Help with test resutls following 6 week thyroxine trial please

[clarebear931]

Please could someone help me interpret these latest blood test results:

12th August 2011
TSH 5.0 mu/l (0.27-4.2)
fT4 18.1 pmol/l (12.00-22.00)
fT3 3.8 pmol/l (3.10-6.80)

I've been on the trial of thyroxine as I had a high TSH of 18 but low normal ft3 and ft4. The endo said I was euthyroid despite my numerous symptoms (tingling in my hands and feet, headaches, memory problems, carpal tunnel syndrome, weird feelings in my head, vertigo, tiredness, anxiety and panic attacks etc etc). It was only when I pointed out that there were two sets of results with a rising TSH of over 10 that he reluctantly agreed to a trial of thyroxine but he said it wouldn't help my symptoms.

After the 6 weeks I was feeling about 75% better. I then went on holiday for 2 weeks and felt even better (wish I could have stayed!). I'm now not feeling as good with the return of the headaches and vertigo but to a lesser extent than before the trial.

My previous results were:

7th June 2011:
TSH 15 mu/l (0.27-4.2)
Free T4 14 pmol/l (12-22)

17th June 2011
TSH 18 mu/l (same range as above)
Free T4 13.2 (same range as above)
Free T3 4.0 pmol/l (3.1-6.8)
Anti-thyroid peroxidase 53 (IU/ml < 100)

TSH and fT4 have both improved but fT3 has actually got worse! My GP didn't really want me to see the actual results and said not to pay any attention to the fT3 and fT4 and that its the TSH thats most important! That's not my understanding from reading on here. Does this suggest that I have a problem converting T4 to T3 and if so why am I feeling quite a bit better (but not back to normal)? I am off to see the endo that was so unhelpful again on Thursday so your comments/help before then would be really great.

Thanks very much.

Clare

[clarebear931]

I think she's a her and I may be wrong but I think they tried to.

Thanks have printed this out too plus some other interesting stuff on the website.

Clare

[gimel]

Haven't yet relocated that link I mentioned, but ran across this one from a doctor in the UK.  Thought you might find this interesting.

"Therefore, in any patient in whom I suspect a thyroid problem I now routinely ask for a TSH, a Free T4 and a Free T3 in order to gain the full picture."

It came from this link.

http://www.drmyhill.co.uk/wiki/Thyroid_profile:_free_T3,_free_T4_and_TSH

I am surprised that the NHS hasn't shut him down.  LOL

[clarebear931]

Thanks I have printed out the study and will take it with me.  If you can find the other reference that that sounds useful too.

Thanks again

[gimel]

One of the typical excuses, when they don't want to bother with a FT3 test.  I had a reference that mentioned that the FT3 test accuracy had improved to the point that it was reliable and should be used.  I can't locate it right now, but I have another link for you.

http://www.ingentaconnect.com/content/routledg/cjne/2000/00000010/00000002/art00002

This study concluded that of the thyroid tests normally used, FT3 correlated best with overall scores from patients rating their hypo symptoms.  When you consider the subjectivity of the patients' ratings, the degree of correlation is amazing.  From that same study they also concluded that FT4 and TSH did not correlate at all.  So you might give the GP a copy of this link and ask if FT3 is so variable, how come it showed the best correlation to hypo symptoms, while FT4 and TSH did not correlate at all?  

[clarebear931]

I am seeing the endo who told me I was euthyroid last month again tomorrow.  I will ask for T3 or at least ask him if he has ever prescribed it, and if so what he is looking for in the test results in order to do so.  I don't think I will have much luck as he didn't even want to give me T4.  In the likely event of failure I will have to try and find a more forward thinking endo.

My Gp told me that ft3 test is totally unreliable as results so variable.  How do I counteract this argument?

Thanks for all of your advice.

[gimel]

I would think that FT3 is the first to drop, thus you become hypo.  Remember that FT3 is the test that correlates best with hypo symptoms.  

