Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Marchlove on May 29, 2022, 04:32:35 PM
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Hi All
I’ve been having a good look around at articles on how to interpret full thyroid function tests.
This is the best one I’ve found so far, but it anyone has any more info regarding this, perhaps we could use this thread to post articles.
https://thyroidpharmacist.com/articles/top-10-thyroid-tests/
xx
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Good idea.
This is the method I use, my former private endo also. I don’t pay attention to TSH now I’m on medication. It is difficult to interpret thyroid results when you are going through perimenopause so ideally a specialist that can look over the whole picture of hormones and what to address first, could be consulted. You have to also understand how thyroid medication affects sex hormones and how HRT affects the thyroid.
https://stopthethyroidmadness.com/lab-values/
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Very interesting info, thanks for sharing. I have been putting off dealing with my thyroid results - obviously as my TSH is within range it's not an issue for the GP and I also just feel on so many meds at the moment between ADs and HRT that I haven't been able to face adding another thing in. But reading the information shared here it does sound like it is something for me to address in the future. Hypo runs in my family and my results have been getting steadily worse over the last two years. Very interesting to hear that the optimal TSH is around 1 and according to those reference results I'm below the bottom reference range for Free Thyroxine, although I do sometimes get muddled with which is the important one to pay attention to!
TSH = 3.16 (range 0.27-4.2)
Free T3 = 4.58 (range 3.1-6.8 )
Free Thyroxine = 12 (range 12-22)
Thyroid peroxidase antibodies = 95.4 (range 0-34)
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Good info ATB! Lots to get our heads around though!
Can’t offer any help I’m afraid Gilla as it’s all too new for me. I’ve just sent for the medichecks full thyroid panel test. My hormone specialist tested my thyroid last November but bizarrely she didn’t test for antibodies, no idea why! x
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Gilla,
Based on those results yes I would say you have hashimotos thyroiditis, the high antibodies should alert your GP really. The Free T3 is the one I pay most attention to but free T4 is the other one to watch and these two together help you monitor dosage if on meds. For diagnosis all of them are important, TSH less so. Your Free T4 should be higher too, yes, 17 or above on that range. Free T3 is also too low. Best way is to look at everything of course, all hormone issues, but your results are pretty clear to me esp as the antibodies are high. There is normally another antibodies related one, TbAb (Anti-thyroglobulin).
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Thanks ATB, yes the other type of antibodies were fine / in range.
Especially with such a prevelance in my family I did figure it was something I might need to address in the future I just (possibly unwisely) can't face adding in "one more" medication at the moment, though I realise it could well be the reason why I suffer with chronic constipation and fatigue.
Thanks for sharing the helpful info on how to read the results as I wasn't aware or any of that.
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Oh it’s so useful ATB having you to offer some interpretation whilst we all learn. Thank you.
I’ll post my results here as soon as I have them. x
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Hi all
Just been away comparing all this to my results from Nov. My bhrt clinic said my thyroid is all fine. I can see a couple of discrepancies with the article Marchlove has posted. I can't fathom out the one ATB has posted ;D
Any comments?
TSH. 0.93 mIU/l
Free thyroxine 14.8 pmo/l
Free T3. 4.2 pmo/l
Thyroglobulin antibody 13 IU/ml
Thyroid peroxidase antibodies 16.2 IU/ml
Looks OK to my untrained eye 8)
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Do you have the ranges in brackets next to them? They can differ between labs
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Ah. OK. Here we are:
TSH. 0.93 mIU/l (0.27 - 4.2)
Free thyroxine 14.8 pmo/l.(12 - 22)
Free T3. 4.2 pmo/l.(3.1 - 6.8.)
Thyroglobulin antibody 13 IU/ml (0-115)
Thyroid peroxidase antibodies 16.2 IU/ml. (0 - 34)
Thanks😊
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Another thing Crispy is weren’t you on the pill when you had this test done last autumn? I believe one article says that progesterone increases FT4, so things have probably changed for you since the test was done. I wonder if MG realised this, so weren’t too concerned. x
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If that’s the case you’d expect her FT4 to be a lot higher and it’s low?
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Looking back at the article what it actually says is
Factors that inhibit conversion of T4 to T3 - low progesterone, low ferritin, plus others.
I’m not at all sure of the impact of the pill or mini pill on all of this. But certainly they are not natural progesterone.
Anyway, I wouldn’t worry at the moment Crispy and just get MG to retest in the summer. X
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Oh ??? I totally thought my thyroid was fine. I assumed that my bhrt clinic would wavt the money of treating me if there was a perceived issue?! The first thing she said was it was good news on my thyroid - all fine. ???
OK, so I wasn't on the pill at time of testing. I had been off about 2 months.
I'm not on hrt. I'm trying bioidentical progesterone only. Also testosterone. So maybe the prog will help?! I wasnt on it at time of test.
