Are the results ok with a tsh that low? I did the test the way it’s supposed to be done. Thank you

[HollyF86]

thanks

[TiggerMe Ambassador]

Welcome aboard, yes your results look pretty good, more important how are you feeling?

Free T4 (fT4) 20.9 pmol/L (12 - 22) 89.0%

Free T3 (fT3) 5.4 pmol/L (3.1 - 6.8) 62.2%

T4:T3 Ratio 3.870 

What are you taking at the moment and have you checked your ferritin, folate, B12 and Vit D levels which are all best optimized

[HollyF86 in reply to TiggerMe]

Thank you for your reply.

I haven’t yet had my vitamins checked , I’ll do that. I feel unwell but my doctor said these results are fine. To begin with on 112 I felt ok , really needed the increase from 100. But over 6 months I’ve gone past feeling well to being absolutely exhausted all the time? I can’t exercise, I struggle to wake up, my appetite is much bigger than usual. Just not feeling great at all but doctor says all ok?

[TiggerMe Ambassador in reply to HollyF86]

Definitely ask your GP to run a 'TATT' (tired all the time) blood panel which should pick up if you are anaemic, liver health, full blood, Iron, blood sugar levels and Vit D

If you are low in any vits and mins you will feel dreadful

[HollyF86 in reply to TiggerMe]

Thank you

[SlowDragon Administrator]

welcome to the forum

Is your hypothyroidism autoimmune

Do you always get same brand Levo at each prescription

What vitamin supplements are you taking

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)

Is this how you did this test

Next step

Test thyroid antibodies if not been tested

Plus vitamin D, folate, B12 and ferritin

[HollyF86 in reply to SlowDragon]

Thanks, yes to all of the questions and I do always get the same brand. I was fine for a while it seems strange that I’m symptomatic again. I’ll get those vitamins done although they’ve been low in previous years and I felt tired but this is a lot different to that. This is can’t function properly at the minute

If that’s my highest tsh , is that a concern ? Seems very very low

[SlowDragon Administrator in reply to HollyF86]

Low vitamin levels result in poor conversion of Ft4 (levothyroxine) to Ft3

Low Ft3 results in even lower vitamin levels

Vicious circle downwards

High Ft4 tends to result in low TSH regardless of how poor Ft3 is

Essential to test and maintain OPTIMAL vitamin levels

Vitamin D at least over 80nmol

Serum B12 over 500

Active B12 at least over 70

Folate towards top of range

Ferritin at least over 70

If/once vitamin levels optimal if Ft3 remains low then look at getting SMALL dose T3 prescribed alongside levothyroxine

This has to be initially prescribed via endocrinologist

Here’s link for how to request Thyroid U.K.list of private Doctors emailed to you, but within the email a link to download list of recommended thyroid specialist endocrinologists who will prescribe T3

Ideally choose an endocrinologist to see privately initially and who also does NHS consultations so that might eventually transfer to getting T3 on NHS

thyroiduk.org/contact-us/ge...

[HollyF86 in reply to SlowDragon]

I’m grateful for your response but I don’t have low t3 or high t4, do I ? I didn’t think I did but please tell me if I’m reading it wrong

Thanks for the vitamin ranges that’s really useful

[SlowDragon Administrator in reply to HollyF86]

Your Ft4 is perhaps/possibly a bit high at 89% though range

And the Ft3 is lower at 62%

That’s a reasonable difference in % through range

This might mean your vitamin levels are low

Or if vitamin levels are good …..perhaps taking slightly too much Levo

Before considering reducing levothyroxine a tiny amount you would want to check vitamin levels

Low vitamin levels, especially low ferritin or B12 could make you feel tired

But being over medicated could also make you feel tired

[HollyF86 in reply to SlowDragon]

Thank you thank you !!

[SlowDragon Administrator in reply to HollyF86]

If vitamin levels are low …..improving vitamin levels would improve how your body uses/converts thyroid hormones and you would expect Ft4 % to drop a little and Ft3 % to improve a little

[HollyF86 in reply to SlowDragon]

that has been the case for me a few times with low vitamin levels

[Tina_Maria]

Low levels of ferritin and low B12 can cause tiredness. Magnesium is also quite important, are you getting enough? And are you stressed at the moment? This could also have a big impact on how you feel. Have you had your ferritin checked recently or other vitamins? Perhaps an idea and then see if there is room for improvement. Once your vitamins and minerals are all optimised, I am sure you would feel much better.

Just to reassure you, my results are quite similar to yours, I am on 100mcg T4 only, my TSH is suppressed (always had been from beginning), T4 on top of range and T3 a good way through the range, only this way I am symptom free. I am surprised that your GP is okay with the low TSH, as they usually get twitchy when it goes below the range and want to reduce dose. I do feel tired sometimes, but then I realise that I have forgotten my Vit B complex or my magnesium for a bit (we are after all only human! :-)) and once I am taking them routinely again, I feel much better. It might be worth for you to try optimising your vitamins and minerals and try taking them routinely.

[HollyF86]

SlowDragon if these are my results in the morning before I took my levo, does that mean when I do take my levo, that tsh is going to drop further and my free t’s probably go over the threshold into overmedicated ?

Thank you

[SlowDragon Administrator in reply to HollyF86]

TSH doesn’t change quickly

But Ft4 would be higher, possibly over range if tested 2-8 hours after taking levothyroxine