Latest test, surprised by T3

[Indigourchin]

Hello

Here are my latest thyroid results, i have to say I don't feel like my T3 is as high as that, I have long covid so maybe my experience is unreliable, however I wonder if my endocrinologist who has been happy last year with my T3 at 4.3 and t4 at 17.2 will want to reduce the T3? Should i postpone my meeting with him in 11 days time, and recheck in case it is an anomaly?

Thanks for any suggestions, and as always this forum is much appreciated

Inflammation

CRP HS Iron Status

Ferritin 203 ug/L

Please note change in ref range for females in line

with NICE recommendations.

(Range: 30 - 332)

0.94 mg/L (Range: < 3)

Vitamins

Folate - Serum 33.3 nmol/L

Vitamin B12 - Active Please note: A Folate result between 7-13 nmol/L may

indicate a possible Folate deficiency.

(Range: > 7)

137.0 pmol/L

Please note change of reference range 29 Jul 2024.

(Range: > 37.5)

Vitamin D 82 nmol/L

Total 25(OH) vitamin D < 25 nmol/L is deficient.

Total 25(OH)D of 25-50 nmol/L may be inadequate in some

people.

Total 25(OH)D > 50 nmol/L is sufficient in most

individuals.

Total Vitamin D level >250 nmol/L - indicates potential

for toxicity.

Please note change of reference range 23 Oct 2022

(Range: 50 - 200)

[TiggerMe Ambassador]

How long after your last T3 dose did you do the blood test?

[Indigourchin in reply to TiggerMe]

8 hours thanks

[TiggerMe Ambassador in reply to Indigourchin]

Was that the whole 15mcg or do you split the dose?

[Indigourchin in reply to TiggerMe]

oh that's 5 mcg

[Indigourchin in reply to TiggerMe]

split dose

[TiggerMe Ambassador in reply to Indigourchin]

It could be that your fT3 is a little high and your fT4 has dropped a little low... I personally feel grim if my fT4 drops below 50% even with good levels of fT3 🤷‍♀️

Free T4 (fT4) 16 pmol/L (12 - 22) 40.0%

Free T3 (fT3) 6.2 pmol/L (3.1 - 6.8) 83.8%

It's probably hard to compare how you felt on your previous results?

It would be worth nudging your Vit D above 100

[Indigourchin in reply to TiggerMe]

thank you very much. do you think it's worth postponing my appointment and retesting my t3, t4, tsh in a week or so?

[TiggerMe Ambassador in reply to Indigourchin]

It depends what your Endo is like and what you hope he is going to advise 🫤

It seems like you followed the usual protocol so no reason to believe these results aren't accurate

My interpretation would be that you need a little more T4 and a little less T3 but I don't know what you have tried in the past?

[greygoose]

You have Hashi's, don't you. So it's possible that that high level has nothing to do with your dose, it's just the disease taking its course. Tell the endo that it's probably only temporary and you would like to stay on your present dose for another six weeks and retest, see where you are then.

[Indigourchin in reply to greygoose]

thanks grey goose, i hadn't thought of that but i do have Hashi's and haven't been very steady of late in myself. i must look into the diet advice. thank you i dont really know enough about Hashi's , also have ehlers danlos and dont know if they have any effect on each other, its just a bit overwhelming! thank you

[greygoose in reply to Indigourchin]

Well, it has nothing to do with diet. Just eat normally.

I hope you'll for give me if I explain Hashi's to you, and if I tell you something you already know! Because your endo won't know, and one of you should.

Hashi's, as I'm sure you know, is an autoimmune disease, where the immune system tries systematically to destroy the thyroid by repeatedly attacking it.

During an attack, the dying cells release their store of thyroid hormone - T4 and/or T3 - into the blood, causing levels to rise without any change to dose - sometimes to almost hyper levels. And thus the TSH drops.