I don't know if I have hypo symptoms or not... I put everything down to my hormones, but reading the list, some I can tick off, others not. Are there any more significant than others???
I guess my main ones would he tiredness and extreme brain fog - but those could be my peri too. I am a cold person, but always have been :-\
X
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Hello
Just jumping in on all things thyroid and agree with ATB. Your TSH is elevated and the low T4 can really make you feel unwell. My current T4 is at this point as well and I’m barely functioning. I have Hashimoto’s so am on Levo and Liothyronine.
May well be worth checking it out as it can cause no end of issues healthwise- depression, chronic fatigue, poor sleep. The list is endless. And so many symptoms can be (mis) read as menopause/ peri.
X
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Exactly shoppingqueen, it is really really hard when thyroid and perimenopause symptoms are the same, that’s why careful analysis is important and an understanding of the whole system. It’s taken me years to get good at understanding my own. Thyroid tests are a lot more helpful than testing estrogen is.
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Interesting article, thanks for sharing ATB. And really interesting to think that thyroid symptoms can be misinterpreted as Peri. I know I have a lot of the classic hypo symptoms: unexplained weight gain, fatigue, chronic constipation, hair loss and thinning eyebrows at the ends but not others (for example I'm not a cold person). I'm seeing my meno doc on July 19th where she will hopefully give me a Testosterone prescription - I want to try that first before addressing my thyroid results (as no doctor is hassling me to address it at the moment). Very interesting though, thanks for sharing!
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Hi All, especially ATB if you’re about!
Got Medichecks coming 10am Thursday to do full thyroid test (plus vitamin e as I’ve been on it for ages).
So according to the article you posted ATB I shouldn’t take my levothyroxine until after the test, is this correct?
Also should I be fasted? X
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Hi!
Yes take Levo after the test- away from food and coffee as usual.
No you don’t need to fast. Let us know how it goes!
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Will do, thank you ATB.
Glad I don’t have to fast :)
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Let us know how you get on and post the results 👍 it’s literally like being your own Sherlock Holmes when it comes to deciphering symptoms and causes.
ATB so glad you are getting there with knowing the difference it’s a science I’m beginning to see- I’m still learning and trying to untangle the hypo from meno- still got my L plates at this point 😂. These forums are a life saver so we can connect with those further along the rocky path for valuable advice and insights.
Thanks for sharing info x
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Hi, micronised progesterone raises t4 and lowers tsh slightly when taken orally if you’re on thyroxine. I’ve just been looking at papers.
https://pubmed.ncbi.nlm.nih.gov/34183565/
I go very much by sleep ability and puffy or slim ankles. I used to be able to tell via bowel movements but peri has messed that up!
I’ve been on thyroxine for 20 years. There is a sweet spot with thyroxine; slightly too much thyroxine can give too much reverse t3 and swingling hypo / hyper symptoms. I’ve just reduced my thyroxine by 75 and tsh hasn’t changed, (0.2) t4 slightly (24 to 19 but I’m a lot better. Gp happy with that. Face less puffy and not crashing in the afternoons.
All hormones can vary wildly during the day, particularly t3.
Always get a test in the morning before taking thyroxine (24 hrs later).
Stop any biotin for a week before a test (b vitamin.)
I’m taking my utrogestan vaginally; if I go to continuous I may take orally but will ask for a thyroid blood test I think a couple of months after.
Being on slightly too much is really bad for bones and to me almost worse than slightly too little. I can’t be much above tsh 1 I find.
You can tweak doses very slightly but must wait for at least 8 weeks (3 months is best) before a test.
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I’m sat here waiting for the Medichecks nurse to arrive feeling very cold. Yesterday I was lovely and warm.
Can’t help thinking that the thyroid test would give me more information if I’d actually taken my early morning Levothyroxine.
After all, don’t I need to know what my levels are on medication not off it! :-\
Any thoughts? X
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I do exercise before the test, like a 10 minute Leslie sansone walking video? Gets you warmed up. I don’t know how much difference taking the medication makes, I’ve found that the way they ask you to do them does give me reliable results that match the symptoms or lack of. I had thought the effects of the thyroid meds aren’t felt for a week anyway. Someone else might have more input.
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No, the advice I was given from The British Thyroid Foundation via Prof Simon Pearce is to take thyroxine after the test.
It has a half life of around 7 days so the dose you take the previous day will still be very much there.
A morning dose can sometimes give a falsely high reading.
It’s all v approximate as all the levels fluctuate during the day anyway, so interpreting tests are always a mix of looking at the numbers but also how you feel. everyone is different too. Tsh is naturally slightly higher in the morning.
If you’re on thyroxine you do need slightly more than healthy people but it’s all individual. Slightly too Much can actually cause similar issues to slightly too little as the reverse T3 action means less T4 is converted.
Good levels of Oestrogen can actually give you cold extremities too!
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Marchlove which test did you get? The full panel? Medi checks are good because the doctors understand the importance of the Free T3 & T4 numbers and that TSH is suppressed on medication so largely irrelevant.
