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Hi there, help with bloods please
Here are my blood test results from the private blood test.
Total thyroxine - 101 nmol/L (59-154)
TSH - 1.87 mIU/L - 0.27-4.2)
Free T4 - 16.6 pmol/L (12-22)
Free T3 - 4.0 pmol/L (3.1-6.8)
Anti-TG Antibodies - 103.5 IU/mL (0-115)
Anti-TPO Antibodies - 33.5 IU/mL (0-34)
Any help on these would be greatly appreciated.
Thank you :)
Total thyroxine - 101 nmol/L (59-154)
TSH - 1.87 mIU/L - 0.27-4.2)
Free T4 - 16.6 pmol/L (12-22)
Free T3 - 4.0 pmol/L (3.1-6.8)
Anti-TG Antibodies - 103.5 IU/mL (0-115)
Anti-TPO Antibodies - 33.5 IU/mL (0-34)
Any help on these would be greatly appreciated.
Thank you :)
Thanks for your reply. :)
My boyfriend nags me to take my T4 at the moment as I've been chopping and changing the time of the dose.
But yes, I wake up quite early in the morning - around about 6.5 hours or so! How strange - and I'm wide awake with thoughts racing through my head. At first I thought it was anxiety or stress but when it happened each and every day at first light that was when I suspected something else. I then thought, I wonder if it may be the T4 as that was the only thing I had recently changed, from morning to evening.
I have had times when I skip medication at night by accident and sleep right through. I thought I was going mad and that it only happened to me!
I now try and drink a hot milky drink to knock me out before bed. I recently tried hot chocolate with almond milk and within a few minutes my eyes were heavy and dark. And it worked in putting me to sleep too! LOL.
My boyfriend nags me to take my T4 at the moment as I've been chopping and changing the time of the dose.
But yes, I wake up quite early in the morning - around about 6.5 hours or so! How strange - and I'm wide awake with thoughts racing through my head. At first I thought it was anxiety or stress but when it happened each and every day at first light that was when I suspected something else. I then thought, I wonder if it may be the T4 as that was the only thing I had recently changed, from morning to evening.
I have had times when I skip medication at night by accident and sleep right through. I thought I was going mad and that it only happened to me!
I now try and drink a hot milky drink to knock me out before bed. I recently tried hot chocolate with almond milk and within a few minutes my eyes were heavy and dark. And it worked in putting me to sleep too! LOL.
Thanks for your reply. :)
Yes, that was a single test conducted quite early in the morning. I was quite tired that day and after the ACTH was injected I had a bit more of a buzz. Test was negative, however. The cortisol was taken first at baseline but the 30 minute cortisol and 60 minute cortisol results did not double. I take it that may be because the baseline result was already quite high?
I have got a home test kit for saliva testing already - which I haven't used but may consider it as my only source of income at present is sick pay. (I am unemployed). I was advised to not go ahead with it anyway until everything with my bloods has evened out. But although they look pretty much normal and my doctor says they are normal I don't feel normal so I can't really say with complete confidence I can pick a right time to do it if that makes sense.
I very much doubt my primary doctor will increase my T4 as she believes I am doing ok on it. But only one symptom out of a handful is not as frequent. As a result of me supposedly doing fine on the T4 she has removed other doses which included the 25mcg and 50mcg from my repeat prescription script and has only left me with the 100mcg.
Yes, that was a single test conducted quite early in the morning. I was quite tired that day and after the ACTH was injected I had a bit more of a buzz. Test was negative, however. The cortisol was taken first at baseline but the 30 minute cortisol and 60 minute cortisol results did not double. I take it that may be because the baseline result was already quite high?
I have got a home test kit for saliva testing already - which I haven't used but may consider it as my only source of income at present is sick pay. (I am unemployed). I was advised to not go ahead with it anyway until everything with my bloods has evened out. But although they look pretty much normal and my doctor says they are normal I don't feel normal so I can't really say with complete confidence I can pick a right time to do it if that makes sense.
I very much doubt my primary doctor will increase my T4 as she believes I am doing ok on it. But only one symptom out of a handful is not as frequent. As a result of me supposedly doing fine on the T4 she has removed other doses which included the 25mcg and 50mcg from my repeat prescription script and has only left me with the 100mcg.
