GP Finally agreed to test my T3 as i was worried about T4-T3 conversion,how are my results please?

[Foxy147]

Hi,

Been on Levo since Early May 2024 (TSH was 5.4 / T4 was 14.1) - (Male 82kg - Age 50)

but over time i have always worried i was maybe not converting T4 to T3.

Finally i got my GP to test T3 T4 and TSH together

(Originally Started on 25mcg - 50mcg - 75mcg - Currently 50mcg)

(Went back down from 75mcg to my current 50cmg at the end of Sept 2024 as felt nauseous and stomach aches,and my TSH had dropped to 0.13 & T4 was 20.1)

Diagnosis overmedicated (these symptoms gone now back down to 50mcg)

So i have just got my latest results -

TSH - 0.6 miu/L [0.2 - 4] Result - Patient is biochemically euthyroid

(Doctor wants to see me,maybe he feels the TSH is too low)

Last time i was on this dose (50mcg) my TSH was 2.7 - 5 months ago

T4 - 17.1 pmol/L [10 - 20]

T3 - 5.50 pmol/L [3.8 - 6.8]

How are these results,am i converting ok from T4 to T3?

Other Tests -

Antibodies Test were fine

Vitamin D - Serum total 25-hydroxy vitamin D level (Xabo0) 104 nmol/L [50 - 100]

B12 - Serum vitamin B12 level (XE2pf) 532 ng/L [211 - 911]

Folate - Serum folate level (42U5.) 13.2 ng/ml [5.4 - 24]

iron Studies - Normal

Serum C reactive protein level (XaINL) < 5 mg/L [< 10]

Chol/Trigs - Normal

Liver - Normal

Urea & Electrolytes - Normal

Haemoglobin - Normal

Serum ferritin level (XE24r) 714 ng/ml [10 - 322] - Above high reference limit; Raised serum ferritin

(Ferritin very high every test (700+)

GP wrote to genetics to see if i could be referred to check for haemochromotosis,but was refused after they checked all my other bloods)

I take a

Vitamin D supplement

Magnesium

Vitamin b Complex

[TiggerMe Ambassador]

TSH 0.6 mIU/L (0.2 - 4) 10.5%

Free T4 (fT4) 17.1 pmol/L (10 - 20) 71.0%

Free T3 (fT3) 5.5 pmol/L (3.8 - 6.8) 56.7%

T4:T3 Ratio 3.109 

Results look good, except the ferritin, if it worries you I'd recommend giving blood to lower this if your GP isn't bothered... how are you feeling? If you feel you need something in between you could quarter a 50mcg and add on alternate days

p.s you've a typo showing T4 when it's your fT3 result

[Foxy147 in reply to TiggerMe]

thanks for the reply,

I feel much better dropping back to 50mcg,i felt really sick on 75mcg,probably why my T4 was over 20,and tsh under range,so overmedicated.

Still feel anxious,and overthinking etc as was the reason i wanted to try levo.

On the plus side,i don't feel as tired through the day,which i did before treatment,and have also gone fom 92-82kg which was much needed

50mcg seems a low dose for my weight/height (82/180cm) to get good levels,is this because i was only subclinical at the start,and din't need much levo? (5.4 tsh / 14.1 T4)

Regarding ferritin -

The Clinical genetics letter my GP got back said -re HFE-related haemochromotosis, we no longer routinely offer appointments for people with a personal or family history of this condition,as the population carrier frequency is high.

Even though untreated iron overload can lead endocrine disorders/diabetes/arthritis/cardiac disease/liver disease etc! I will look into giving blood,as my readings are more than douvble what they should be,even changing diet and drinking way less alcohol,and exercising.

They also said in the Genetics letter to my GP (no idea what they mean)

Result C282Y not present -GH highly unlikely,H63D heterozgote Carrier of h63D mutation - not expected to cause iron overload, H63D Homozygote - Has 2 h63d mutations (one on each gene copy) not expected to cause iron overload,C282Y Heterozygote- not expected to cause iron overload (first degree relatives may wish to seek advice)

c282Y Homozygote - at risk of iron overload but many individuals will never developclinical disease,patient can consider blood donation.

So i will look into giving blood.

My GP want to see me,i think he will suggest my TSH is too low,but i feel ok,and 25mcg last time left my levels not as they should be.

[TiggerMe Ambassador in reply to Foxy147]

What a shocking response! Even though your genes may not suggest a high chance of haemochromotosis you do have elevated ferritin... Fact! Your CRP is low showing little inflammation which could give a false high ferritin result. Too much iron is very bad for all organs

If you do attend a blood donation clinic do not mention raised ferritin level or possible haemochromotosis (which you have been told you don't have) or they will turn you away which leaves you without options!

My sister had a similar issue with ferritin at this level and I insisted she give blood regularly then finally a few months ago her GP acknowledged this and she now attends the clinic and regularly has blood taken and thrown away as she does have haemochromotosis and direct relatives must be informed 😵

Your TSH isn't too low so absolutely politely refuse any reduction, your dose does seem small but you obviously absorb and convert well, we all need what we need and it sounds like you are doing well, to really find your sweet spot dosage wise you can make very small adjustments as I mentioned by cutting up pills, it could be that 62.5mcg might be just right 🤷‍♀️

Which B complex are you taking?

I wouldn't be surprised if your TSH starts to rise as things settle as it did previously on 50mcg (2.7) which is too high

Have you found any issue with dairy in your diet since starting Levo?

[Foxy147 in reply to TiggerMe]

Thanks

No,i have not noticed any probs with dairy,i drink a glass of semi skinned milk before bed,and have milk in tea/coffee (decaf)and eat cheese occasionally.