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Also not everyone is just on thyroxine, so whatever you take, take it after the test just to be sure.
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Hi ATB and Clarella
Yes got the full works thyroid check done and didn’t take my thyroxine until after the test.
It’s all such a muddle for me, but I’m glad I’ve at last got the full panel done.
I’ll report back with my results and also list current symptoms, so hopefully you more knowledgeable ladies might help me understand what might be going on.
Big thank you xxxx
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You’re welcome. Also I was advised by an old specialist to take my daily body temperature as well, first thing in the morning before getting up. If you Google it you will find more info and a chart to help you. It’s a good way of assessing and some think the most reliable. I prefer all 3, symptoms, tests and temperatures when I think I’m not quite right.
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Will do ATB xx
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Hello All,
I’m following this post as about to have thyroid tests. Not sure if just menopause, but have extreme fatigue and other possible thyroid symptoms like flaky nails, feeling cold, especially my feet, brain fog, the list goes on…. You mention taking temperature ATB in mornings, is your temperature always low when you are poorly with your thyroid? Does it fluctuate? Is it only ‘normal’ once treatment is effective?
Many thanks for posting all this info, it’s really helpful. Xx
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Yes you’ll have a low body temp if hypothyroid, consistently low. If you give it a Google there’s a few doctors that have written a lot on it.
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Hi All
Here are my results from
Medichecks
TSH 1.25 mU/L Range 0.27- 4.2
Free T3. 3.63 pmol/L Range 3.1 - 6.8
Free Thyroxine 16.8 pmol/L Range 12-22
Antibodies
Thyroglobulin 11 IU/ml Range <115
Thyroid Peroxidase <9 IU/ml Range <34
I’m on 60mcg thyroxine. I’m under weight so my specialist I think bases it somewhat on body weight.
Any suggestions anyone? xx
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You would want your FT3 to be in the upper quarter of the range and it’s at the lower end of it instead, but with a FT4 about halfway, which is where it should be. This suggests to me possibly a conversion issue. You’re on T4 only medication which might be the issue, also on a low dose of it. Are your estrogen levels good?
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Thanks ATB.
Not had estrogen tested for awhile so not sure but don’t do well on high estrogen. Is there a connection with estrogen and FT3?
Specialist said she would put me on T3 if I had conversion issues. She doesn’t prescribe NDT by the way.
xx
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It’s very confusing now estrogen and thyroid interest, but estrogen fominajce reduces the amount of active thyroid hormone available. Hypothyroidism itself can create estrogen dominance as it inhibits excretion of estrogen. I would definitely discuss T3 meds with your GP, synthetic T3 & T4 works for most people, my doctor didn’t think it was right for me but one day I’m going to try it again because I don’t like NDT- it works but I don’t like taking it. Anyway, I also meant to ask do you have symptoms of hypothyroidism right now? Do the test results make sense?
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I was very surprised my antibodies were normal, might be because I have taken selenium for awhile.
The tests make sense in that although a lot of my original hypothyroid symptoms have diminished something still doesn’t seem right.
I suppose the main symptom that is not right is lack of energy, although this does fluctuate.
I will speak to specialist about T3.
How is this usually prescribed, oral, sublingual?
Do you start low and increase?
Thank you ATB. Hopefully this will help others watching this thread. xx
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Yes it’s a tablet/grain form like T4. I don’t know about starting it when already on thyroxine, but assume that it’s the same as starting on both, which is yes starting low as well, and gradually increasing.
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Hope you’re feeling a bit better today xx
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I am, thank you. I might still not quite be with it though as I ate too close to taking Utrogestan. Completely forgot!
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Very interesting thread,
I am starting to look into my thyroid and I know I am low on T3. So all the links are very useful along with the marvelous knowledge imparted.
I wonder if there are any links to more enlightened specialists who diagnose and treat well? Or do they all go by the book? I do not want to wait until I hit the floor before I get diagnosed. My GP is useless - all levels of everything in blood tests -including those just above ( by one point) deficient , are classed as you are ok. ??? ::).
PMxx
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If you go to ‘thyroid uk’ ( not the BTF ) have a list of doctors that order full panels and have all different thyroid meds as options. It’s also possible menopause and estrogen dominance lower available thyroid hormones, an experienced practitioner will know if it’s true hypothyroidism.
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Hi, I recently had blood tests for suspected Sjogren’s and have returned a positive ANA so my GP will be referring me to rheumatology. A rheumatology appointment is likely to take an age, and I wonder if some of my symptoms may be caused by an under active thyroid (my body temperature is always on the low side, 35.7 to 36.4, I always feel cold, have dry eyes and mouth, have put on weight and suffer from bad fatigue in the afternoons). My GP did not test my thyroid function and I wonder if you think this would be helpful? Thanks for your advice x
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Yes, indeed it would Sid. They are classic symptoms, so get your Gp to test TSH and if you can persuade them T4 and let us know the results.