I take my t4 at night too. Just had this discussion with my wife last night because she was getting mad at me for waking her up in the morning. At precisely 6.5 hours after taking my t4 i get a fast pulse and anxiousness that wakes me out of bed. So if i go to bed at 10, i get it 430 and I'm ready to start my day LOL
My solution has been that i go to bed at 12 so it wakes me at 630 and thats when i jump out of bed. I think I'm on too much.
Some people say this is impossible, but i know what i feel. One time i skipped my medication at night on accident and slept rich through the whacky period the next morning.
My solution has been that i go to bed at 12 so it wakes me at 630 and thats when i jump out of bed. I think I'm on too much.
Some people say this is impossible, but i know what i feel. One time i skipped my medication at night on accident and slept rich through the whacky period the next morning.
No, autoimmune and slow conversion don't necessarily go hand in hand. I have Hashi's, and I'm quite happy on T4 only. Considering that Hashi's is the most prevalent cause of hypo in the developed world and that T4-only therapy is the therapy of choice in mainstream medicine, ostensibly a lot of people convert well with Hashi's.
Many endos don't use T3, especially in the U.K. They were taught in med school that if FT4 was okay, FT3 would be as well...not true, but they stubbornly stick to it.
Cortisol could be contributing to your energy dip. Was that a single test? A 24-hour saliva test is a better alternative for cortisol. You get four discreet readings at four different times of day so that you can really see what's happening at each. Unfortunately, like T3, many mainstream doctors treat saliva testing like it's witchcraft.
Would your primary doctor increase your T4? Perhaps you could try that while waiting to see the endo. It could help. I think it's a viable alternative.
Many endos don't use T3, especially in the U.K. They were taught in med school that if FT4 was okay, FT3 would be as well...not true, but they stubbornly stick to it.
Cortisol could be contributing to your energy dip. Was that a single test? A 24-hour saliva test is a better alternative for cortisol. You get four discreet readings at four different times of day so that you can really see what's happening at each. Unfortunately, like T3, many mainstream doctors treat saliva testing like it's witchcraft.
Would your primary doctor increase your T4? Perhaps you could try that while waiting to see the endo. It could help. I think it's a viable alternative.
Thanks for your reply.
Yes, when I took the T4 in the morning I felt bad later on in the day.
Unfortunately my doctor did not prescribe me T3 at my appointment as she, in her words, "does not understand anything about T4 to T3 conversion" which I find hard to believe as she understood what I have to be autoimmune and I thought the autoimmune illness and the T4 to T3 conversion would go hand in hand?
So I would probably have to go through my endocrinologist about getting T3 but I understand some endocrinologists are selective with dispensing T3. To make matters worse the endocrinologist I see keeps moving my appointment further and further away and if getting T3 is something worth looking into it'll take longer and longer for me to get any better.
Would high cortisol have anything to do with the energy dip? A recent short synacthen test put my basal cortisol quite high at 622 nmol/L - which was seen to be quite high in someone with hypothyroidism.
Thanks :)
Yes, when I took the T4 in the morning I felt bad later on in the day.
Unfortunately my doctor did not prescribe me T3 at my appointment as she, in her words, "does not understand anything about T4 to T3 conversion" which I find hard to believe as she understood what I have to be autoimmune and I thought the autoimmune illness and the T4 to T3 conversion would go hand in hand?
So I would probably have to go through my endocrinologist about getting T3 but I understand some endocrinologists are selective with dispensing T3. To make matters worse the endocrinologist I see keeps moving my appointment further and further away and if getting T3 is something worth looking into it'll take longer and longer for me to get any better.
Would high cortisol have anything to do with the energy dip? A recent short synacthen test put my basal cortisol quite high at 622 nmol/L - which was seen to be quite high in someone with hypothyroidism.
Thanks :)
T4 tablets go to 200 mcg, I believe (could be more), and some people take more by combining tablets. Theoretically, you can take as much as you need to take to get FT4 where it should be. Given absorption issues, etc., what you take is often not what's absorbed.
However, I think a more usual increase of 12.5-25 mcg would probably get your FT4 up to 50% of range. You're not far from 50%, so I'd tend to be conservative.
If I understand correctly, when you took your T4 in the morning, you felt good early in the day, but started to feel bad later in the day??? T4 really shouldn't have that kind of circadian rhythm. Perhaps the best thing to try would be adding in a little T3. You might then be able to move your T4 back to morning. You could split your dose of T3 into two half doses and take one in the morning with your T4 and the other in the early afternoon to see if that helps your afternoon energy dip. You don't want to take T3 too late in the day; most people find it can disturb sleep if you do.
