Thoughts on latest blood test results

[catpotter44]

Hi everyone,

I had my levothyroxine increased to 100mcg in June (after having to fight for it!) And I am feeling so much better for it! If anyone could comment on my latest thyroid results and also Vitamin D, I'd appreciate it.

My latest blood test results with percentages from blood draw end Sep are:

TSH 0.27 μUI/mL (0,380-5,330)

fT4 1.17 ng/dL (0,54-1,24) 90%

fT3 2.98 pg/mL (2,5-3,9) 34%

Vitamin D 31.6 ng/mL (20-100)

ESR 43 (1-10)

I'm feeling mostly great at the moment apart from some flares on and off.

Am I right in thinking my thyroid hormone is quite good (for now)? T4 at 90% seems pretty optimal. I got these result online and am seeing the doctor this week, so I'm preparing for a fight when she sees TSH under range!

Vit D I last had tested in March, it was 33 at the time (up from 19 in Nov) and I was supplementing 4000IU a day until the end of July. So I assume it had continued to rise from there. But I was not supplementing for the two months until my blood test. I'm shocked that it fell to just below where I was in March! I also supplement Magnesium. I have restarted my Vitamin D supplementation, but can anyone tell me why vitamin D would drop so quickly? Anything that might help in raising and maintaining it?

B12 and folate were not tested, but were good last time they were and I have been supplements with Iggenus B-complex since then.

Thanks!

[TiggerMe Ambassador]

Good to hear you are feeling well 👏

Your fT4 levels are good but you aren't converting very well as your fT3 would ideally be only just a little lower than your fT4.... I'm not sure what the policy is in Spain for offering T3 or NDT?

Vit D levels tend to drop as we can't store it for long and we generally become worse at absorbing and producing it as we age 🫤 Ideally you are aiming for 40-80ng/ml, most of us in the UK supplement all year with slightly more needed in the darker months

[catpotter44 in reply to TiggerMe]

Thanks for replying! And thanks for the advice regarding conversion.

I'm not sure what the policy is regarding T3 or NDT. I think it would be a fight. It's been a struggle to get doctors to increase my levo as it is. I'm extremely lucky that my current doctor is testing T4 and T3 regularly. But she doesn't seem to know what to do with it. I'm going to keep it in mind, but the relation between T4 and T3 has varied a lot between different tests, in some T3 was in fact more! Maybe once things are more settled and my nutrients are optimised it would be worth looking into. How do you know if you aren't a good converter or if it is other factors effecting conversion? I've been wondering how my conversion is.

Interesting that we can't store Vitamin D for long. I guess it's going to be one that I have to be continual with. My goal has been to get it up to at least 60, but haven't gotten there yet (that I know of).

[TiggerMe Ambassador in reply to catpotter44]

You're welcome, it's a really useful Bio you have written and does rather sum up the rather hit and miss treatment that many of us have to suffer

The March result is a bit random isn't it, did it coincide with a flare up? Did you remember to stop taking the B Complex a few days before as biotin can interfere with results?

TSH 1,27 (0,380-5,330μUI/mL) (18% through range)

fT4 1,16 (0.38-1,40 ng/dL) (88% through range)

fT3 3,79 (2,5-3,9pg/mL) (92% through range)

Vitamin D 33.5 (20-100ng/mL)

Vit D is certainly worth supplementing year round, it just goes to show even if the sun is out it doesn't mean we're able to produce enough, this is a really handy calculator to work out what you might need to reach a certain level....

grassrootshealth.net/projec...

Like you say if you are feeling generally well then just trying to keep everything optimized to allow your body to gradually recover it's equilibrium is a good idea, it's all about finding your sweet spot rather than chasing perfect thyroid results and it certainly look like you have been tuning in and listening to your body which is by far the best approach 🤗

[catpotter44 in reply to TiggerMe]

Wise words, gosh, how I appreciate the support and camaraderie we have on this page. And we certainly all need it! 💜

I'm pretty sure I would have stopped the B complex before that blood test, so, yes, I guess it must have been a flare. Because I was undermedicated for quite a while it's hard to know what has been that and what has been flares. My bio doesn't show my June test, in which the T4 and T3 were more balanced:

TSH 1,07 (14%)

T4 0,97 (58%)

T3 3,31 (58%)

My doctor liked those results of course, but at the time I still had little energy and other symptoms, and as I was on a fairly low dose still (88mcg) I fought for an increase to 100mcg. So, all my recent tests have had a very different relation between T4 and T3 and I'm not sure what to think!

[TiggerMe Ambassador in reply to catpotter44]

Interesting! It might actually be that your sweet spot could be alternating 88/100 as your conversion was better on the slightly lower dose and as fT4 gets nearer the top of range conversion can suffer which seems to be the case in your latest results.... though you feel better which is the all important thing!