It’s a start, you might have to test further privately but it’s small steps with this things.
Good luck xx
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Thank you x
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Hi All
Here are my results from
Medichecks
TSH 1.25 mU/L Range 0.27- 4.2
Free T3. 3.63 pmol/L Range 3.1 - 6.8
Free Thyroxine 16.8 pmol/L Range 12-22
Antibodies
Thyroglobulin 11 IU/ml Range <115
Thyroid Peroxidase <9 IU/ml Range <34
I’m on 60mcg thyroxine. I’m under weight so my specialist I think bases it somewhat on body weight.
Any suggestions anyone? xx
Unsure how you’re on 60, is that alternate day dosing? I’d nudge it up very slightly to see if you can get tsh around 0.5, t4 will be a little higher at around 19-21 and then hopefully t3. Also need to see how you are after 2-3 months at that dose.
I wouldn’t try t3 till you know you can’t convert.
There’s a tricky sweet spot with thyroxine as if t3 gets a little too high the body dials down conversion. Then you swing a bit and can feel similar symptoms to hypo. I’ve personally had tsh staying the same despite dropping thyroxine. Felt better for it as actually had more t3 naturally made.
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TSH should largely be ignored once you’re on medication. I wouldn’t use it to determine dose, I’ve been told over and over again it’s unreliable once medicated as it’s suppressed from medication.
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It’s compounded Clarella.
I’m going to stay awhile longer on this dose as not been on it very long and also stupidly stopped it for 5 days when I got covid!
I’ve got a review in early August so I think will see how I’m doing them as specialist will do bloods.
X
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A word of caution for anyone thinking of supplementing with selenium to help lower thyroid antibodies. Don’t take too much, especially if you have amalgams!
I only take 100mcg a day although 200mcg would probably be ok without testing.
Also, if you do decide to supplement it’s best to use organic. X
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I eat 1 Brazil nut a day for selenium. You’re right it is easy to get too much, even in Brazil nuts. 4 or more a day could lead to toxicity.
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Good morning all,
So I’ve had my thyroid results
TSH 2.34 range 0.27-4.20
Free t4 15.4 range 12.0-22.0
Free t3 5.20 3.1-6.8
Anti thyroidperoxidase 11 range <34
Anti thyroglobulin 15 range <115
Interestingly, my TSH has increased from 0.73/0.98 back in 2018 when tests were done, and has been increasing on each test since to date?
My interpretation of this is from all of your helpful comments and website links is as follows:
My Free t3 is above mid range, but would ideally be in upper quarter, and my free t4 should be above mid range but is below.
I’ve been taking my basal aux/underarm temperature for last 9 days and my average is 35.9’C
I do have what appear to be many of the symptoms related to thyroid, feeling cold, especially feet, fatigued with difficultly staying awake in the afternoons, constipation, anxiety, muscle weakness, trouble sleeping etc, - the list goes on as I know many of you know.
I’d really appreciate any comments/advice from those of you who are clearly very knowledgable. I’m concerned that if I talk to my usual GP about this they will say my results are normal. I think I am menopausal too, and had started on HRT back in March, and initially I felt slightly better, but then there was trouble with supply and I was put on a different one, and tbh im not sure if that one just wasn’t as good, or whether there is more things going on here, like thyroid, as then I started to feel even worse so have stopped the HRT completely.
Im so fed up with feeling so rubbish and fed up! :-\ Sorry to moan, but it really does get you down at times, especially when you are made to feel that you are making a fuss about nothing as your blood results are deemed to be ‘normal’!?
Thanks so much all of you lovely ladies for reading this, I hope you are having a good day, and I look forward to hearing what any of you have to say ;) x
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Thanks so much ATB 🙏, really appreciate you taking the time to reply.
I no longer have a womb so difficult to say re cycle, but yes I will continue to measure temperature for sure 👍, record symptoms, and look in more details about estrogen/sex hormone effects.
All great advise, many thanks again x
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Hi All
Thought I’d put a post on here to see how everyone is doing?
It’s a pity we no longer have ATB to guide us through our thyroid issues but hopefully we can muddle through with the use of the great links she provided at the start of this thread and the advice she has also given.
I feel it’s important to keep this thread going as it has good information for people just starting their thyroid journey and indeed for those of us who are already taking thyroid medication.
I’m due to have my thyroid bloods taken again soon, so I will post the results once I have them. xx
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It is known that GPs are reluctant to do further testing if patients' thyroid function test returns 'within normal limits'. This is for men was well as women, even when patients return over and again feeling ill >:(
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Hope it’s ok to post on this thread as it’s been quiet for a while.
I’m researching thyroid as I don’t have symptoms but my thyroid panel results are strange. I stopped all HRT on the 14th of September to try and work out what’s going on.
How are you doing Marchlove?
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Hi Tora
I’m doing ok thyroid wise, I think! Due for a review soon.