Doctors, who have no inkling of how Hashi's 'works', completely freak out at seeing the results and want to slash or dose - or stop your thyroid hormone all together. But, these high levels are only temporary. Evenutally the excess hormone will be used up/excreted, and you'll go back to being hypo again. And at that point, you will need your full dose again.

The best thing is if doctors never see results like this. And the patient stops taking his thyroid hormone without telling the doctor. Then starts taking it again when s/he starts feeling hypo again. That way, you avoid having to plead with a reluctant doctor to put your dose up again, because they just don't like doing that!

[Indigourchin in reply to greygoose]

thank you, that was incredibly helpful, i didn't realise that. My endo did sayI had Hashi's but didn't explain anything about it. All of which makes me feel I'll postpone the appointment, retest when i feel a bit better and take those results. I am so grateful to all of you on this forum, thank you greygoose

[greygoose in reply to Indigourchin]

I don't suppose he knew enough about to explain. I've never met one that did.

[TiggerMe Ambassador in reply to greygoose]

Not actually testing positive for antibodies... (though can't be discounted) healthunlocked.com/thyroidu...

Looking back at these results I'd still be inclined to increase T4 by 12.5mcg and then review T3 after next test

Edit... just looked back a little further and raised TGAb

but suggestions 2 years ago to raise T4 dose... healthunlocked.com/thyroidu...

[Indigourchin in reply to TiggerMe]

thank you i'm certainly going to reflect on this and probably postpone my next appointment, on top of long covid had another recent intense virus and will test again when feel better, than you

[TiggerMe Ambassador in reply to Indigourchin]

I just edited the previous answer which you may have missed

Probably the best idea until you feel settled otherwise it just leaves you questioning doesn't it

[Indigourchin in reply to TiggerMe]

would T3 on the same dose possibly lower if T4 was better?

[Indigourchin in reply to TiggerMe]

Hi TiggerMe, apologies for being slow, i don't understand the TGAb reference? If i haven't raised T4 it is because the endo before this current one ( 2012) said I should really be on 75 T4 if i was going to take T3, . Would you anticipate a fallin T3 if i maintain the same dose but raise T4 by 12.5. Thank you so much

[Indigourchin in reply to Indigourchin]

arg sorry, i don't know how to edit a post, i assume looking where you directed me, that it is about testing positive for Hashi'! apologies and thanks

[TiggerMe Ambassador in reply to Indigourchin]

Don't worry, but if you ever need to then press the More🔽 and the dropdown shows Edit 🙂

[Indigourchin in reply to TiggerMe]

thanks!

[TiggerMe Ambassador in reply to Indigourchin]

Your post from a couple of years ago showed raised antibodies which fluctuate and a year later were back in range

No doubt "I should really be on 75 T4 if i was going to take T3" was based on TSH rather than actually looking at your fT4 level 🙄they also have some silly guidelines that say T4 dose should be reduced by 50mcg when adding T3 which is nonsense!

No, I wouldn't expect your fT3 to fall due to adding slightly more T4 but it might drop back if you are actually having a Hashi flare as described so well by  greygoose above

[Indigourchin in reply to TiggerMe]

well thank you for your time, between you and greygooseI have learnt quite a bit today! Much appreciated

[TiggerMe Ambassador in reply to Indigourchin]

You are most welcome, it's always good to talk things around 🤗

[greygoose in reply to TiggerMe]

And the OP said above that her endo told her she had Hashi's. So, pretty clear, I would have thought.

[TiggerMe Ambassador in reply to greygoose]

Ha ha ha... I'm sorry, since when have you/we believed what Endo's say? 😅

Autoimmunity on the Medicheck's results are green so antibodies must be low

[greygoose in reply to TiggerMe]

As you said yourself, antibodies fluctuate. But you only need one positive result to know you have Hashi's. And the OP had that high result - indisputably high - two years ago:

healthunlocked.com/thyroidu...

[TiggerMe Ambassador in reply to greygoose]

Yes, but if this was a flare up you expect antibodies to have risen?

