best time to take thyroid blood tests?

[thyroid-warrior]

I've understand that the best timing to take a thyroid blood test is before 9am.

If the earliest timing available in my neighbourhood is between 9.30am to 10am, would it still be acceptable? Thank you!

[TiggerMe Ambassador]

Welcome aboard

If that's all on offer then Yes, it only really effects TSH levels but hopefully they are testing frees as well, many opt for a home finger prick kit so they can have more control over timing

Continuity is key to be able to compare results 🤗

[thyroid-warrior in reply to TiggerMe]

Thanks! I'm thinking of the bluehorizonbloodtests.co.uk... - that include the free T3 and reverse T3 and might well do a checks on the vitamin levels.

I was experiencing extreme fatigue, bone/joints aching, brain fog, cold intolerance in October and the TSH and free T4 came back "normal".

TSH = 1.4 mu/L

FT4 = 20.8 mu/L.

Also tested for

serum ferritin 150 ug/L

b12 folate 704 ng/L

serum iron 20.1 umol/L

serum transferrin 1.88 g/L

Se unsat iron binding capacity: 47 umol/L

% TransF. Saturation 43%

Combined total vit D2 + D3 levl: 246 nmol/L

Haemoglobin estimation 136 g/L

Total white cell count 7.8 10*9/L

Platelet count 240 10*9/L

Red blood cell count 4.13 10*12/L

Haematocrit: 0.41 L/L

Mean corpuscular volume: 99.0 fL

Mean corpusc. haemoglobin (MCH): 32.9 pg

Mean corpusc. Hb. conc. (MCHC) 333 g/L

RDW: 12.2%

Neutrophil count: 5.3 10*9/L

Lymphocyte count: 1.7 10*9/L

Monocyte count 0.6 10*9/L

Eosinophil count 0.2 10*9/L

Basophil count: 0.0 10*9/L

Nucleated red blood cell count: <0.03 10*9/L

The GP concluded there was nothing wrong with my thyroid and we went down the rabbit hole of doing another set of tests : Cytology, Hep-2 nuclear pattern, anti-CCP antibody level , DNA binding autoantibodies, renal profile, bone profile, Erythrocyte sedimentation rate - all of which returned normal.

I was at my wits end as fatigue got worse towards the end of October. I was recommended by my acupuncturist to increase the dosage. So I decided to switch from 87.5 to 93.75 and immediately my energy returned! But my energy levels still fluctuate from time to time and it's not consistent. I also switched the dosage timing from morning to evening and changed my meds to teva from the default brand.

I can still function but not optimally. I struggle with brain fog and feeling body aching very often. Maybe once or twice a week I feel more energized the entire day. The rest of the time, I only feel more alert from afternoon onwards. It's very difficult as I can only work 50% of the time due to the brain fog.

After all the changes, I went to the GP to request for another round of blood tests as I discovered the possibility of a T3 trial with NHS.

se thyroid peroxidase Ab conc: 185 kIU/L

TSH: 3.1 mu/L

serum free t4 level: 19.3 pmol/L

I took the tests before 9am but I took my medication the evening before.

Even though I mentioned my symptoms, but the GP pushed it to the endocrinologist and the endocinologist rejected my request to test for T3, saying my TSH and T4 and there is no need to test for T3.

I'm not getting any support from the GP and the endocrinologist has dismissed my concerns.

I've tested going from 93.75 to 100 but it didn't work very well as I started getting heart palpitations after the fourth day in a row.

I'm guessing my conversion from T4 to T3 is not constant and efficient.

I get cold hands and feet at different times of the day. It's like suddenly an internal generator would come on and I feel normal and alert while other times, I struggle with the other symptoms and also bloating. It's rather erratic. I have also cut out alot of food like no dairy and limiting gluten.

In the meantime, I'm testing if a higher alternating dosage could give me more constant energy, having 93.75 and 96.875.