My specialist told me a couple of months ago when I complained that I felt hot all the time (not flushes) that generally we need less levothyroxine in the summer that we do in the winter, that was a new one for me!
Do you want to share your thyroid results on here, to see if anyone can help?
Mx
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Hi ML,
That’s good to hear! I’ve recently read that levo can need adjusting in the summer too. Sounds like you’ve got a good consultant that listens to your symptoms.
The NHS did a basic TSH & T4 test in late August, my TSH was undetectable and the T4 was 22 on a range of 12-22. As I felt good it was deemed normal. I’ve since found out that my TSH has not been detected for years. I’m not on thyroid meds as didn’t know there may be an issue.
I did a Medichecks advanced panel two weeks ago, the results (range in brackets) are:
TSH 3.53 (0.27 - 4.2).
FT4 17.8 (12-22).
FT3 3.93 (3.1- 6.8 )
Thyroglobulin Anti’s 11 (<115).
Thyroid PEROXIDASE 9 (< 34).
B12 Active 150 (37.5 - 150).
Ferritin 105 (13-150).
Folate 16.59 (3.59 - 19.45).
Vit D 160 (50-200).
CRP HS 0.73 (0-5).
I’m not sure how often to re-test so I’m thinking every two weeks?
There’s so much conflicting info regarding thyroid!
Thanks.x
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Hi Tora
I’ll get back to you later as need to get my thyroid book out before I reply!
Hopefully Wrensong will be along to give a more accurate interpretation of your results, as I’m still quite a newbie to it all.
Mx
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Hi Tora
It’s all a bit odd indeed!
I’m slightly confused as to the reason for stopping your hrt, was it purely to see what might be going on with regarding your undetectable Tsh?
What’s strange is that in a very short space of time, your TSH went from undetectable to 3.53.
I’ve looked online (I expect you have as well!) and there seems to be a number of reasons for a undetectable TSH result.
The only ones I was previously aware of was too high a dose of levothyroxine or Graves’ disease, but the first reason doesn’t apply and it doesn’t sound like Graves’ disease as you have no symptoms.
HRT, especially oral, can apparently increase TSH, but that has not, so it seems, been the case with you.
I don’t know quite what to suggest. I was hoping Wrensong might be along but she doesn’t look at the forum that often. However, she is always happy to help with thyroid issues, so I would PM her and ask her opinion.
Apart from that your must recent thyroid results suggest the following-
TSH migh be a bit high, but if no symptoms it’s probably ok.
FT4 looks fine
FT3 is low, it should be in the upper quarter.
If yoo look back through this thread you will see suggestions for a couple of supplements that help conversion from T4 to T3.
Zinc (start with 15 mg for a few months and then you can increase to 30mg if you want. I stick with 15 mg though. Take with food in evening.
Selenium - I take 100 mcg a day
There’s something to be said for why try and fix something that you don’t have symptoms for, so it’s a bit of a dilemma.
M x
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Hi Marchlove,
I really appreciate your time, help and kindness with this, thank you.
I stopped the HRT when I got the Medichecks results showing TSH of 3.53 and low FT3. This was done in haste and I’ll introduce HRT in much smaller doses when I’ve had more tests or if symptoms return.
The GP believes I’m hypERthyroid and that my insomnia, hyperactivity and flexibility are symptoms. I would just say I’m an active, energetic person opposed to hyperactive! The recent results don’t suggest hyperthyroidism to me but I’m concerned with being told of non-detectable TSH over several years.
I’ve tracked nutrients since February with really good results. I eat a lot of selenium so I don’t supplement it but aim for 30mg of zinc daily, I always hit at least 22mg. Have you noticed a difference with supplements/watching nutrition?
I’m not too concerned about TSH as if it’s telling my thyroid to release more T3 that explains why it’s higher - at least it’s working!
I’ve ordered a full screen from the NHS lab place and will repeat the Medichecks tests and just monitor it for now. It’s a good excuse to rule out frightening stuff that can lower T3.
I’ve left a message for the MS too.
I’ll keep a look out for Wrensong.
Thanks for this. X
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Hello Tora, I see you've had a helpful reply from Marchlove already & like the 2 of you I'm also somewhat confused by your thyroid situation. That your pituitary is producing TSH in proportion to your thyroid hormone levels (responding appropriately both when you've had more & less thyroid hormone in your bloodstream) is reassuring though, so I don't think there's cause to worry unduly.
I'm a bit surprised that your GP didn't refer you for Endocrinology opinion if your TSH has been undetectable for years & your T4 accordingly around top of range, suggestive of mild hyperthyroidism, though if your antibodies have not been raised (I see they're not raised in your latest test) & you've felt well, perhaps you're among the small percentage of people whose results in good health naturally fall just outside the ref range for one or other blood tests, in other words that this situation is normal for you. A couple of my (non-thyroid) bloods have been for many years outside ref range, one of them often really quite low & no-one is ever concerned about those as I'm told there would be other related abnormalities in a disease state.