I realize that it is far more difficult to bet properly diagnosed and treated in the UK.  I have corresponded with a number of UK members.  One that had success gave this suggestion.


"What I have learned from my experience is that you have to go to the Dr's office and TELL THEM WHAT YOU WANT and to go backed up with knowledge.  You have to tell them that you have done your reading and looked into your condition and care about the long-term treatment of your health and thyroid.  If you fight for what you want, you will eventually find someone that is happy to go along with your wishes.  But we all have to take charge of our own health, right?"

Personally I would spend my time following this suggestion instead of hoping that an increase in T4 med is going to increase your FT3 level adequately.  You need T3 med.

[clarebear931]

Thanks ver much. I think I read that as you become more hypo that ft3 is the last thing to drop. Does it follow that it's the last thing to rise and that therefore given more time and a higher dose of t4 it may go up without additional t3 being prescribed? I only ask in hope as it's difficult to get doctors in the uk to prescribe t3. Thanks.

[gimel]

Trying that link again.  


http://hormonerestoration.com/files/ThyroidPMD.pdf

[gimel]

TSH has no direct effect on symptoms.  Neither does FT4.  FT4 is just a storage hormone, available for being converted to FT3.  Your FT4 is already high enough, yet your fT3 is at rock bottom of the range.  

I wish I could post a link to a letter written by a good thyroid doctor, but I am on my laptop right now and cannot do so.  Anyway, here is a pertinent quote from that letter.  

"T4-only therapy (Synthroid, Levoxyl), to merely “normalize” the TSH is typically inadequate as the H-P axis is often under-active to begin with, is more sensitive to T4, and is over-suppressed by the once-daily oral thyroid hormone peaks. TSH-normalizing T4 therapy often leaves both FT4 and FT3 levels relatively low, and the patient symptomatic. Recognizing this, NACB guidelines call for dosing T4 to keep the TSH near the bottom of its RR (<1) and the FT4 in the upper third of its RR; but even this may not be sufficient. The ultimate criterion for dose adjustment must always be the clinical response. I have prescribed natural dessicated thyroid for your patient (Armour or Nature-Throid). These contain T4 and T3 (40mcg and 9mcg respectively per 60mg). They are more effective than T4 therapy for most patients. Since they provide more T3 than the thyroid gland produces, the well-replaced patient’s free T4 will be around the middle of its range or lower, and the FT3 will be high-“normal” or slightly high before the AM dose."

[clarebear931]

Perhaps I should try the increased dose of thyroxine and see if getting my tsh down a bit further and ft4 up a bit more helps before getting too concerned about ft3?

[gimel]

I can readily understand why you still don't feel well, since your FT3 is too low in the range.  The drop you wondered about may be nothing more than test variability as well.  If you were tested three times in a day, you could well see that much variation from test to test.  A change of .2 is nothing to be concerned about.  The thing to be concerned about is that your FT3 is in the lower quarter of the range.  It may well need to be in the upper quarter of the range, in order for you to get symptom relief.  

[flyingfool]

It is possible that as your FT4 converts, it is immediately used.  Thereby not allowing much to remain in the bloodstream.

just a thought.

[clarebear931]

Thanks for your reply.  Yes my GP has only recommended a small increase in thyroxine.  If my fT3 has dropped I can't understand why I feel better rather than worse than previously?  Still don't feel great though.

[gimel]

TSH is actually the least important of the tests done.  The most important is FT3 because it largely regulates metabolism and many other body functions.  Scientific studies have shown that FT3 correlated best with hypo symptoms while FT4 and TSH did not correlate at all.  

Studies have also shown that about 60% of patients taking T4 meds did not convert T4 to T3 adequately.  Your results shown the same trend.   You need to switch to a T4/T3 combo type med, or add in some T3 to your meds.  From the response of your doctor so far, I expect that you need to look for a good thyroid doctor that will treat you clinically by testing and adjusting FT3 and FT4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results.  Many of our members report that symptom relief for them required that FT3 was adjusted into the upper part of its range and FT4 adjusted to around the midpoint of its range.