I asked the GP for blood tests in December following tests in September after Thyroidectomy in August. the GP only requested TSH so I managed to get the hospital endocrinology to do tests but I don't seem to be able to get a follow up appointment. I feel fine but the TSH is very low and my vitamin D is low so wondered if anyone has any advice about how the results looks and whether I should start taking vitamin D. It was fine in September because I had been taking calcium with vit d for a few weeks but is now low again as it was before I had the thyroidectomy.
Free T4 18.5 (10.8-25.5)
Free T3 4.2 (3.1 - 6.8)
TSH 0.23 (0.27-4.2)
D3 30 (50 - 174)
Should I worry about the low TSH? I had the thyroid removed due to suspicious nodules that turned out to be benign.
Thank you!
Written by
Grbca
To view profiles and participate in discussions please or .
Did you test as recommended? Morning draw, fast overnight, delay dose until afterwards, cease biotin supplements.
Whatnots current replacement dose? Your GP may suggest dose reduction as TSH low. But your FT4 & FT3 are not over range. Your FT3 is in fact lower in range.
It’s possible poor nutrient are reducing FT4 to FT3 conversion.
Was folate, ferritin or B12 tested at all?
Were you deficient in calcium? Not recommend to supplement otherwise. You are vitamin D deficient & should supplement. It’s also recommended to take cofactors magnesium & K2.
Yes I followed all the good advice before the blood test which was first thing in the morning before I took my levothyroxine. I have been on 125 since my thyroid was removed and I have felt OK.
Folate, ferritin and B12 were not tested.
Calcium was 2.27 (2.2 - 2.6) and adjusted calcium was 2.35.
Prior to thyroid removal I was taking Vitamin D so wonder if I should be re starting that.
What should FT4 to FT3 conversion be? Should my FT3 be a bit higher? This is all new to me.
It’s actually quite normal for FT3 to be a little lower through the range than FT4.
Once on replacement most will feel well with TSH around 1, FT4 top 3rd of range & FT3 over mid point. Eg FT4 75% & FT3 55%. (But it is an individual thing, many need different)
I just calculated your percentages & you are at:
Free T4 18.5 (10.8-25.5) 52%
Free T3 4.2 (3.1 - 6.8) 32%
If you feel well there’s no need to alter.
I do wonder why your TSH is low though, you’d expect it to be higher with lower in range FT3.
Have you a history of low TSH?
Many need to maintain supplementing vitamin d all year round
TSH before thyroid removal was 2.46 but 6 weeks post op it was 0.23, 6 weeks later it was 0.21 and then 0.23. I don't know why it is so low.
I have been putting on a bit of weight recently but not sure if that is related to anything to do with my medication. I still don't really understand what my levels should be but am just grateful that I feel OK.
Was FT4 & FT3 missed off when that TSH was tested? It’s well within NHS range, so often further testing isn’t done, but it’s higher than average TSH. Would be interesting to know what your FT4 & FT3 was pre surgery.
I think that if your thyroid wasn’t removed due to cancer then your TSH shouldn’t be beneath the TSH range (suppressed). It’s only thyroid cancer that Drs insist for a suppressed TSH to stop any cancer returning. You’re probably on a little too much levo T4 but that’s hard to prove as your blood test was done without taking your t4 levo. If you’d have taken it your t4 level would be higher and maybe over the range which causes low TSH. I alternative my blood tests. I do them with taking and without taking my t4 and t3 medications so I know how high and how low the levels get. We try to aim for a TSH around 1.00 -,2.00. This is generally where a healthy persons TSH usually is.
If your vitamin D is low then yes supplement. But keep an eye on your vitamin D levels not to go too high as that will bring unwanted symptoms. I’d also check b12, folate and ferritin. One can feel good when all vitamins are optimal. But most of all your thyroid levels need to be optimal also. Your T3 is on the low side. You may need help with that and consider taking liothyronine T3 medication also.
We generally feel best when the T4 is up in the top quadrant of its range at around 80% with the T3 tracking just behind at around 70% through it's range and at around a 1/4 ratio T3/T4 -
The accepted conversion ratio is said to be 1 / 3.50 - 4.50 - T3/T4 with most people feeling at their best when they come in this little ratio at 4 or under -
so if I divide your T4 result 18.50 by your T3 result 4.20 - I'm getting 4.40 - showing you slightly wide of centre and struggling to convert the T4 into T3.
T4 is a pro-hormone and needs to be converted in the body into T3 which is the active hormone that runs the body - much like fuel runs a car -
and conversion of T4 into T3 can be compromised by non optimal levels of the core strength vitamins and minerals - viz - ferritin, folate, B12 and vitamin D -
I now aim to maintain my ferritin at around 100 - folate around 20- active B12 125 ( serum B12 500++ ) and vitamin D up at around 125.
so suggest you ask your doctor to run these and we can advise you where ' optimal ' tends to sit in the ranges - as just being in a NHS range- somewhere - anywhere - is not optimal as some NHS ranges are too wide to even be sensible .
Once on any form of thyroid hormone replacement and especially not having a thyroid -
the TSH is the lest important marker and you must be dosed and monitored on your actual thyroid hormone levels - the Free T3 and T4 -
Your HPT axis - the Hypothalamus - Pituitary - Thyroid feedback loop on which the TSH relies on as working - is now down regulated - as there is no thyroid in situ and this circuit loop open ended - making the TSH a very unreliable measure of anything.
There is a lot to take in and get your head round - I think first and foremost you need a dose increase in T4 - Levothyroxine and your core strength vitamin and minerals run and we can advise on your blood test results as you go through the process of trying to find your best dose and thyroid hormone treatment option - as detailed on my previous reply.
You can find all your previous posts and replies by just pressing on the Profile Icon sitting on the task bar probably top right on this screen is using a laptop.
I don't know about your area but the difference I found is if the hospital request the GP to do these tests every 6 or 12 months as appropriate and the results will then come back to the surgery copied to the hospital. Or at the hospital during routine appointments. There is a tick box on the form our nurses use that gives a full panel for Thyroidectomy. Do you know what caused the nodules? You should still be under a surgeon or Endo at this early stage to make sure everything is ok and you are responding to Levothyroxine well.
You should have a calcium test done by the hospital to ensure your Parathyroid glands were not damaged during the operation, otherwise you shouldn't need it.
Your GP is likely to suggest a reduction in Levo with these results but it is still early days so insist it is left alone for now. Retest in 3 months. Do you have a phone number for the Endo clinic or secretary?
Go on high dose of D3 (4,000 iu) for a while to get your Vitamin D up. Look at others advice below re other vitamins. Everyone in the UK needs Vit D particularly in winter.
Test vitamin D twice a year when supplementing, especially in early years, while you work out how much vitamin D you need to maintain at least over 80nmol
You may need higher dose in winter than summer
GP will often only prescribe to bring vitamin D levels to 50nmol.
Some areas will prescribe to bring levels to 75nmol or even 80nmol
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
Graves, thyroidectomy, fluctuating high blood pressure
Most recent blood results 
New blood test results 
Help understanding results after starting Levothyroxine.
blood test after taking vitamins