There are apparently cases where a genetic mutation causes TSH to be undetectable, but this seems to be quite unusual. I can post links if you're interested, but I'm thinking you've probably already come across those yourself, as you say you've been researching.
It might help us make more sense of what's going on if you wouldn't mind sharing a bit more info along the following lines, though please don't feel obliged to divulge anything you'd rather not.
Do you know what your FT3 has been during the years your TSH has been undetectable & whether your FT4 has at times been above top of range? Also do you know whether your antibodies have been raised in the past, when your TSH was undetectable?
As you say, your latest (Medichecks) TFT doesn't suggest hyperthyroidism, so like you, I'm wondering whether your HRT has had an effect on your thyroid status, so could you tell us what HRT you were on, if that's OK - type & dose. Oral oestrogen can increase thyroid binding globulin (TBG), in turn reducing the amount of active thyroid hormone available & though transdermal forms are said to be less likely to do this (many sources say they have no effect on thyroid hormone) a few hypothyroid members, myself included, have found transdermal forms also affect our thyroid levels. My very experienced endocrinologist has confirmed this can happen. It's said that a healthy thyroid should compensate for this though & adjust output accordingly.
At time of most recent testing, did you feel any different with your TSH higher & T4 lower than has previously been the case for you, especially given your T3 - the more active form of hormone - was shown to be lowish (though still within range)?
Your B12 is at top of range - can I ask is this because you're on B12 supplements?
If you are thinking of retesting your thyroid in a few weeks, I think you might be wise to stop for a while beforehand any supplements you've not been advised to take, just in case any of these might skew the picture - I think ideally we want to know what your body can do for itself. I'm not sure whether you mean here that your GP has agreed to comprehensive screening on the NHS I’ve ordered a full screen from the NHS lab place
?
Sorry not to be of more help.
Wx
P.S. have kept coming back & editing this for clarity & as new thoughts arise. Sorry!
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Hello Wrensong,
Thank you for your help here. It’s really appreciated.
I think I was made aware of the GP’s August test results because since Covid they are used to conducting appointments on the ‘phone, previously results were given on a face to face appointment. My TSH was tested yearly from 2015 to 2019 and I vaguely remember being told to eat goitrogens, I remember this as I had to google the word. I was always told the results were normal after telling them I felt well. An FT4 (22 with range 12-22) was done in 2019 but T3 and antibodies were never tested.
I was prescribed sleeping pills throughout this period due to relentless insomnia, I stopped those in 2020.
I started HRT in September 2021 on 4 Oestrogel pumps and testosterone and felt great. In March I felt like a zombie, I wasn’t tired or depressed but I lost interest in everything and people noticed. I saw a dietician and an MS who increased the Oestrogel to 8 pumps, gradually over a month. The dietician recommended a month off exercise and a huge increase in protein and greens. Within days I felt brilliant from the dietary changes alone. I took two months to increase the gel to 8 pumps and I’ve been in good spirits since.
It might be relevant that without realising the diet was gluten & lactose free so I’ve continued without both.
I stopped all HRT on the 14th of September, when I got the Medichecks results, out of fear and because I thought it’d be useful to see what future thyroid tests would show. So far I still feel really good. I was supplementing with a pill of B12 and one Vitamin E once a week but stopped that 7 days before doing the Medichecks test. The B12 result was >150 and the doctor said I should reduce B12 if supplementing. I don’t use supplements at all now.
I’ve purposely not returned to my GP yet. I was going to get a few tests done so that I have more understanding first. The GP has not ordered any tests, I’ve ordered a Full Screen (TSH, FT3,FT4, Cholesterol, B12 & Iron) from the NHS Lab place, the patient pays for it. I was going to repeat the Medichecks test every two weeks but I don’t know whether this is too frequent!
I’m going on holiday today so please excuse any typos and I hope I’ve given the right info. As usual I’m behind with packing!
Thanks so much for your help, I was starting to get worried but you’ve really put me at ease. I’ll log in tonight.
Tora.x
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Bless you Tora & thank you for the extra info. I will try to come back & post again later when I have more time, but please just enjoy your holiday, have a lovely time if you can & put this on the back burner while you're away.
Wx
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Hi again Tora, I'm hoping you're somewhere lovely on holiday by now & that you won't log on to the forum until you get back. Not sure when that will be, but I was hesitant to post now for fear I may say something inadvertently worrying, but as you said you're intending to log on tonight I thought you were probably hoping for a reply sooner rather than later.
If thyroid antibodies were not tested during the years your TSH was undetectable it's more difficult to know whether an autoimmune condition could be behind the long term low TSH-high FT4 combination. Your antibodies are not raised now, which is reassuring. If you were always told the results were normal I'm assuming that although the TSH was undetectable, as in the 2019 results your FT4 never went above top of ref range.