[greygoose in reply to TiggerMe]

Were antibodies even tested in the last blood test? I can't see any mention of them.

As far as I can see, they were last mentioned 10 months ago. The OP wasn't having any signs of a Hashi's 'hyper' swing in those results. We don't know what's happened to them. But, ten months ago, even though they were in-range, they were still pretty high.

[TiggerMe Ambassador in reply to greygoose]

In the main picture the green spot next to them shows they are in range, it would be helpful if Indigourchin could add them

Antibodies result

[greygoose in reply to TiggerMe]

OK, so you don't actually know what the level is.

What's more, even if they aren't raised in this test, it doesn't prove anything. This swing was only a little one - the FT3 isn't even over-range, just high in-range, and the FT4 has even dropped since last year. So it's possible that the antibodies weren't needed. They only increase in number when they sense there is a job to do, not automatically. So, if no Thyroglobulin was leaked into the blood, the Tg antibodies would not be activate.

Besides, it was just a theory, a suggestion, a maybe. Why did you feel compelled to argue about it? Was that really necessary?

[TiggerMe Ambassador in reply to greygoose]

No, but they'll be within range.... Didn't know I was arguing about it? Just piecing together the clues to try and get a better all round view of the situation, you very sensibly suggested a flare up could be to blame and I went looking to back this up or dispel it

[greygoose in reply to TiggerMe]

How do you know they'll be in range? Isn't that a rather presumuptuous statement?

And if what you've been doing isn't arguing, I'll eat my hat. You started out by telling me I was wrong, the OP didn't have Hashi's. Now, you are asserting that her antibodies are in-range without any even seeing them. That doesn't sound very open-minded.

[Indigourchin in reply to greygoose]

Thanks for all the suggestions, here are the other results, Thank you!

type on white

[TiggerMe Ambassador in reply to Indigourchin]

Thanks for adding 🙂

[greygoose in reply to greygoose]

OK so they are in-range, but as I said above, that doesn't prove anything in real life. It certainly doesn't mean the OP doesn't have Hashi's.

[TiggerMe Ambassador in reply to greygoose]

The green spot before it shows they're within range else it would be red to flag them as out or range (as with the TSH)... I first questioned the Hashi's tag as I'd only come across the previous results which were within range and I agreed with you that this isn't conclusive... I then continued to look back through the history and came across a raised TgAb result and added an edit to my original answer.

I'm really not into arguing but always happy to question and debate, sorry you feel aggrieved

[greygoose in reply to TiggerMe]

Thank you. I can read a blood test report.

Pretty sure you found a raised TgAB result, not a TRAB. But whatever.

I don't feel aggrieved but just fed up with all the 'question and debate' about a simple suggestion I made. I shall hesitate before making it again on another thread. All this really was not necessary. And, that, as far as I'm concerned is the end of that. I still think the sudden rise in FT3 could be to do with the Hashi's - and I did say 'could be', noot 'is'. But, the only way to prove it is to see if the level goes down by itself.

[TiggerMe Ambassador in reply to greygoose]

Yep thanks, indeed

[Hidden in reply to TiggerMe]

I have not followed this whole treat, but I was diagnosed with raised anti-TPO and anti-Tg (although I think one is enough for a diagnosis). Then: those levels fluctuated wildly throughout the years which caused various doctors to declare me ’cured’ whenever they were in range. After +20 years, a doctor told me there was nothing wrong with my anti-TPO test so certainly I did not have hypothyroidism…But at least he ordered an ultrasound. It showed my thyroid gland was the size of a walnut so Ord’s disease (same end results as Hashi’s but fewer if any Hashi swings it would seem). So, an in-range anti-TPO and/or anti-Tg result proves nothing in my experience.

[Indigourchin in reply to Hidden]

Thank you Sunflower64 , i had an Ultrasound a few months back for something else which commented in passing 'thyroid was atrophied as you would expect with thyroid disease' Thank you, I'd never heard of Ord's disease!

