Update on blood results on post taking carbimazole

[ja4ne]

I have just had results from blood test taken Oct 8th, they are TSH 0.83 (0.30-4.50), T4 14.7 (11-22), T3 4.2 (3.1-6.8), these results are with taking just under 1/4 of a 5mg tablet of carbimazole from the last blood tests taken on 21st August which were TSH 0.99 (0.30-4.50), T4 11.6 (11-22), T3 4.3 (3.1-6.8). I am wondering why my TSH has dropped and my T4 has risen and if I need to be on carbimazole tablets, any thoughts welcome please.

[pennyannie]

Hey there again :

With a ' normal ' functioning thyroid - the TSH does lower as the T4 increases - so I wouldn't be too concerned about this -

Well - yes - the next step would be to stop the AT drug and see if your thyroid reverts to normal function without the need for any drugs.

However you were already taking NDT prior to this ' blip ' so would imagine you will be back to being hypothyroid and taking some form of thyroid hormone replacement.

I think I remember your last Graves antibodies blood test being a negative - am I right with this fact ?

[ja4ne in reply to pennyannie]

Hi pennyannie,thank you for your reply, the endo said to take one 5 mg carbimazole after the August blood results but with feeling so ill I cut it down myself, I have not taken any thyroid replacement tablets since last year. The TRAB results were <1.0 lU/L (1.0-1.8)

[pennyannie in reply to ja4ne]

Ok then - so hopefully your thyroid results will continue to improve -

A ' euthyroid ' - fully functioning normal thyroid would look like a TSH at around 1.20-1.50 with a T4 at around midpoint and a T3 tucked in just behind the T4 - in percentage terms - though the ranges.

We know your thyroid was already without full function as you were taking a small dose of NDT previously - so likely this will be your choice of support going forward :

So when do you next see this endo as if your T3/T4 blood tests are rerun beforehand - your bloods will look quite strange if you start taking NDT before officially being discharged ?

[ja4ne in reply to pennyannie]

So do these results suggest hypothyroidism instead of hyper, I see the endo in approx 2 weeks time so I suppose she will think they are ok!

[pennyannie in reply to ja4ne]

These results have your TSH in the range - which is good and likely means there are no Graves antibodies pushing the TSH down -

Your T4 is around 34% through its range with your T3 tracking just behind at around 32% through its range.

I would hope that your T4 continues to increase to around midpoint - say 16/17 - and around 50% through its range with the T3 also increasing through its range accordingly.

Currently both T3 and T4 look too low and I suspect you may be experiencing symptoms of hypothyroidism.

A low T3 though ' in the range ' - is hypothyroid land -

just as too high and over the range T3 may take you into hyperthyroid territory -

Do you ever monitor yourself on blood pressure, pulse and temperature AM and PM to see what's happening on the inside ?

How are you feeling as it's not just all about blood tests - as these tend to run a couple of weeks behind symptoms being tolerated and just a snapshot in time as to have some facts on a piece of paper that should coincide with asking the patient how they feel ?

[ja4ne in reply to pennyannie]

Thank you for the explanation pennyannie, I keep an eye on my blood pressure but will start AM and PM doing it and pulse and temp, I feel very depressed, nauseaus, no energy, cold feeling and tired.

[pennyannie in reply to ja4ne]

Yes - I'm not surprised - your T3 and T4 are too low to allow you to function well :

It does take time - no one bounces back from Graves - it's a slow build - talk through your symptoms with the endocrinologists - though not sure what they could come back with -

Once discharged and more comfortable in yourself - I'm guessing you will need some form of thyroid hormone replacement.

I'm sorry about this feeling of constant sickness - has this just occurred since being diagnosed - and what, if anything has been done about it ?

Apart from the sickness - all these other issues are acknowledged as being symptoms of hypothyroidism.

When metabolism runs fast as in hyperthyroidism or too slow as in hypothyroidism the body struggles to extract key nutrients from the food you eat - no matter for well and clean you eat -

and if your core strength vitamins and minerals - those of ferritin, folate, B12 and vitamin D are not maintained at optimal levels these can compound your health issues further than necessary.

Please get these blood tests run and we can advise where ' optimal levels ' tend to be -

as just being in a NHS range somewhere for anything - is not where you will find your optimal health and well being.