My next plan is to test for reverse t3 and t3 privately and getting T3 meds privately.

Do you have any tips and advice?

[TiggerMe Ambassador in reply to thyroid-warrior]

😬'Normal' is about as useful as 'Fine' when it comes to blood results I'm afraid 😕 we aim for optimal.... Your GP seems to like to test everything but fT3!

We wouldn't recommend an rT3 test as they are pricey and don't tell you anything useful

Your other results look pretty good, I'll query folate which has been lumped in with B12 and I've never seen a combined D2&3 result so don't know about that, Vit D ideally 125nmol/L so this seems high?

Magnesium is generally low and testing is unreliable

I'd suggest a cheaper thyroid panel to give TSH, fT3 & 4 as we just don't know how much is being converted to the active form which is the key thing and possibly more useful a cortisol saliva test

[thyroid-warrior in reply to TiggerMe]

Thanks for sharing! Yes, apparently the GPs are not authorized to request for the test. In their system, it wasn't an available option. But the endocrinologist basically brushed aside my concerns and said looking at the TSH and T4, there is no need for a FT3 test.

Vit D was higher as I was taking a supplement.

How would a cortisol saliva test help? Is there a difference between testing it in the morning or afternoon?

[SlowDragon Ambassador]

Welcome to the forum

For full Thyroid evaluation you need TSH, FT4 and FT3 tested

Also both TPO and TG thyroid antibodies tested at least once to see if your hypothyroidism is autoimmune

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

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)

[thyroid-warrior in reply to SlowDragon]

Thank you! I'm planning to get FT3 and reverse T3 tested as I'm suspecting my T4 to T3 conversion isn't working very well.

I tested for se thyroid peroxidase Ab conc: 185 kIU/L recently.

2022: Thyroid peroxidase antibodies (TPOAb) - 172.6 kIU/L

2023: Thyroid peroxidase antibodies (TPOAb): 230.6 kIU/L

Does that mean I have Hashimoto's?

What's the difference between testing for TPO and TG thyroid antibodies?

[TiggerMe Ambassador in reply to thyroid-warrior]

TPO antibodies often elevated in people with Hashimoto's thyroiditis, an autoimmune disorder that causes an underactive thyroid. TPO antibodies are also found in some people with Graves' disease and in 1–20% of people with thyroid cancer. However, high levels of TPO antibodies do not necessarily indicate cancer. Range <34

Tg antibodies are directed against thyroglobulin, a protein in the thyroid gland that helps produce thyroid hormones. High levels of Tg antibodies are a sign of Hashimoto's disease.

Range <115

So yes you have Hashimoto's

[thyroid-warrior in reply to TiggerMe]

Thank you for clarifying. I looked into my old test results from Thriva and realized my TgAB seems in the normal range.

Last year (2023) for Thyroglobulin antibodies (TgAB) - 107.5kU/L.

In 2022, Thyroglobulin antibodies (TgAB) was 72.3 kU/L .

It seems like only my TPO is consistently over the range. Does that make any difference if one is normal and the other is not?

Is it possible to get TPO down to under 34?

[TiggerMe Ambassador in reply to thyroid-warrior]

Both are showing autoimmune activity as your TgAB is creeping closer to the top of range. TBH you are already replacing the hormone your thyroid should have been making for most of your life so these are really just flagging up the autoimmune side which can possibly be slightly lowered by avoiding trigger foods such as dairy and gluten to reduce inflammation

It's not unusual to only have one or other antibodies raised

Many people will collect more than one autoimmune disease 😕

Have you looked into your sex hormones? When these start to change they affect thyroid hormone levels and share many of the symptoms

[SlowDragon Ambassador in reply to thyroid-warrior]

We don’t recommend getting Reverse T3 tested

It’s an extremely expensive test and doesn’t tell you much

High thyroid antibodies confirms autoimmune thyroid disease also called Hashimoto’s

Have you had ultrasound scan of thyroid

And you need coeliac blood test too - assuming you aren’t yet on gluten free diet

which brand of levothyroxine are you taking and do you always get same brand at each prescription

Vitamin D

That’s an odd result…..seems exceptionally high

How much vitamin D are you taking

What other vitamin supplements are you taking

[thyroid-warrior in reply to SlowDragon]

Thanks for sharing! Was wondering if Reverse T3 is helpful in giving any insight if there are irregularities in T4 to T3 conversion at all?

