T3 only, let alone Sustained Release L-T3.

L-T4 in the UK costs from around 69p to about £3.27 for 28 tablets. (The 12.5 microgram tablet is inconsistently high cost at about £15.)

You just might care to look at the NICE guidelines for thyroid disease. Many here will disagree with some aspects, but they do at least provide a focus and define a standard approach.

Any doctor in the UK would need to be able to stand up and defend their treatment decisions if they diverge substantially from these guidelines. Starting a new patient on SR L-T3 would constitute truly major divergence.

(Don't expect it all to make sense, at least first time through. It is a complex document but some parts really are quite straightforward.)

Thyroid disease: assessment and management

nice.org.uk/guidance/NG145

Maybe I'm missing something? Don't take my word for anything. Always check advice against other sources. Always ask if you need to.