[ja4ne in reply to pennyannie]

I have had the nauseaus from when I started the carbimazole tablets, the GP says they are side effects so that is why they want to give me radioactive treatment, my ferritin is 91 ug/L (23-400), folate >20.0 ug /L ( Above 2-5 ), B12 969 ng/L (197-771) and Vit d 91 (25-150 nmol/L )

[pennyannie in reply to ja4ne]

There is an alternative to Carbimazole - Propylthiouracil - ( PTU for short ) an older drug used especially for women who are pregnant and those who can't tolerate the side effects of Carbimazole - I'm sorry you didn't have this information though looking back I did mention this to you a few months ago.

Well if this is a current reading for vitamins and minerals - onwards and upwards- maybe ease up on the B12 supplement ?

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

[pennyannie in reply to pennyannie]

As I wrote previously this ' blip ' was likely not Graves - as your antibodies were questionable - and not a true positive -

Did you ever get your TPO / TgAB antibodies run - as it could well be Hashimoto's -

an AI disease that presents with transient hyper phases which are not medicated with an AT drug as the T3 and T4 do not keep rising higher and higher - as in Graves -

but fall back down into range by themselves - though longer term the thyroid gland becomes disabled with the patient needing thyroid hormone support.

Looking back you were diagnosed with a nodule and several years ago a goitre - so your thyroid health is not clear cut with there being just one issue being apparent. #

Maybe have a read around Hashimoto's AI Thyroid Disease - as not everybody has over range TPO / TgAB antibodies all of the time - and see if this registers at all - thyroidpharmacist.com

[ja4ne in reply to pennyannie]

My latest antibodies Anti-thyroidperoxide are 10.6 <34kiu/l and Anti-thyroglobin 17.5 <115 KU/l, I do wonder if having covid did something as my T3 and T4 went high after having it and vaccines, they have never been so high before. Is there a difference between a goitre and a nodule, I am a bit clueless myself.

[pennyannie in reply to ja4ne]

In a nutshell a goitre can be caused by being either hypo or hyper -

and a thyroid nodule can cause an excess of T3/T4 thyroid hormones -

Were these historic thyroid health issues considered and dismissed before treatment with the AT commenced ?

[ja4ne in reply to pennyannie]

Thank you for explaining, This endo said I did not have a goitre and had to have a thyroid uptake scan which I did, the results showed I was hyperthyroid so I would have to take carbimazole tablets, she did say they were having quite a lot of people with thyroid issues after covid outbreak.

[pennyannie in reply to ja4ne]

Yes I know and have read this all before -

I was checking back to see if you had been told there was an alternative AT drug - if Carbimazole wasn't tolerated well - and you were -

so for your endo to suggest there wasn't an alternative AT drug and that the next step would be RAI - was wrong.

I know when unwell one isn't in a fit state to question the medical profession - and another reason why forums like this exist to help explain things one step at a time.

[ja4ne in reply to pennyannie]

No I was not told by the endo there was another AT drug because I was not tolerating carbimazole and I did not know there was another one myself.

[pennyannie in reply to ja4ne]

I know and why you were advised here some posts ago that there was an alternative AT drug - Propylthiouracil - PTU - if Carbimazole was not tolerated well by the patient.

[ja4ne in reply to pennyannie]

Sorry yes I was advised by this forum there was another AT, I had completely forgot (brain fog),

[pennyannie in reply to ja4ne]

No worries - we've all been there -

but it just puts into question anything this endo has said -

though I'm not suggesting you take any AT drug.

Hopefully your T3 and T4 will start to build back into good strong levels within the ranges as detailed yesterday and your health and well being improve.

Just as an aside if you go back on the NDT - it does not present in blood tests as synthetics and most doctors have no idea how NDT works -

NDT is liable to lower your TSH reading - but increase your T3 reading rather than your T4 reading.

[ja4ne in reply to pennyannie]

Thank you for all the information, I am stopping taking the little piece of carbimazole tablet and see what happens, will wait until I see the endo in a couple of weeks before starting anything else. I think NDT will be the way ahead.

[pennyannie]

Hopefully nothing will happen - and as your T3 and T4 build back up in the range your symptoms will be alleviated - just wait until after you are discharged from endocrinology before taking any NDT .