All taken before 09:00 - fasting and no LT4 for over 24hrs
I previously had my bloods taken at the beginning of November after a dose increase change in August . Annoyingly GP only tested TSH ( she usually does T4 too at my request.) Anyhow at the same time, due to other issues I had B12 and folate tested too. I was deficient in folate and without consultation Folic Acid was dished out but that is another story.. I finally had a face to face consultation at the end of December and agreed another blood test which should have included IFA. The computer system was down when the nurse took bloods on Tuesday so I told her what I expected to be tested for. I have just seen the results on the NHS app. (No IFA on there, perhaps that takes longer.) The GP has entered “A discussion with Clinician needed.” My pre-results booked appointment is not until next month though. I imagine she is referring to the FT4 rather than the low in range FT3.
TSH was 0.547mu/L (0.27 - 4.2) 3 months previously 0.688 so not suppressed.
Would any of you reduce your Levothyroxine immediately based on these results?
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Myristica
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yes I would reduce T4 but only with the introduction of T3, your conversion of FT4 to FT3 is very poor. I would imagine you are quite symptomatic. I feel well with FT3 between 5.5 and 6.5.
Over range FT4 eventually gives me sore eyes, upset stomach and joint pain.
Thank you for your reply. This is the very first time I have had T3 measured so I was surprised to see it so low. I wonder if my low folate is not helping? Because of that too it is hard to differentiate what is causing what. I certainly do not feel overmedicated. I may get one or two days a week when I feel energised. Because FT4 has not been tested since last August when my dose was increased I have no idea if it was already over the reference range in November.
More experienced members will comment but your T4 is over range which is not good. How long have you been medicated ? Could things be swinging around with an autoimmune attack?
If you have several tests with such low T3 then you may be a poor converter and need T3 in some form.
Thank you for your reply. This is the only time T3 has been tested, and I think only because I asked for it. Only been titrated up since diagnosis and initial medication 18 months ago. TPOab were tested initially after diagnosis but were negative. Yes, I am aware T4 is over their reference range.
Thank you for your reply, not been diagnosed as autoimmune as had -ve TP antibodies.
I have taken Accord always apart from the time of initial diagnosis 18m ago when given Teva and then mercury pharma . My weight suggests I ought to be on at least 175mcg but yes, currently on 150mcg daily.
B12 514 - 197-771
Folate 4.67 - 3.89 - infinity
Ferritin 195 ug/L - no range
Vit D - not tested as far as I can see but did request it
I had been told to stop any folate supplements and anything else in December prior to the recent bloods. The GP had initially prescribed 5mg folic acid in November for 3m but after a week I felt so unwell with bloating and swollen ankles that I stopped. Bought my own L-methyl folate instead but was reluctant to take it as I had been taking b12 supplements during the summer and believe my bow results were skewed so was worried it would drop further.
I have been previously tested for coeliac and had endoscopy a few years ago and this recent test for IgA was negative too.
2.97 g/L - 0.70-4.00. It was 3.04 g/L in 2019.
I do not follow a strict gluten free diet but have been low carbing (less than 60g daily) now for a couple of weeks and that has noticeably helped reduce bloating after eating.
I have just started my own B12 complex and B-complex since the bloods were taken Tuesday.
You only need a vitamin B complex, not a separate B12 as well
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)
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 2 per day and/or may need separate methyl folate couple times a week
Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels
Low vitamin levels affect Thyroid hormone working
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
Trying gluten free diet for 6-12 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse
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
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
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
Hi Myristica. I'm in a similar situation to you re low in range FT3, over range FT4 and suppressed TSH. My GP without consulting first decided I was overmedicated and has reduced my levothyroxine from 250mcg to 225mcg. I can't get an appointment to discuss until the end of this month. I already feel symptomatic of low thyroid I think it's been about 5 weeks at the reduced dose. I'm trying to optimise my vitamin levels currently but feel like this reduction has been a set back.
Thank you for your reply. This is the problem with GP’s at the moment, it is hard to get timely appointments within a few days after bloods.
The thing is my TSH is not suppressed and if they had only tested that, she would have just marked it as normal. This is why, in my opinion anyone who is receiving replacement T4 hormone ought to have full TFT’s taken each time.
Thank you to everyone who has taken the time and trouble to reply to my post.
I am going to reduce my daily dose from 150mcg by taking 100mcg on alternate days until my appointment next month and then try to get another test for the end of March.
I just hope that I do not become badly symptomatic again.
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