Help with second set of results after diagnosis

[Cp12]

Hi. I was hoping may help me understand these results. The gp phoned to say results are back in range but tsh still low and need to see endriconolgy. I have a appointment on the 21st. I've been taking 20mg of carbimazole.

At diagnosis on 24/9/24

T3 16.50 (3.1-6.8)

T4 32.3 (11.0- 23.0)

TSH 0.01 (0.27-4.5)

5/11/24

T3 Not tested

T4 19.2(11.0- 23.0)

TSH 0.01( 0.27-4.5)

TPO 13ML (<34.0)

AWAITING TRAB RESULTS.

Why would my tsh not have moved at all?

Bloods not done at 9am was afternoon. Had to go in for fbc for sore throat so the did them all together. They also took bone profile some being out of range, results below, could this be related to thyroid? The gp never mentioned these but have always been in range before.

Serum calcium level 2.62 ( 2.2-2.6)

Serum adjusted calcium concentration 2.65( 2.2- 2.6)

Serum alkaline phosphate level 142 ( 30.0- 130.0)

Thanks in advance.

[PurpleNails Administrator]

TSH will be the last to change & wont start to rise until FT4 & FT3 levels are lower. Sometimes the TSH can stay low. My TSH didn’t rise when I began treatment. Even when my Frees were in range it remained suppressed for many years.

Your FT4 is in range. I find drs will keep you on a dose or up a dose of carbimazole to force TSH to rise, but you don’t want FT4 & FT3 to get too low. How are your symptoms?

Dr might repeat high calcium in 3 months, If abnormal parathyroid hormones should be checked. Mine were abnormal, but not consistently. Drs were not concerned.

[Cp12 in reply to PurpleNails]

PurpleNails thanks for the reply. I had the parathyroid bloods and they were within range. Symptoms wise they have improved but this last week I don't feel great again I can't put my finger on it just don't feel right and very tearful again.

[PurpleNails Administrator in reply to Cp12]

Did GP recommend you reduce carbimazole? your FT4 (& FT3 although not tested) will continue to drop at same rate. GP may have left it because TSH still low.

It’s good the symptoms have improved & being tearful may be a symptom of abnormal or fluctuating levels.

[Cp12 in reply to PurpleNails]

No he said to continue with the same dose and see what endriconolgy say next week. So am I right in the thinking that t3 and t4 could drop to low resulting in hypo?

[Tina_Maria]

How is your Vitamin D level?

Low vitamin D levels can cause hypercalcemia and vitamin D deficiency is a common cause of hypercalcemia. However, vitamin D deficiency can also mask underlying hyperparathyroidism, which should be checked and excluded.

[Cp12 in reply to Tina_Maria]

In September my vitamin d level was 39mnol. The range says levels between 25 and 50 sugest insufficiency. But gp said this was satisfactory. They wasn't tested this time. Do you think I should have them checked again?

[PurpleNails Administrator in reply to Cp12]

Correct. Most feel symptoms when FT3 low. Some are equally or less affected by abnormal FT4. Your FT3 looks disproportionately high. so sometimes the FT4 falls too low with FT3 Still high. This can ballance out but not always. Push for FT3 To be tested alongside the others.

[Tina_Maria in reply to Cp12]

A Vitamin D level of 39 nmol/L is far too low, and it will drop even further over the winter months, as the angle of the sun is too low to produce Vitamin D in your skin. This level might be satisfactory for GP (and he does not have to live with this low level), it is however not good for your health. Your level should be at least 80 nmol/l or even above.

I would start daily supplementation with 3000IU of Vitamin D3 plus Vitamin K2 (Vit K2 helps with calcium absorption and regulates calcium levels in your blood). Take a magnesium supplement as well when you take Vitamin D3, as this helps with the absorption. As Vit D is fat soluble, best to take it after a fatty meal. If you get a magnesium supplement, get either Mg citrate (can have a laxative effect in some people), Mg glycinate or Mg taurate, as these are all forms that the body can easily absorb.

I had very low levels of Vitamin D a few years back and have supplemented with 3000IU Vit D3 +K2 all year round since then. My levels are now 126 nmol/L and I test once a year.

[OXO1]

Hi , my TSH readings were similar to those above. They started moving in the right direction at 3 months at which point the endo reduced the carbimazole dose to 10 from 20