My wife just got her thyroid tested because she is on HRT and we suspect her estradiol may be causing an issue. Are her results optimal? Here are the results:
TSH
1.56 mu/L (normal range 0.27 - 4.2 mU/L)
Thyroxine
17.7 pmol/L (normal range 12 - 22 pmol/L)
Triodothyronine
4.2 pmol/L (normal range 3.1 - 6.8 pmol/L)
Test was taken at something like 6AM.
Hello
Optimal is individual, but nevertheless, these results are not what most would class as optimal.
FT4: 17.7 pmol/l (Range 12 - 22) 57.00%
FT3: 4.2 pmol/l (Range 3.1 - 6.8) 29.73%
You can see that her FT4 is just halfway through the range for results and her FT3, the most important hormone, is just 30% through the range. I have spent a lot of my time with my FT3 in the 30-40% range and always had very little energy.
Many think we need to aim for a TSH of 1 or below. But the most important number if the FT3.
Others will be along to talk about co-factors etc. But I would say there is room for a dose increase here. Often when we start HRT, we need a small raise in thyroid meds. But that doesn't mean HRT is bad, it's part of the thyroid axis and is necessary for good health. So look into getting a better dose of thyroid.
Is your wife on Levothyroxine?
FT4: 17.7 pmol/l (Range 12 - 22) 57.00%
FT3: 4.2 pmol/l (Range 3.1 - 6.8) 29.73%
I very much doubt it.
Optimal is not a number, it's how you feel. But I doubt anyone would feel good with that low FT3. Her FT4 is low, too, but she would appear to be a poor converter.
With a doctor's limited understanding of thyroid, I can understand your doctor's reluctance to increase her dose. All the results are in-range, so for a medic there can't possibly be a problem. They just don't know what it's all about and are terrified of losing their licence.
Ideally, one would increase the levo before going on too T3, but if her GP won't play ball, and he wants to try T3, you would need to write a new post, asking members to PM you their trusted on-line sources, because we are not allowed to discuss suppliers on the open forum. 
Thank you for your input. She's having hair thinning problems. Could numbers like these cause that? She's also on testosterone gel, but the last time that was tested it was pretty low. The hair thinning is happening on all of her head.
Most certainly those numbers could cause hair-loss. That's a welll-known symptom of hypo, and with those numbers she is still hypo.
But, so could low nutrients - especially iron. Has she had her viit D, vit B12, folate and ferritin tested lately? Most hypos have low stomach acid and therefore low nutrient levels.
I believe most of those things were normal according to the GP, but we weren't given the actual numbers. She has an HRT appointment this week and can ask for a print out.
When a doctor says 'normal', all he means is that they're somewhere within the range. He doesn't know any better. But logic will tell you that the ranges are so wide that they cannot possibly be 'normal' all the way through. It's where the result falls within the range that is important. And that is why you always need to get a copy of the results. But no-one is going to just give them to you, you do have to ask at reception (not the doctor!) for a print-out. It is your legal right to have one.
Unfortunately testosterone treatment can cause hair loss. Sounds like she need someone really good to consider the balance of all her hormones. As mentioned by greygoose she needs to get her vitamins / nutrients right. How is her diet/ gut function?
Yes I've been trying to get that for her but either the GP isn't cooperating or she forgot to ask for some things. GP tested TSH and T4, and that was it for hormones. She has an HRT appointment this week so I'll ask her to request a full hormone panel, but I'm not sure whether they'll be willing.
However, from what I understand testosterone causes patterned hairloss, and what she has is everywhere. Could be both I suppose.
Well she could go and get a full blood test done privately so she knows what she’s dealing with and would be helpful to show to any specialist she sees.
I personally think that diet and exercise can have a profound effect on overall wellbeing and getting those two things right is difficult but crucial and has the most positive impact.
I think her testosterone would need to be pretty high and out of range to cause hair loss. I wouldn’t immediately cut the T out as it can have so many positive benefits on clarity of thinking, energy and libido. Hair loss was one of my main symptoms when I was diagnosed hypo - it was coming out in clumps. Unfortunately Menopause can also cause hair loss, so it may be an amalgam of many causes. So many overlaps with these two conditions.