Hyperthyroidism can certainly be a cause of insomnia, but so can many other things, menopause & stress being classics, as well as certain supplements taken at the wrong time of day, but I'm a bit surprised you were prescribed sleeping tablets long term. You say you felt well so, apart from the query over high energy, I take it you didn't have other symptoms suggestive of hyperthyroidism such as feeling disproportionately hot for the environmental conditions, difficulty maintaining weight, passing lots of water (frequency &/or large volumes), nervousness, racing thoughts?
8 pumps of gel is a high dose, but depends on how well you absorb of course. Please don't bother to answer any of this on hols, but do you know what your oestrogen levels were at the various times - before HRT, on 4 pumps of gel & on 8 pumps? You don't mention a progestogen so have you had a hysterectomy & if so did they take your ovaries with it?
I'm sorry you were frightened by the change in your latest TFT results. They are all within range (though your FT3 is lowish) & you say you feel well, so I wouldn't worry too much. But it must have been unnerving to have no explanation for this when your previously consistently unusual TSH & FT4 results had already been something of an underlying concern for you. I don't think it would be unreasonable to ask for an endocrinology referral for expert opinion on the years of undetectable TSH & top of range FT4, especially if your next test shows your levels are odd in any way.
It's great that you still feel good without the HRT & I hope you don't start to feel adverse effects from the abrupt withdrawal, but if so you may need to start it again for the short term to help your body adjust & then taper off more slowly if you want to retest your thyroid after a few weeks of no HRT.
If you do want an HRT-free TFT I think if you can, I'd wait 4-6 weeks after stopping HRT altogether to let your body settle. I think the HRT should be out of your system by then but I'm not sure how long it may take your thyroid to stabilise if HRT was affecting your thyroid levels, despite it being transdermal. It seems possible given you were on a hefty dose of oestrogen, assuming you absorbed enough of it. As I mentioned earlier a healthy thyroid is said to adjust output to remain in balance under the influence of HRT & your latest thyroid results are not abnormal, but we don't know for sure you haven't had a mild thyroid condition ongoing for a while before you started HRT. Either way, given you've felt well apart from in March, I don't think you need to worry too much, but if your GP agrees & it's what you'd like, I think an endocrinology opinion would give you more certainty.
Just another thought about supplements - I believe biotin especially at high doses (in B group & some multivits) can give falsely low TSH & high T4 results, so if you were on any biotin containing supplements during the years your TFTs were borderline hyperthyroid, that could perhaps have skewed the results.
Lastly, please never worry about typos - we all make them & no-one's judging us for those on here!
If you see this before you get back I hope you have a fab holiday. Please let us know how you get on with the next test if you have time & feel like sharing.
Wx
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Hi All
I’ve been meaning to post my latest thyroid results so sorry for the delay.
I’ll start with my oldest ones-
Gp, just TSh
2016 1.67
2020 2.83
Thyroid Specialist
Nov 2021
TSH 3.26 (0.27-4.2)
FT4 15.2 (12-22)
FT3 4.23 (3.1-6.8)
No Antibody tests done
Medichecks
June 2022
TSH 1.25
FT4 16.8
FT3 3.63
Thyroglobulin Ab. 11 (<115)
TP Ab. <9 (<34)
Thyroid Specialist
August 2022
TSH 2.03
FT4 16.2
FT3 3.75
Thyroglobulin Ab. 13
TP Ab. <9
My thyroid specialist also does my Hrt which is compounded.
So good news about the antibodies!
From what I’ve read FT4 should be just over midrange so ideally 17-18
and FT3 should be higher end of range so I suppose ideally over 6.
So to my inexperienced eye, it looks like my FT3 is not high enough but would be grateful if anyone else can advise (Wrensong!).
I take selenium and zinc which supposedly should help the conversion of FT4 to FT3.
My main symptoms are body aches, constipation (although this has improved somewhat) and the soles of my feet burn especially at night.
In the summer my levothyroxine dosage was 60mcg and I did feel rather hot most days, even when we weren’t having scorching weather.
I’ve recently started to feel colder (haven’t we all!) so I’ve had an increase of levothyroxine to 70mcg.
I sometimes wonder if I have some form of fibromyalgia? Although it’s so sporadic. Yesterday I ached all day and today it’s hardly noticeable.
My review is not for 2 weeks to discuss the latest results so would be most grateful for any input.
I hope you’re having a great holiday Tora.
M x
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Hello Marchlove, always happy to chat about thyroid if it might help, but can't advise as such. Can only share what I've learned from personal experience & reliable sources & make suggestions in the hope this will give food for thought & perhaps help throw a little light on what can be a confusingly obscure picture. I like to find out how someone's feeling, not only what their symptoms are, but their instincts about their condition & encourage them to learn as much as they can so that they gain confidence in interpreting what their body is telling them & can be fully involved in decisions about their care. I think from what I've seen of your various posts around the forum you are knowledgeable about health & already do all that! So not sure I can help much. But happy to compare notes.