No, I haven't had any ultrasound scan of thyroid. I have been taking meds since I was a child - for 36 years. I experienced brain fog, fatigue often when I was younger but as I was told, taking thyroid medication means I could lead a normal life so I never attributed it to the thyroid gland. I also mitigated brain fog with loads of coffee and I also did exercise quite regularly. It's only in the recent years, the brain fog/fatigue/cold intolerance got worse and now I'm actually looking at my labs and trying to understand what's happening. I haven't taken any TPO or TGAB tests since I was a child till two years ago.

Brand wise - I've always been on generic levo - either the MercuryPharma or the one with the copper(brown?) box. It's whatever the pharmacy gives.

Recently I've requested to switch to Teva which does not have a lactose filler. I looked at the ingredients closely and noticed the ones I usually have all have lactose fillers inside.

I took a vitamin D supplement which had 2,000IU - that's why it was higher than usual. I paused on that for a while after the result.

I'm taking magnesium, omega-3, vitamin B1 and multi-vitamins.

I've done a coeliac blood test last year and it says negative. I did a food intolerance test before and found out I was intolerant towards gluten and wheat.

Yeast also don't sit well with my gut. I noticed subsequent body aches and body seems to go into shut-down mode more easily. Most recently, I discovered soy was another culprit. I'm trying to do a food log to identify potential food culprits. Do you know if there are specific foods that are more likely to be triggers?

[SlowDragon Ambassador in reply to thyroid-warrior]

multivitamins never recommended on here

Most contain iodine not recommended on Levo and especially with Hashimoto’s

Never supplement iron unless tested and deficient

Test vitamin D, folate, B12 and ferritin at least annually

Extremely common to develop gluten intolerance

Almost as common to develop dairy intolerance

And anyone on levothyroxine does best avoiding all soya

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances.

Most common by far is gluten. Dairy is second most common.

A trial of strictly gluten free diet is always worth doing

Only 5% of Hashimoto’s patients test positive for coeliac but a further 81% of Hashimoto’s patients who try gluten free diet find noticeable or significant improvement or find it’s essential

A strictly gluten free diet helps or is essential due to gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and may slowly lower TPO antibodies

As your coeliac test is negative you can consider trialing strictly gluten free diet 

Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse

chriskresser.com/the-gluten...

amymyersmd.com/2018/04/3-re...

thyroidpharmacist.com/artic...

drknews.com/changing-your-d...

Non Coeliac Gluten sensitivity (NCGS) and autoimmune disease

pubmed.ncbi.nlm.nih.gov/296...

The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported

nuclmed.gr/wp/wp-content/up...

In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned

restartmed.com/hashimotos-g...

Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.

Similarly few months later consider trying dairy free too. Approx 50-60% find dairy free beneficial

With loads of vegan dairy alternatives these days it’s not as difficult as in the past

Post discussing gluten

healthunlocked.com/thyroidu...

Recent research in China into food intolerances with Hashimoto’s

healthunlocked.com/thyroidu...

More interesting Chinese research on Hashimoto’s and leaky gut

nature.com/articles/s41598-...

[thyroid-warrior in reply to SlowDragon]

Thanks for sharing the resources! I will read more into them.

The one that strikes me the most is "And anyone on levothyroxine does best avoiding all soya" -> only recently I came to this realization. I've been consuming loads of soya when I was young. Only recently I seem to put two and two together to realize where the body aches were coming from...