However, I think a more usual increase of 12.5-25 mcg would probably get your FT4 up to 50% of range. You're not far from 50%, so I'd tend to be conservative.
If I understand correctly, when you took your T4 in the morning, you felt good early in the day, but started to feel bad later in the day??? T4 really shouldn't have that kind of circadian rhythm. Perhaps the best thing to try would be adding in a little T3. You might then be able to move your T4 back to morning. You could split your dose of T3 into two half doses and take one in the morning with your T4 and the other in the early afternoon to see if that helps your afternoon energy dip. You don't want to take T3 too late in the day; most people find it can disturb sleep if you do.
Sorry about your reply when you tried to post it and thanks for replying.
I'm not sure what time I can move my T4 to. It used to be first thing in the morning but I have found that I start to feel better and towards the later half of the day I feel bad again. Which was why I moved to evening and before bed.
Back when I had my T3 first tested, back in November, I was taken off the thyroid medication and had been off for a month beforehand as the doctor I saw thought it had been resolved. When the doctors noticed my TSH was rising again they put me back on and said for me to restart at 100mcg.
How much higher a dose of T4 can I go?
Thanks :)
I'm not sure what time I can move my T4 to. It used to be first thing in the morning but I have found that I start to feel better and towards the later half of the day I feel bad again. Which was why I moved to evening and before bed.
Back when I had my T3 first tested, back in November, I was taken off the thyroid medication and had been off for a month beforehand as the doctor I saw thought it had been resolved. When the doctors noticed my TSH was rising again they put me back on and said for me to restart at 100mcg.
How much higher a dose of T4 can I go?
Thanks :)
I just typed a whole reply that got blown away when I tried to post it...grrr.
Your FT4 has gone up nicely, but your FT3 has actually gone down considerably.
Taking T4 at night really "shouldn't" affect sleep, but if at all possible, it might be best to try moving it to another time of day to see if it helps your sleep pattern.
If the root cause of depression is thyroid, anti-depressants often don't work, and they can actually worsen depression.
I think you have several alternatives, none of which, unfortunately, is a clear cut solution. You've only been on meds for six weeks, and you could still be in the process of rebalancing, so you could give it a little more time to see what happens to your FT3 and symptoms. You could increase your T4 meds a little in order to get your FT4 up to midrange or a little high. You could add in some T3.
I wish I could be more specific, but I think all of those are viable options you could discuss with your doctor. Decisions, decisions...
Your FT4 has gone up nicely, but your FT3 has actually gone down considerably.
Taking T4 at night really "shouldn't" affect sleep, but if at all possible, it might be best to try moving it to another time of day to see if it helps your sleep pattern.
If the root cause of depression is thyroid, anti-depressants often don't work, and they can actually worsen depression.
I think you have several alternatives, none of which, unfortunately, is a clear cut solution. You've only been on meds for six weeks, and you could still be in the process of rebalancing, so you could give it a little more time to see what happens to your FT3 and symptoms. You could increase your T4 meds a little in order to get your FT4 up to midrange or a little high. You could add in some T3.
I wish I could be more specific, but I think all of those are viable options you could discuss with your doctor. Decisions, decisions...
Thanks for your reply.
Before meds my FT4 was 10.9 (10-22)
Before meds my FT3 was 5.5 (4.1-6.8)
I can't honestly say I feel any different. The only thing that's improved is the constipation but other things like fatigue, depression, low sex drive and mood swings are still there. My last period was late and heavy and I have been getting cramps in my legs.
I've also been waking up in the middle of the night and I'm not sure if this is due to me taking the T4 at night. This has become more frequent and started after taking the T4 at night so I am thinking that it's the reason why.
Doctors now think it's depression and I didn't get anywhere with my appointment today as the doctor I saw knows nothing about T4 to T3 conversion.
She has said for me to go back to the endocrinologist about that but my appointment with them keeps getting moved. This same doctor wants to look at other things that could be causing my depression but I'm not sure what she means. The doctor I saw before her has talked me into taking anti-depressants but they've had no effect whatsoever.
Thanks :)
Before meds my FT4 was 10.9 (10-22)
Before meds my FT3 was 5.5 (4.1-6.8)
I can't honestly say I feel any different. The only thing that's improved is the constipation but other things like fatigue, depression, low sex drive and mood swings are still there. My last period was late and heavy and I have been getting cramps in my legs.
I've also been waking up in the middle of the night and I'm not sure if this is due to me taking the T4 at night. This has become more frequent and started after taking the T4 at night so I am thinking that it's the reason why.
