Blood test comments please.

[Alilev]

Please could you knowledgeable people comment on my recent private blood test results?. My Levothyroxine was upped from 75 to 100mg in June after my TSH shot up. It came down after the higher dose but now I have high T4. Do I need a reduced dose ?

TSH : 0.19 (0.27 - 4.20)

Free T4 : 24.2 ( 12.0 - 22.0)

Free T3 : 4.6 (3.1 -6.8)

T4 total : 142 (66-181)

TPO antibodies : 256 (par for the course)

cortisol 437 ( 166- 507 a.m)

Magnesium 0.8 (0.7-1.0)

Thanks for any insights. I’m feeling OK apart from a slight increase in pins and needles in hands and feet - I inject B12 weekly but I’ve been suffering from a cold/ cough that refuses to leave.

[SlowDragon Administrator]

Was thyroid blood test 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)

Do you always get same brand levothyroxine at each prescription

no vitamin D, folate, b12 or ferritin results

what vitamin supplements are you taking apart from B12 injections

Are you also taking a daily vitamin B complex and daily vitamin D and magnesium?

Are you on gluten free and/or dairy free diet

[Alilev in reply to SlowDragon]

It was early ish in the morning but I had eaten. Will take note in future. I must admit I have not bitten the bullet re going gluten and dairy free. I know my B12 is high as I have chosen to self treat because I only get 10 weekly NHS injections.,This wasn’t enough to get rid of neurological symptoms. Once a week B12 injection s work for me. I always have Teva Levothyroxine. Vitamin D generally good as I spend a good few weeks in Spain every year. I generally take B multi Vits daily and Folic acid on the day I do the B12 jab. I can see I need to up the magnesium so will start taking some. I’ve dropped off taking selenium so generally need to get better with taking supplements. My ferritin hasn’t been too bad in the past, but I do sometimes take Spatone to keep it topped up.

[SlowDragon Administrator in reply to Alilev]

Suggest you retest again including vitamin levels in Jan

Many thyroid patients find they need to take vitamin D continuously all year to maintain good vitamin D levels

See if improving vitamins can increase Ft3 and lower Ft4

Similarly you may see absorption and conversion improvement if on gluten free and/or dairy free diet

Perhaps consider trialing gluten free after Christmas

If Ft4 remains over range after these experiments try SMALL dose reduction in Levo eg 75mcg once week and 100mcg rest of week

Retest in 8-10 weeks

[Alilev in reply to SlowDragon]

Thank you. That all sounds excellent advice.

[Sleepman]

If free T4 is high the forum does not seem to recommend this. If you took levo just before bloods this may be giving false result

Your fT3 is 40% which is not too bad but may be a bit raised if you took levo just before the test

you have the splendid Slowdragon commenting on specifics

How long have you been on levo ?

[Alilev in reply to Sleepman]

I usually take Levo when I wake up in the night. Often at 4 am so a good few hours before I tested. Been on Levo for 3 years.

[SlowDragon Administrator in reply to Alilev]

I usually take Levo when I wake up in the night. Often at 4 am so a good few hours before I tested. Been on Levo for 3 years.

So Ft4 falsely high if did this

Last dose should be 24 hours before test

If 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

[Alilev in reply to SlowDragon]

Thank you. I didn’t know this -will make sure I do this in future.

[Mona1966]

do you also experience numbness in parts of your hands and feet? This is what I experience and thought it might be my fibromyalgia playing up 🤷‍♀️

[Alilev in reply to Mona1966]

I have done in the past but I believe this was a result of low B12. Since injecting B12 weekly, these symptoms have cleared up.