The B complex i take is attached (I take 2 a day)

I will chat to my GP about the results,and ask about 62.5,or 75 & 50 alternate days,and refuse a reduction if asked.

Iron Saturation results were - Satisfactory

Pathology Investigations

IRON SATURATION repeat; ? Iron overload; Other

Iron 20.0 umol/L [11.6 - 31.3]

Unbound Iron Binding Capacity 32.80 umol/L

Total Iron Binding Capacity 52.8 umol/L [45.0 - 76.0]

Transferrin Saturation 38 %

Ferritin 732.70 ug/L [30.0 - 337.0]; Above high reference limit

Serum transferrin level 2.08 g/L [2.0 - 3.2]

Vitamin B Complex

[TiggerMe Ambassador in reply to Foxy147]

Best to keep your 75mcg prescription and then do the experimenting yourself which gives you more wiggle room

Personally I'd bin those due to the form of B6 as testing is expensive and the better form is available (I happened to find out that pyridoxine blocked my uptake) ... do we assume Vit B is B3 Niacin?

helvella.blogspot.com/p/hel...

You might like this post where we had a good old chat about B Complex's and came up with an acceptable list which is handy to compare any new products... healthunlocked.com/thyroidu...

[Hidden in reply to Foxy147]

Why were you put on levo with subclinical hypo? What were your symptoms? Have you had thyroid antibodies tested?

Are you sure you need to be on levo permanently? It seems patients diagnosed with a slightly raised TSH, T4 in range and no antibodies can sometimes stop levo and remain euthyroid.

[Foxy147 in reply to Hidden]

Because my tsh was 5.4 and over the top of the range,and t4 was only 14.Everyone on this forum who advised said i definitely needed to be on levo,and tsh should be around 1 or lower,which it now is,and t4 around where it should be now,if not slightly higher.

So people will feel better treating it and lowering tsh,and highering T4,than just settling with what you have got surely.

Most people start Levo when subclinical hypo,as it only gets worse in the future apparently i read everywhere.

I went to gp to check my thyroid initially as was always tired,anxious etc.

I asked to try it,the Doctor didn't suggest it.

My antibodies were tested and fine.

Everything has been tested,and only ferritin was high.

Subclinical is just a word doctors use to avoid diagnosing people and having to treat them, which they hate. They don't even really know what the word means. But their definition of subclinical is just a TSH below 10!

I was tested twice before starting on 25mcg,and the 2nd test went from 4.5 to 5.4 TSH and T4 went from 16.2 to 14.1

Tested (10/01/2024) - Abnormal - Need to Speak with Doctor

TSH - 4.5 miu/L [0.2 - 4]

T4 - 16.2 pmol/L [10 - 20]

—————————————————————————

Tested (8/05/2024) - Borderline - Need to Speak with Doctor

TSH - 5.4 miu/L [0.2 - 4]

T4 - 14.1 pmol/L [10 - 20]

Are you saying i didn't need to be on levo with a tsh of 5.4 & T4 14?

[Hidden in reply to Foxy147]

I am not saying you did not need to be on levo, only that not everyone with subclinical hypothyroidism gets treatment which seems more commonly prescribed in the US than Europe. So I was curious as to why they chose to treat you, that’s all, and you said you asked yourself to be put on levo.

I see that you already got good replies eight months ago which might still be valid:

healthunlocked.com/thyroidu...

[elaar]

Raised Ferritin isn't a good measure of haemochromotosis, you need to tally it with Transferrin/Tsat and Iron results to get a true picture. You would normally be in an iron overload state as well, and with the Iron Panel coming back as normal, I'm assuming it doesn't suggest Haemochromotosis.

[Foxy147 in reply to elaar]

Thanks

Iron/Ferritin results were

Iron Saturation results were - Satisfactory

Pathology Investigations

IRON SATURATION repeat; ? Iron overload; Other

Iron 20.0 umol/L [11.6 - 31.3]

Unbound Iron Binding Capacity 32.80 umol/L

Total Iron Binding Capacity 52.8 umol/L [45.0 - 76.0]

Transferrin Saturation 38 %

Ferritin 732.70 ug/L [30.0 - 337.0]; Above high reference limit

Serum transferrin level 2.08 g/L [2.0 - 3.2]

[elaar in reply to Foxy147]

Hi, they look completely normal to me (I'm not an expert though). Worth keeping an eye on the Ferritin. It may be high due to Iron-unrelated inflammation amongst other things.

[Boatin]

Haemochromotosis would only normally be diagnosed if Trans Saturation is above 50%. The Haemochromotosis UK charity is very good and has a free helpline. They carry out more blood tests in a week than the NHS does in a year.

Even though the lab range is normally up to 400, apparently males shouldn't have a level above 300 regularly. Although ferritin can be raised through normal day to day colds, coughs, bumps etc.

They suggested to me that I get my Iron trans Saturation tested. They also suggested giving blood after tests to see if I feel better, as struggling with CF and brain fog.

[Foxy147 in reply to Boatin]

thanks

Iron Saturation results were - Satisfactory

Pathology Investigations

IRON SATURATION repeat; ? Iron overload; Other

Iron 20.0 umol/L [11.6 - 31.3]

Unbound Iron Binding Capacity 32.80 umol/L

Total Iron Binding Capacity 52.8 umol/L [45.0 - 76.0]

Transferrin Saturation 38 %

Ferritin 732.70 ug/L [30.0 - 337.0]; Above high reference limit

Serum transferrin level 2.08 g/L [2.0 - 3.2]