Doctors now think it's depression and I didn't get anywhere with my appointment today as the doctor I saw knows nothing about T4 to T3 conversion.
She has said for me to go back to the endocrinologist about that but my appointment with them keeps getting moved. This same doctor wants to look at other things that could be causing my depression but I'm not sure what she means. The doctor I saw before her has talked me into taking anti-depressants but they've had no effect whatsoever.
Thanks :)
I played with the calculator a bit this morning. I have no clue what their algorithm might be, and I think they need a better definition of terms attached to the calculator and also a discussion of how the range on GD should be interpreted.
My first comment would be that their reference ranges for FT3 and FT4 are quite different from the ranges your lab uses. In order to get a useful number out of the calculator, I think you'd have to figure the percentage of range in your lab's range and compute what that would be in their range and use that as your result, not the actual result you got from your test.
I think what they're doing is trying to quantify and give more definition to what we say all the time: FT4 is guideline around 50% of range, and FT3 guideline is upper half to upper third of range and FT3 should be higher in its range than FT4 is in its. In order to get a result in the middle of the GD range, you have to enter an FT3 result that is 68% of range...suspiciously close to the beginning of the upper third of range that starts at 67%.
To tell you the truth, they may be onto something, but I think the calculator is probably very crude right now, and it's documentation (unless you've found more) is dismal.
So, back to your numbers: You've been on 100 mcg for six weeks. You're FT4 is at 46% of range (what was it before meds?), so that's looking good. FT3 is a little low at 24% of range (before meds?).
How are you feeling? Have your symptoms resolved. If not, are they continuing to improve?
FT3 often lags FT4 a bit in the beginning. After being hypo for a while, conversion has to ramp up again. Some of us found that once FT4 was stable, FT3 continued to rise for quite a while afterwards. So, you might be yet to get a boost in your FT3. Symptom relief can lag both of those.
You're kind of at a crossroads, and how you feel is what's really important.
My first comment would be that their reference ranges for FT3 and FT4 are quite different from the ranges your lab uses. In order to get a useful number out of the calculator, I think you'd have to figure the percentage of range in your lab's range and compute what that would be in their range and use that as your result, not the actual result you got from your test.
I think what they're doing is trying to quantify and give more definition to what we say all the time: FT4 is guideline around 50% of range, and FT3 guideline is upper half to upper third of range and FT3 should be higher in its range than FT4 is in its. In order to get a result in the middle of the GD range, you have to enter an FT3 result that is 68% of range...suspiciously close to the beginning of the upper third of range that starts at 67%.
To tell you the truth, they may be onto something, but I think the calculator is probably very crude right now, and it's documentation (unless you've found more) is dismal.
So, back to your numbers: You've been on 100 mcg for six weeks. You're FT4 is at 46% of range (what was it before meds?), so that's looking good. FT3 is a little low at 24% of range (before meds?).
How are you feeling? Have your symptoms resolved. If not, are they continuing to improve?
FT3 often lags FT4 a bit in the beginning. After being hypo for a while, conversion has to ramp up again. Some of us found that once FT4 was stable, FT3 continued to rise for quite a while afterwards. So, you might be yet to get a boost in your FT3. Symptom relief can lag both of those.
You're kind of at a crossroads, and how you feel is what's really important.
I think I found the site (free code), but it doesn't seem to want to let me sign up. Perhaps you could copy and paste the pertinent information, like what goes into the calculation, why it's supposed to work, etc. Thanks.
I'm sorry, but I wasn't aware there was a way to calculate the deiodinases. Can you send me a link to the calculator, please? If the site isn't one that MedHelp allows, you can PM me.
Hi thanks for your reply.
Yes, I am on 100mcg of Levothyroxine and have been on it for 6 weeks.
I did an online calculation that has said that my thyroid's sum activity of peripheral 5' deiodinases (GD) is 22.28 (20-40). Does that mean I am not converting T4 to T3 that well? I have an appointment with my doctor on Wednesday so I would like to be able to put my case forward to have T3 as well as T4.
Yes, I am on 100mcg of Levothyroxine and have been on it for 6 weeks.
I did an online calculation that has said that my thyroid's sum activity of peripheral 5' deiodinases (GD) is 22.28 (20-40). Does that mean I am not converting T4 to T3 that well? I have an appointment with my doctor on Wednesday so I would like to be able to put my case forward to have T3 as well as T4.
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