What do my results mean

[Nowebag49]

My blood results are as follows

TSH 11.0

T4 18.1

T3 2.8

No comments made by my GP but I feel awful. Constantly tired and constipated, extremely dry skin. Lack of concentration and forgetful.

[Obsdian]

Could you add the ranges please.

But a quick glance definitely shows you aren't converting t4 into t3 well so no surprise you feel dreadful!

[Nowebag49 in reply to Obsdian]

TSH range 0.27 to 4.2 Result 11

T4 range 12 to 22 Result 18.1

T3 range 3.1 to 6.8 Result 2.3

[Buddy195 Administrator]

Welcome to the forum Nowebag49

So we can offer better advice, can you tell us more about your thyroid condition, eg ongoing symptoms, plus add ranges in for blood tests- as these vary between laboratories.

TSH should always be under 2, so an elevated reading indicates your thyroid is struggling. GP should be offering a retest in 6-8 weeks with a reading over 10, and if still high in subsequent tests, offering medication.

Have you had thyroid antibody or key vitamin tests (ferritin, folate, vitamins D and B12)? If not, do ask GP for these in first instance

we are a helpful & supportive group- keep posting & asking questions 🦋

[Nowebag49 in reply to Buddy195]

TSH range 0.27 to 4.2 Result 11

T4 range 12 to 22 Result 18.1

T3 range 3.1 to 6.8 Result 2.3

[Nowebag49 in reply to Buddy195]

No I haven't had Thyroid antibody test - I was diagnosed at least 25 years ago and have never been offered these. My problems seem to have become worse as I have got older.

[SlowDragon Ambassador]

welcome to the forum

How much levothyroxine are you taking

How long have you been on current dose

Do you always get same brand levothyroxine

Do you take levothyroxine waking or bedtime

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)

High TSH suggests that you need dose increase in levothyroxine

See/contact GP for dose increase in Levo

Perhaps initially by 12.5mcg daily

Use a weekly pill dispenser for storing pills, this makes it much easier to see if missed a dose

When were vitamin D, folate, ferritin and B12 last tested

What vitamin supplements are you taking

[Nowebag49 in reply to SlowDragon]

75mg

Since July 2024 when it was reduced from 100mg as surgery said the dose was too high

Usually

Waking

I have an appointment with my GP next week

B12 normal range 200 to 900 Result 302 and

Serum folate normal range 3.0 to 20.5 Result 3.7 August 2024

Omega 3 fish oil and Vitamin D

I am also prescribed Furosemide 29mg

Ezetimibe 10mg

Utrogestan capsules 100mg

Oestrogel 1 pump 1.25g between both arms

Could any of the above be interfering with my thyroid medication.

[SlowDragon Ambassador in reply to Nowebag49]

Do you take levothyroxine on its own, on empty stomach and then nothing apart from water for at least an hour after

And no other medications or supplements within 2 hours

Vitamin D tablets or gels and any HRT you swallow at least 4 hours away

Vitamin D mouth spray can be taken an hour after Levo

Test vitamin D twice yearly when supplementing

aiming for vitamin D at least over 80nmol minimum

Can test via NHS private testing service

vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function.

There’s a version made that also contains vitamin K2 Mk7.

One spray = 1000iu

amazon.co.uk/BetterYou-Dlux...

It’s trial and error what dose we need, with thyroid issues we frequently need higher dose than average

Are you taking Ezetimibe for high cholesterol

You may not need once correctly treated

nhs.uk/conditions/statins/c...

If you have an underactive thyroid (hypothyroidism), treatment may be delayed until this problem is treated. This is because having an underactive thyroid can lead to an increased cholesterol level, and treating hypothyroidism may cause your cholesterol level to decrease, without the need for statins. Statins are also more likely to cause muscle damage in people with an underactive thyroid.

B12 and folate far too low BECAUSE of being hypothyroid/on inadequate dose Levo

With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a separate B12 supplement

A week later add a separate vitamin B Complex 

Then once your serum B12 is over 500 (or Active B12 level has reached 70), you may be able to reduce then stop the B12 and just carry on with the B Complex.

If Vegetarian or vegan likely to need ongoing separate B12 few times a week

Highly effective B12 drops

natureprovides.com/products...

Or

B12 sublingual lozenges

uk.iherb.com/pr/jarrow-form...

cytoplan.co.uk/shop-by-prod...

In-depth article on different forms of B12

perniciousanemia.org/b12/fo...

B12 range in U.K. is too wide

Interesting that in this research B12 below 400 is considered inadequate

healthunlocked.com/thyroidu...

perniciousanemia.org/b12/le...

And why aiming to keep B12 over 500 recommended

perniciousanemia.org/b12/le...

Great reply by @humanbean on B12 here

healthunlocked.com/thyroidu...

Low folate

supplementing a good quality daily vitamin B complex, one with folate in (not folic acid)

This can help keep all B vitamins in balance and will help improve B12 levels too

Difference between folate and folic acid

healthline.com/nutrition/fo...

B vitamins best taken after breakfast

Igennus B complex popular option. Nice small tablets. Most people only find they need one per day. But a few people find it’s not high enough dose and may need separate methyl folate couple times a week

Post discussing different B complex

healthunlocked.com/thyroidu...

Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule) Thorne can be difficult to find at reasonable price, should be around £20-£25. iherb.com often have in stock. Or try ebay

IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 5-7 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate folate supplement (eg Jarrow methyl folate 400mcg) and continue separate B12 if last test result serum B12 was below 500 or active B12 (private test) under 70:

[Nowebag49 in reply to SlowDragon]

Levo first thing after getting up. (7am ish).

Omega 3 and Furosemide mid morning.

Vitamin D at lunchtime.

Ezetimibe, Utrogestan and Oestrogel (10pm ish)

I fall asleep quickly and sleep through until 7am ish.

[SlowDragon Ambassador in reply to Nowebag49]

75mg

Since July 2024 when it was reduced from 100mg as surgery said the dose was too high

What were results on 100mcg ?

Was test early morning

You should have been retested 3 months after dose reduction

Did that happen, if yes what were results

Your dose was clearly reduced too much

You are now hypo and need dose increase

Perhaps initially to 87.5mcg daily

Retest in 8 weeks

Always do 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)

[Nowebag49 in reply to SlowDragon]

23/8/24

Serum free T3 level 2.3

Serum free T4 14.5

Serum TSH 5.19

Not tested 3 months later

I did a private test in October

Results: Free T3 2.8

Free T4 18.1

TSH 11.0

Now prescribing 100 and 75 on alternating days

[SlowDragon Ambassador in reply to Nowebag49]

23/8/24

Serum free T3 level 2.3

Serum free T4 14.5

Serum TSH 5.19

please add ranges on Ft3 and Ft4

With these results dose levothyroxine should have been INCREASED

On levothyroxine TSH should always be below 2

and Ft4 at least 60-70% through range

Ft3 at least 50-60% through range

I did a private test in October

Results: Free T3 2.8

Free T4 18.1

TSH 11.0

Did you give these results to GP

[Nowebag49 in reply to SlowDragon]

Yes, GP has now prescribed 100 mg alternating with 75mg

[SlowDragon Ambassador in reply to Nowebag49]

As you were in need of dose INCREASE when on 100mcg you’re likely to need further increases over coming months

Many (most?) on levothyroxine when adequately treated will have Ft4 at least 60-70% through range if not higher

TSH usually around or below 1

Essential to test and maintain GOOD vitamin levels

GP who reduced dose last August was completely wrong to do so

Dose should have been increased

[FancyPants54]

One pump of oestrogen is horribly low. It can't actually get any lower! But that's just another thing making your feel horrible, you are also very under under medicated.

SlowDragon has given you tons of really useful info. Print it and start working through it. But you will need a dose increase back to 100mcg Levo as soon as possible. Then tackle them for an increase to 2 pumps of gel.

[Nowebag49 in reply to FancyPants54]

Had a breast cancer scare in 2009 taken off of HRT tablets. Checked and all clear. Full hot flushes and night sweats and all menopause systems for a year.

Requested to go back on HRT and prescribed Oestrogel gel and Utrogestan. Cleared menopausal systems.

[SlowDragon Ambassador]

suggest you test thyroid and vitamin levels privately at 8-10 weeks after being on higher dose and working on improving B12 and folate far too

Include testing BOTH TPO and TG antibodies

Testing options and includes money off codes for private testing

thyroiduk.org/testing/

Medichecks Thyroid plus BOTH TPO and TG antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes BOTH TPO and TG antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

Medichecks and BH also offer private blood draw at clinic near you, or private nurse to your own home…..for an extra fee

Only do private testing early Monday or Tuesday morning.

Tips on how to do DIY finger prick test

support.medichecks.com/hc/e...

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

Going forward

You need to test folate, B12 and ferritin at least annually

[SlowDragon Ambassador]

TSH should always be below 2 on levothyroxine

gponline.com/endocrinology-...

Graph showing median TSH in healthy population is 1-1.5

web.archive.org/web/2004060...

Comprehensive list of references for needing LOW TSH on levothyroxine

healthunlocked.com/thyroidu....

onlinelibrary.wiley.com/doi...

If symptoms of hypothyroidism persist despite normalisation of TSH, the dose of levothyroxine can be titrated further to place the TSH in the lower part of the reference range or even slightly below (i.e., TSH: 0.1–2.0 mU/L), but avoiding TSH < 0.1 mU/L. Use of alternate day dosing of different levothyroxine strengths may be needed to achieve this (e.g., 100 mcg for 4 days; 125 mcg for 3 days weekly).

sciencedirect.com/science/a...

The optimal daily dose in overt hypothyroidism is 1·5–1·8 μg per kg of bodyweight, rounded to the nearest 25 μg.

Even if we frequently start on only 50mcg, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or somewhere near full replacement dose (typically 1.6mcg levothyroxine per kilo of your weight per day)

cks.nice.org.uk/topics/hypo...

bnf.nice.org.uk/drugs/levot...

nhs.uk/medicines/levothyrox...

Adults usually start with a dose between 50 micrograms and 100 micrograms taken once a day. This may be increased gradually over a few weeks to between 100 micrograms and 200 micrograms taken once a day.

Some people need a bit less than guidelines, some a bit more