Thoughts on these results.

[ErraticAspie]

Haven't been feeling well for some time. Latest blood results are the below:

Serum TSH level: TSH 0.83 mU/L (0.27-4.2 U)

Free T3 6.1 pmol/L (3.1-6.8 U)

Free T4 17.7 pmol/L (12.0-22.0 U)

Dose is 112.5 mcg.

Thanks.

[GlowCoach Administrator]

8 months ago you posted these results on 100mcg Levo:

TSH 2.1 mU/L (0.27-4.2 U)

Free T3 5.4 pmol/L (3.1-6.8 U)

Free T4 16.4 pmol/L (12.0-22.0 U)

Your current results look pretty good.

How are vitamins looking? ferritin, folate, B12 & D3?

[greygoose]

From your last post 8 months ago:

Presently. I have high conversion, which has led my (excellent and well regarded endocrinology Prof) endocrinologist to say that I don't need T3.

FT4: 16.4 pmol/l (Range 12 - 22) 44.00%

FT3: 5.4 pmol/l (Range 3.1 - 6.8) 62.16%

No, I don't think that's true. You don't have high conversion. Conversion that high doesn't exist. See, you can't convert more T4 than you actually have. And in those last labs you didn't have much - only 44% through the range. And you will only ever convert 30% of that T4 to T3. So, in nature, the FT3 will always be lower in range than the FT4.

But what you do have is Hashi's. So, it's pretty certain that your thyroid was under attack when those labs were done. Did they raise your levo at that point to bring the FT4 up? Because in your latest labs both FT4 and FT3 have risen. So, you possibly do convert quite well, but pretty certain that high FT3 is only temporary. And your not-very-low TSH backs that up. And your 'excellent and well regarded endocrinology Prof' should know that. I'm not impressed.

However, he is right in suggesting that at the moment, you probably don't need any more T3. What you need to do is wait for the FT3 to drop below the FT4 level and then retest and see how well you convert. But too much T3 is as bad as too little, so not sure that taking T3 is going to sort out all your symptoms. Have you got all your other ducks in a row?

[ErraticAspie in reply to greygoose]

Please forgive me for my lack of understanding,, but I have a few questions. Before these, I should have said that ai have been on this dose for a long time IIRC pretty well since that post (and have not seen my Endo since then either, I will show him them these results). a) Why is it that my T3 would sit elevated through the range relative to T4 in my case. Could this be from secretion directly from the under attack thyroid? I also have two nodules, could these be hot nodules? Is the possibility of concurrent Graves/hyperthyroid antibodies worth investigating.

[greygoose in reply to ErraticAspie]

What is IIRC?

a) Because you have Hashi's, yes. But nothing to do with 'secretion' as such. When the immune system attacks the thyroid, the dying cells deposit their stock of ready-made hormone - T4 and/or T3 - into the blood, causing levels to rise. This is only a temporary rise, the levels will eventually drop, but it can take quite some time for the excess hormone to be used up/excreted.

b) There's always the possibility of a hot nodule, but I think they're pretty rare. Have you never had an ultrasound of your thyroid?

c) Not in my opinion, no. You possibly do have some TRAB antibodies, it's not unknown. But I really don't think you can have hyper FT3 and hypo FT4 at the same time. That's not how Graves' works according to my understanding. And your FT3 isn't even high enough to be considered hyper, it's still in-range. I was just pointing out that the high-ish FT3 has little to do with conversion and - more than likely - everything to do with Hashi's.

[andyjs2 in reply to greygoose]

Greygoose, I always greatly appreciate your knowledge and insight! Question: here in the US, there is an author of the book Stop the Thyroid Madness, who says that for someone on T4 or NDT, their TSH should be very low, their FT4 should be midrange, and their FT3 should be in the upper quarter by the time they start feeling well. I think they say this even for someone with hashi’s? This seems contrary to what you just posted. Are they wrong about this?

[greygoose in reply to andyjs2]

Oh yes! I know all about that book!

Well, for a start, if you are on T4 only, you cannot have your FT3 in the upper quarter and your FT4 mid-range. It just doesn't work that way, as I explained to ErraticAspie. You can't convert more T4 than you have in your blood.

On NDT is an entirely different matter because of the T3 it contains. And anybody that doesn't know that has no business writing books!

Or did you mean T4+T3 or NDT? As far as I know EA is on T4 mono-therapy.

[andyjs2 in reply to greygoose]

Actually both I think. You do make a lot of sense, though, now that I think about it.

[andyjs2 in reply to andyjs2]

Oh, I see that the unit for FT4 is ng/ml and it’s pg/ml for FT3, at least on my labs. So does that mean they can’t really be compared like that since the FT3 unit is 1/1000 of the FT4 unit?

[greygoose in reply to andyjs2]

To compare them we convert them to percentages.

Handy percentage calculator:

thyroid.dopiaza.org/

[andyjs2 in reply to greygoose]

Thanks, great tool!

[greygoose in reply to andyjs2]

No, can't be both. There's a hell of a lot of difference between blood test results where T3 is involved and T4 mono-therapy.

If you're taking T3, either as a separate pill, or in NDT, your FT3 is obviously going to be higher in range that the FT4 because taking T3 lowers the FT4. OK, so you can take extra T4 to bring that level up but then it gets hellishly complicated to start throwing around the 'should bes'. Your results 'should be' where they make you feel well, and to hell with the ranges! Ranges are pretty meaningless anyway. And given how different we all are, having an FT3 in the 'upper quarter' might make some people feel well, but might be too much for someone else - or even not enough for another.

I think you should either reread that book, or throw it in the dustbin, where it belongs.

[ErraticAspie]

Sorry, IIRC is If I remember correctly.

Regarding a), thanks.

Regarding b) I have had two ultrasounds of thyroid that showed nodules, but never been tested for hot nodules, but I don't know how one would go about that. Entirely anecdotal, but I have felt significantly worse since the nodule came along.

Regarding c) thanks.

[greygoose in reply to ErraticAspie]

Oh, please, don't use abbreviations like that. I bet very few people know what that means.

Most people have nodules on their thyroids, even if they don't have a thyroid problem. What do you mean by 'since the nodule came along'. Do you actually know when the nodule appeared? It would be very unusual for someone to know that because it would mean having two ultrasounds very close together, just at the right time. which would be a huge coincidence. But, if you're worried about these nodules, ask for them to be tested to see if they're hot. That's all I can suggest, I'm afraid. But I really, really doubt these nodules are hot because you are not hyper. You are hypo.

[ErraticAspie in reply to greygoose]

Thanks. Yes, I suppose you are correct RE: nodule. I mean simply that I only noticed it fairly recently (within the last 14 or so months) and at around the same time (in fact, slightly before) some new symptoms emerged.

Are there any other possible reasons that come to mind for the High T3. You were correct in assuming earlier in the thread that I have increased in dose between the two blood tests, 100 to 112.5 mcg. But considerable time has passed between the dose adjustment (was my first blood test in 8 months), and both test have the same pattern of the T4 being relatively lower than the T3 with a non supressed TSH. I take your point on the possibility of the depositing of hormones from the under attack thyroid causing the spike in T3 levels, but it is interesting that this pattern has been true on two difference doses some time apart.

[greygoose in reply to ErraticAspie]

I'm afraid I have nothing to add to all that I've already said. I don't think there are any other possibilities than the ones I've mentioned.