[TiggerMe Ambassador in reply to Indigourchin]

We tend to just get put in the Hashi pile, I've only ever had slightly raised TPO

Hashi's tends to come with a goitre (lump) whereas us Ord's just shrivel up 🙃

[Hidden in reply to Indigourchin]

Ord’s is just Hashimoto’s without a goitre and causes the gland to atrophy. They are both autoimmune and both result in hypothyroidism. Some suggest the disease should be called Hashimoto’s-Ord’s disease,

[TiggerMe Ambassador in reply to Hidden]

I'm the same, we were just debating if there were signs of a flare up in this case which might be why fT3 was slightly more raised than expect, though this again comes down to test timings after last dose so some variation is likely due to it's nature

[SlowDragon Administrator]

How much Levo are you taking and is it always the same brand

How much was it reduced when T3 was added

What was CRP test result…..it doesn’t appear to be on there

And as you have Hashimoto’s (& EDS) are you on strictly gluten free diet

And/or dairy free

If dairy free, is your Levo lactose free

Thybon Henning T3 is lactose free

[Indigourchin in reply to SlowDragon]

thank you, it is so long ago it is hard to remember but think i was on 150 T4 but before T3/T4 had also been on Armour /Erfa which suited me well. the T4 brand , 100mcg has been the same for the past 18 months but have no say on that. T3 is Thybon Henning

very strictly gluten free , only eat goats cheese and a touch of parmigiana so could give those up

CRp was ok i think , 0.94 (range <3)

[SlowDragon Administrator in reply to Indigourchin]

Goats cheese is fine ……

Cows milk has different enzymes to goats milk

[Indigourchin in reply to SlowDragon]

Thanks , that's a relief about the goat's cheese, sometimes i wonder what will be left to eat!

[FallingInReverse]

I’m wondering how you feel…. Are you “ok” or have symptoms changed/popped up?

i have to say I don't feel like my T3 is as high as that

There was a blood test I had where my free Ts were similar ie, 40-50% ft4 and very hear top of range for ft3. And at that time I felt better than ever.

You say you don’t feel like your t3 is that high…. Does that mean you feel ok and are surprised you don’t feel jittery or anxious with a ft3 that high?

Or

Are you fatigued and would expect to be less so with a t3 that high?

I’ll just say that I felt relatively great with a t3 at that level. It ultimately tipped to be above the range… that wasn’t good (heart rate high, sleep disruption,etc) and so a few weeks ago I titrated my t3 dose down. In a few weeks I’m anxious to see just how close to the top of range it is!

top of long covid had another recent intense virus and will test again when feel better

But I also want to share that recently I had a huge stressor in the fall and I decided to stay put in all my dosing until that passed.

And especially with viruses, they wreak havoc on our bodies in lots of ways. The inflammation, the healing responses, nutrients aren’t used as effectively, sleep gets disrupted and that has its own knock in effects.

So I haven’t read through this whole thread but did want to ask how you are feeling and also point out that time is your friend regards to getting another blood test. I have found waiting (even when I feel awful) helps me remove variables and ultimately make better dosing decisions as things settle over time.

[Indigourchin in reply to FallingInReverse]

Thank you FallingIn Reverse, it has been a stressful time , not least Long Covid and various other health/life issues plus as i mentioned a different non Covid virus which resulted in a bunch of tests, through that I had felt that at least my thyroid was stable, ( i do realise T3 and T4 are actually within range, but my T3 has never been that high as far as I remember, maybe twenty five years ago when my dose got mixed up but I was jittery/thinner. ) I have felt fatigued - i always feel fatigued - (plus long covid this past year) but not especially jittery, , all the different things i feel in the last year could easily be attributed to Lord Covid/ otherVirus and the various other things Ehlers Danlos, back problems , so i didn't question thyroid because I wasn't losing weight and didn't feel especially jittery, but like you mention i could be feeling good at that level in the range and given time it might tip above. Thank you very much for the help , it is much appreciated