Might be worth bearing in mind if negotiation is needed 🤗 but even better if you can hold onto the 100mcg prescription and possibly trial the alternating dose without committing 🙃

[catpotter44 in reply to TiggerMe]

Oh wow, this was perfect timing! I read this just before my doctor's appointment. And it makes lots of sense! I have been feeling MUCH better on 100 than 88mcg, especially in terms of energy and ability to do physical activity, but I have had a few other mild symptoms just starting to pop up...so the higher T4 affecting conversion to T3 makes a lot of sense!

Doctor straight up say the TSH and said "you've gone hyper". I have to take things this doctor says with a grain of salt, but I'm grateful that at least she tests all the thyroid hormones, which is more than any other doctor I've had. Anyway, I'm going to try 100mcg Mon-Thurs and 88mcg Fri-Sun. I'm keeping fingers crossed it helps my conversion and doesn't give me a drop in energy again. I told her that I'd want to go back on 100 if I felt worse. She said to test in 6 weeks, but I think 8 would be better.

Any advice on what to expect when decreasing dose?

[TiggerMe Ambassador in reply to catpotter44]

Excellent! 👏👏

FYI you can't become 'hyper' just over replaced which you aren't either as your free's are within range 😉 they tend to say hyper when your TSH drops below range

So hopefully you will only feel improvements on the slightly lower dose and tackling low Vit D, I'd suggest taking a loading dose of Vit D & K2 MK7 10,000ui for a few weeks and then drop back to say 5000ui daily, see if you can get her to test it along with your thyroid and yes I'd drag it out to 8 weeks as it's a slow process altering T4 🤗

Well done you!

[catpotter44 in reply to TiggerMe]

Thank you so much for your kind words and support TiggerMe! I really appreciate the good energy ❤️

Yeah, I know that with my frees in range I'm not really 'hyper' or over replaced; she says lots of things that I just have to ignore. Although it was a word in Spanish she explained that it was like, pharmaceutically induced hyper. But anyway, I'm happy with the outcome, so thank you for the advice!

Oh, yes, loading dose it a good idea. Unfortunately she won't give me another Vitamin D test this time, but I've still got a long way to go with it, so I don't think there's a risk of going over. I think she'll give me a complete blood panel in Jan or Feb.

Edit: one more thing, do you think you could point me in the direction of more info about high in range T4 slowing conversion to T3? I've been having a little look around, but finding it difficult to find much info. Thanks!

[Wua13262348 in reply to catpotter44]

T3 is banned in Spain as per previous posts on the forum. I believe that also rules out NDT as this contains T3. I believe I have also read on the forum that although banned, Spain actually supplies Germany, possibly the Netherlands and Denmark????? with the raw T3 for dispensing labs to use to provide compounded T3. Go figure!

T4 levothyroxine can be bought over the counter.

I believe , from general googling, that the more fat you carry the more Vit D you will likely be able to store. Thin people likely have the capacity to store less.

If you read b12oils.com if I remember correctly, you need adequate VitB2 to have biologically active B12, and if this is not the case, Vit D will be biologically inactive. A serum blood Vit D test cannot tell if your Vit D is biologically active or not.

I believe Slow Dragon and others on the forum have a genetic mutation which causes problems re. Vit D. Can't remember specifically what the problem or mutation is.

[catpotter44 in reply to Wua13262348]

I didn't know that T3 medications were banned in Spain. Weird, that they produce it for other countries though. So strange. Hopefully I can find the sweet spot with levo and don't have to go down that road.

And thanks for the info on Vitamin D. 😊

[helvella in reply to catpotter44]

I don't think T3 is banned. It can be obtained under special import rules.

But there is no liothyronine product on their main portal:

aemps.gob.es/

(There is an English language option towards top right. But I think you have to search in Spanish - liotironina.)

[Tina_Maria]

I think your latest results show that although your T4 is nearly on top of the range, your T3 is quite low compared to it. As others have pointed out, you may not be converting enough T4 to sufficient amounts of T3, this is why you would need a higher dose of T4, so you can get some T3 (which is the active hormone).

If your TSH goes low (or is suppressed), a lot of GPs go into 'you are hyper/over-replaced' panic mode, so be prepared to have a fight if you want to stay on that dose. If you can, it might be worth trying some T3, but not sure if that is an option.

Two months not supplementing can have a big impact on your Vit D levels. As an example, I was spending a whole summer in the South of France in one year and my Vit D levels did not rise higher than 26ng/ml (65nmol/l). Hence I try to supplement with 3000IU Vit D + K2 + Mg all year round.

[catpotter44 in reply to Tina_Maria]

Yeah, I was surprised about the vitamin D, but now I know! Definitely going on my all year round supplement list!