Latest TFT Results

[lc1973]

Good morning.

Looking for some feedback/advice re latest results please.

Currently taking 250mcg levothyroxine. I have hashimotos. Have also been taking B vits, Vit D, Iron, Selenium & Zinc daily. I have recently managed to lose a stone deliberately as a result of portion control and eliminating sugar from my diet, it may also be as a result of the added vitamins and nutrients.

TSH 0.07 Range 0.27 - 4.2

FT4 26 Range 12 - 22

FT3 4.3 Range 3.1 - 6.8

Could it be that a reduction in levo is required? Could it be poor conversion? I started taking the selenium to assist in the conversion but still think the ft3 result could be better. I don't have hyperthyroidism symptoms and am still very puffy with lots of weight to lose.

Hoping someone can help.

Thanks in advance.

[SlowDragon Administrator]

previous post 6 months ago

healthunlocked.com/thyroidu...

Extremely low B12 and ferritin

Presumably you have been working on improving since then

Daily B12, daily vitamin B complex

And if still taking iron supplements a FULL iron panel test 3 or 4 times a year

Have you retested vitamin levels

If not that’s next step

ESSENTIAL to maintain GOOD vitamin levels

This test

was test early morning, ideally before 9am, only drinking water between waking and test and last dose levothyroxine 24 hours before test

Do you always get same brand levothyroxine at each prescription

Which brand?

Ft4 is over range

[lc1973 in reply to SlowDragon]

Hi SlowDragon

Yes, I've been carrying on with all of the vitamins and added in selenium and zinc in the last couple of months but haven't tested the vitamins so will need to do that. Would you suggest staying on the 250mcg until I know if the vitamins are at their optimal levels before speaking to the GP, appreciate you can't give medical advice...just trying to work out best course of action? I take the same brand all the time as it is named with the pharmacy. The test was fasting. I take levo at night time as it works better for me. The test was done around 12 hours after last dose guess this will have some bearing on the results but possibly not the ft4 - Ft3 ratio?

[SlowDragon Administrator in reply to lc1973]

The test was fasting. I take levo at night time as it works better for me. The test was done around 12 hours after last dose guess this will have some bearing on the results but possibly not the ft4 - Ft3 ratio?

This will mean Ft4 result is falsely high as last dose was only 12 hours before test

Next test make sure to leave 24 hours

As you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test

If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal

[lc1973 in reply to SlowDragon]

Thank you SlowDragon. I'll be sure to adopt this for testing going forward.

[pennyannie]

Hello Ic:

We generally feel best once on T4 - Levothyroxine when the T4 is in the top quadrant of its range at around 80% with the T3 tracking just behind at around 60/70% through its range.

So we can see your T4 is over range at around 140% with your T3 at just around 32% through its range and you are not converting or utilising the T4 well enough and your thyroidal hormone balance way off where it needs to be.

Put another way - the accepted conversion ratio when on T4 only medication is said to be :-

1 / 3.50 - 4.50 T3/T4 - with most people feeling best when they come in this ratio at 4 or under -

So - if I divide your T4 by your T3 result I'm getting your conversion ratio coming in at just over 6 - so just another check confirming you are not converting well the T4 - Levothyroxine.

You are on a decent dose - I wonder if you have absorption issues ?

There is a liquid T4 Levothyroxine - do you think this could help you ?

Have you seen an endocrinologist regarding your results and the apparent non ability to convert well the T4 and had a trail of T3 - Liothyronine suggested thereby making a T3/T4 combo of hormones suggested ?

I should have looked back at previous posts - sorry - but if I do this now - I 'll lose this reply -

No thyroid hormone replacement works well until ferritin, folate, B12 and vitamin D are up and maintained at optimal levels -

I now aim to maintain ferritin at 100 - folate around 20 - active B12 125 ( serum B12 500 ++ ) and vitamin D at around 125:

Do you have Hashimoto's and are Auto Immune ?

I read that healing the gut and stomach wall essential and food intolerance such as gluten, dairy, wheat etc may need to be eliminated - many forum members find the research and suggestions of Dr Izabella Wentz useful - and she writes as thyroidpharmacist.com.

[lc1973 in reply to pennyannie]

Thank you for your informative reply. I haven't retested any of the vitamins so I will do that soon. Not sure whether I should book an appointment with the gp with a view to asking for a endo referral or whether the gp will refuse and want to reduce the dose even though it would appear to not be converting too well. I did have a trial of liothyronine some years ago but from the gp who took me off of it for no good reason. I'm wondering also whether to give us a few more months on the vitamins and supplements and do another tft to see if the conversion has improved and not consult gp. What do you think would be the best course of action?

[SlowDragon Administrator in reply to lc1973]

I would retest correctly including vitamins

Then reassess

Don’t give GP these results as they are likely to reduce your dose

[pennyannie in reply to lc1973]

So - I had a quick look back and saw you were diagnosed with Hashimoto's some time ago.

Given time this AI disease damages and disabled the thyroid and mot people will need to replace with a fuller spectrum thyroid hormone replacement - either a T3/T4 combo or Natural Desiccated Thyroid.

You first need to get your T4 back into range to around 80% - so around 20 in this range - so drop down the dose by 25mcg and see how that goes as it's not doing anything positive this high - then slowly add in a little T3 - Liothyronine.

So first off then - talk to your doctor and ask for a referral to an endo :

Thyroid UK - the charity who supports this forum hold a list of recommended endos and thyroid specialists NHS and Private - maybe email admin @thyroid uk.org and get the list- obviously if you can afford to go Private it will be faster and effective.

Roseway Pharmacy - listed on the Pharmacy page on Thyroid Uk website now offer a video consult and prescription service and read they are very supportive of thyroid patients, much cheaper than seeing someone privately and prescribe all thyroid hormone replacement options - you'll likely need to offer a current blood test - so maybe this quickest solution.

T3 is said to be around 4 times more powerful than T4 - so 25mcg T4 is around 6.25mcg T3 - so ideally if with 25mcg T3 tablets quarter them :

A fully functioning working would be supporting you on 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 mcg. so that could be some sort of rough aim of where you're trying to get to.

Doctors were told to stop prescribing T3 in around 2016 when the price went up by some 6000% - maybe that's when / why your doctor withdrew it -

To prepare yourself for adjusting down your T4 and introducing a little T3 - we also need the vitamins and minerals up and optimal to help support and carry you through seemlessly -

and for maximum absorption / utilisation of any thyroid hormone replacement you will need good gut and stomach acidity - so have any issues you had now been rectified and you been have tested for gluten, dairy, wheat etc and adjusted your diet accordingly, if necessary.

[lc1973 in reply to pennyannie]

Thank you pennyannie. Lots to think about.

[pennyannie in reply to lc1973]

Good morning -

Just another thought - if you go into openprescribing.net you can see by surgery how supportive your surgery are compared to other surgeries in writing T3 prescriptions and similarly with your area compared to other ICB areas.

Just enter Liothyronine as the drug :

Since your doctor withdrew your T3 for no reason - would be interesting to see and a question for your doctor to reinstate same for you - though likely now you 'll need to be sanctioned by a NHS endo and currently the O/P waiting list is very long so likely not a quick fix.

P.S. Just read that your results were a false high - so your T4 will not be as over range as it appears - but tend to think you will still have a conversion issue and need more than T4 monotherapy to achieve thyroidal balance of T3 and T4 hormones.

[lc1973 in reply to pennyannie]

Great information. Thank you.