Technically, it isn't testosterone that causes hair loss. It's DHT, but the body can turn testosterone into DHT. Some women, apparently, have an issue where their body turns transdermal testosterone into DHT, which can cause hair loss and aggression. So the testosterone itself wouldn't need to be high if it's becoming DHT at a high rate. But my wife isn't aggressive. She's got a higher libido but she's not angry or ready to fight. I don't think it's testosterone but checking DHT would rule that out. Hopefully the gp can do that.
Hi I don't think any GP would check her DHT being female - unless you go privately - sometimes there are pathways that are blocked within the body that cause the medication being taken to just slop around with nowhere to go - this was my problem and it was the thyroid/liver connection - I do not drink and haven't done so since I was 22 years of age when I realised that I had an allergy - just a tiny amount of alcohol even in a sherry trifle would make me ache all over and be sick. The enzyme to metabolise alcohol was missing due to thyroid issue that - at the time I didn't know I had. That had to wait until I got to 50 although the symptoms I had to suffer along the way were awful ! No blood test for liver issues would show anything either - it is a thyroid issue - slow metabolic issue so that a drug being taken will stay in the body longer as the liver slows to clear anything - for example I was unable to take any antibiotics or any drugs for that matter as I had allergies to them - what was happening was that one tablet would still be in the system when I took the second one etc. so that clearance was minimal and I became toxic - once I was on thyroid medication the very same antibiotics/drugs were no problem at all.
Re the hairloss, my experience of HRT was that it caused the hairloss. I tried various forms (patches, gel, spray) and all caused it, once I stopped taking it due to the many other side effects I was experiencing, my hairloss lessened hugely and very quickly. It’s quite common for it to do that even without adding in testosterone which as you are aware can also cause it. It is a listed side effect in most of the oestrogen leaflets. Obviously everyone is different and things affect them in various ways.
I had exactly the same experience with HRT. It was very worrying at the time and I cried every time I washed my hair at the amount that was falling out.
I know that feeling, it was so awful, looking at photos from then my hair was so thin and changed in texture. It’s not completely back to how it was but it’s much better a year on from stopping HRT. I’m envious of people who can take HRT without issues; for me the side effects were just too many and much, I wish I’d never tried it but until you do you can’t know if it will suit.
I had a dreadful 10 years of menopause & my female gp did not believe menopause was a physical health problem. She said it was a mental health problem & it was all in women's heads. So she refused to refer to a menopause clinic. Anyway, I paid & went to a few different menopause clinics. For some reason the clinics kept shutting down. Anyway at the last menopause clinic not only did I get the best menopause advice, plus trying all the different HRT & testosterone choices I got the best thyroid advice. The doctor knew all about the NHS T3 scandal & she helped & advised me better than any thyroid endo. I'm T3 only & she knew T4 didn't suit everyone & was disgusted T3 was being withheld from patients who would benefit from it long term. The menopause clinic is just outside London, it was expensive but worth every penny because she understood about thyroids & T3. Since covid I think she now does menopause clinic telephone appointments. Plus she is a private gp & does telephone consultations which are a lot cheaper. I'm thinking it might be an idea for your wife to book a private gp appointment to get some basic advice before/ instead of booking a menopause appointment. Beat Wishes
We got her on E, P, and T before moving from the US to the UK in January. As a result getting her on those things has been relatively painless, but I'm not convinced the local gps here really understand the meds they're prescribing.
I agree. Local gps do not understand the medication they are prescribing & they are especially not bothered about menopause & thyroid related problems
How is she feeling overall though.
I believe most of those things were normal according to the GP, but we weren't given the actual numbers.
You are legally entitled to printed copies of your blood test results and ranges.
The best way to get access to current and historic blood test results is to register for online access to your medical record and blood test results
UK GP practices are supposed to offer everyone online access for blood test results. Easiest option is NHS app, you may need "enhanced access" to see blood results.
If you can’t currently see test results online, simply ask receptionist at GP surgery to give you access. You will need to have photo ID with you.
This currently only applies in England, not across the whole of the UK. Nether Scotland nor N.Ireland have released an NHS app for patients. (Scotland supposedly due in December '24.) Wales has an app, but only for booking appointments, repeat prescriptions and amending personal details
Link re access
patients-association.org.uk...
healthunlocked.com/thyroidu...
In reality some GP surgeries still do not have blood test results online yet
Alternatively ring receptionist and request printed copies of results. Allow couple of days and then go and pick up.
Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine
which brand of levothyroxine is your wife taking
Does she always get same brand at each prescription
ESSENTIAL to test vitamin D, folate,ferritin and B12 at least annually
Exactly what vitamin supplements is she taking
Aiming to maintain OPTIMAL vitamin levels for good conversion of Ft4 to Ft3
Hairloss often low iron/ferritin
Or zinc
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)
T3 ….day before test split T3 as 2 or 3 smaller doses spread through the day, with last dose approximately 8-12 hours before test
Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins
Post all about what time of day to test
healthunlocked.com/thyroidu...
Testing options and includes money off codes for private 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...
IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 3-5 days before ALL BLOOD TESTS , as biotin can falsely affect test results
endocrinenews.endocrine.org...
In days 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
Is there any reason your wife cant post for herself? While a sympathetic husband is wonderful, surely it would be easier for her to give details on her own health issues? The devils in the detail!
Yes. She's busy and she prefers I handle this type of thing. I usually research and ask questions then we talk about it and she decides what she wants. The only tests I don't have numbers on are the recent ones her gp ordered and she doesn't know those ones either.
She's an English teacher in a secondary school and is learning a new education system. I'm a PhD student working at home and my schedule is flexible, so I'm in a better position to find these kinds of answers.
Optimal when you don't have thyroid disease and are not on meds is in the top 50% of the range for both FT3 and FT4. She's not there with FT3.
Optimal for those with thyroid disease on meds is in the top quartile for FT3, and it really depends on their med mix for FT4. If they are on a combo med, it's also nice to see FT4 in upper 50%, with LOW RT3. If they are on mostly T3, then FT4 doesn't matter, and can be below range.
Is your wife having symptoms?
Hey BuckFamily
The most important thing, regardless of blood tests and lab ranges etc., is …. how does she feel? Why do you suspect her Estradiol is causing an issue?
She feels much better on HRT but not good enough. We're concerned about estradiol because she's on levothyroxine and I read that estradiol can block absorbtion. She's had hairloss that could be related to her testosterone gel or to thyroid. It started between the time she started estradiol and the time she added testosterone, and the hair loss is diffuse and not in a pattern, which is what happens with T caused hair loss. Therefore, I'm theorizing that the added estradiol is inhibiting her levothyroxine. Plus, low T3 runs in her family among women.
Hi there as someone who has tried everything - I was on HRT for over 30 years and felt amazing it changed my life - I was on the bio identical type gel - but when I hit the menopause everything went wrong and a thyroid problem came to light big time - I eventually had to come off it as I had oestrogen dominance but my thyroid problems hadn't been really sorted out at that point - but what I can say is that when I tried testosterone my hair fell out - it is well known that this hormone can cause disruption to the hair growth cycle which can take a long time to sort out.
Yes I've heard that from lots of women. We want to get her testosterone and DHT tested as well. She has an appointment to ask the GP this week.
Testosterone isn’t licensed for women in the UK. GP Specialists/consultants can prescribe products that are licensed for men for women, but it’s generally hard to get so just be aware that if you refuse it, it might be tricky to get back. That said, it didn’t do much for me and I stopped it.
I can’t remember the exact science, but I seem to remember that Estrogen blocks some of the same binding agent (SHBG) that thyroxine latches to, so it’s quite usual to have to increase your thyroid meds (T4/T3) when taking HRT.
Agree - uptake can get around the problem !
Also, I'd mention that it seems there's a particular problem with transdermal testosterone and hair loss. They don't seem to use injectable testosterone for women here, but in the US that is more common, and many of the women I've spoken to have told me that switching from transdermal to injections resolved the hairloss.
Not sure I would consider injections as I am always cautious - whilst the 'medical professional' might consider I need a certain drug etc. - they don't know me and everyone is different - to have an injection is - in my opinion - a bit risky as there is no way back if it doesn't agree with you - but taking gel or tablets even - you can start slowly and build up to see if it suits. Even if a supplement company says take two a day to start - I take one or half a tablet if it says take one !
The problem is that the kind of testosterone used by the NHS requires a lot of it all at once and not very often. There are other kinds that leave your system in a day. Some women in the US microdose testosterone cypionate every day using an insulin syringe. I don't think they do more than 20 mg a week. But I don't think the NHS can get that.
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