I haven't read back through this thread so I'm not sure how you came to be on thyroid meds & whether you'd started these before any of the test results you posted above. I see though, that your TSH increased steadily between 2016 & 2021, though remained within range at first mention of a thyroid specialist, so I'm wondering whether this was the doctor who started you on replacement, presumably on the basis of whatever symptoms you had then? Or were your TFTs out of range at some point?
Can I ask at what point you started HRT? I'm assuming oestrogen & progesterone, but what about testosterone? And do you feel the HRT has had any effects, good or bad, on your thyroid situation? Sorry, it can be really difficult to work out cause & effect, I know.
Some hypothyroid patients really struggle with thermoregulation, including me & like you I find summer temps (for me anything above low-mid 20s) hard to tolerate, despite my TFTs being more representative of under than over treatment & a low BMI meaning I'm not well padded for insulation! Yes, the other side of the coin is finding it hard to get/stay warm in cooler weather - currently really struggling with that too. Can I ask do you get too hot at night even in cold weather? I can't seem to crack that, whatever dose of oestrogen I take & I'm definitely not overmedicated as regards thyroid.
From what I’ve read FT4 should be just over midrange so ideally 17-18
and FT3 should be higher end of range so I suppose ideally over 6.
The question of what to aim for as regards thyroid blood levels on replacement is contentious! Personally I think it's more helpful to work towards a dose on which you feel your best rather than try to get FT4 or FT3 to a specific point, as what suits us can be can be a very individual thing & in my experience also changes with age. In my 40s I felt & functioned best with a lower TSH & higher dose of Liothyronine than I can tolerate at 60. I wouldn't worry that you'll only be well if you achieve T3/T4 levels towards top of range for example, as that may not be right for you, especially at our age.
Your latest TSH looks fine, but you'll know that's not necessarily a good indicator in isolation. I feel best with mine around 2-3 at this age & my Endocrinologist prefers it around 2.5, but you may be quite different.
As you say, your FT3 is quite low & as you know, this is the active form we need to drive our metabolism, so your coldness, constipation & aches might improve if you could get that up a bit to a level at which you feel comfortable but not overtreated. Maybe something to discuss with your Endo next time.
As ranges can vary a bit between labs, would be helpful if you could post the ref ranges for the latest lot if you know them & have time? Be interested to see where your FT4 falls as it's quite low on my lab range which goes from 12-26. If you're currently only on Thyroxine, it would be far easier & more convenient for you if you can get your T3 level up a bit by increasing your T4 dose rather than starting liothyronine at this stage. You may find you're able to convert well enough with enough T4 in your system. You say you've recently increased to 70mcg - was this after the latest test? If so maybe that will be all you need. How do you get 60 & 70 mcg doses btw - compounded?
The burning feet - me too. Do you take B12 & have you had your levels tested? My Endocrinologist likes me to take some, as my level was towards bottom ref range before supplementing, but it didn't improve the burning despite bloods showing a good increase towards top of range.
I can't comment on fibromyalgia, but aching muscles & joints can be a feature of hypothyroidism & low oestrogen, of course. Not easy to suss out is it?! I've recently started to notice my joints prod me fairly reliably when my oestradiol level's fallen.
I have supplemented with both selenium & zinc in the past, following thyroidectomy & before the T4 conversion defect was diagnosed, but now on T3 I don't take either. I try to eat healthily & want my thyroid replacement to be optimal & not to have to rely on nutritional supplements to make up any shortfall, though I understand why some people like to, especially if their thyroid is still intact & they're concerned about antibody levels. I also make sure any doctors involved in my care are aware of any supplements I take.
Currently only on Vit D, prescribed by my Endo some years ago as low on testing. Are you on Vit D, Marchlove? Thinking about your fatigue. Also the constipation, as Vit D supplements can cause/worsen this - I'm sure you'll know that though.
Sorry this is so long, with so many questions embedded & please don't feel obliged to answer anything you feel may not be helpful.
Wx
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Thank you Wrensong for your thorough and helpful reply.
A lot to think about!
I will digest all you have said before my appointment next week and if you don’t mind I might have a few further
questions to ask.
All a bit overwhelming.
I so love to learn, good teacher’s are invaluable so thank you for your input.
M x
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Hi Wrensong
So, no my TFT’s have never been out of range and yes I started on Thyroxine in December 21 based on my symptoms then, which were feeling cold, constipation and fatigue.
Like you I have a low BMI.
Summer 21 I was on the Studd regime of high dose transdermal estrogen and Utrogestan for seven days and felt awful.
I started on compounded in Nov 21 and yes I do take testosterone.
I’m sorry but I do not know how my Hrt effects my thyroid, so I can’t answer that. I suppose I’d know this if I’d been taking thyroxine before I started Hrt but as I didn’t I’ve got nothing to compare.
At present at night in cold weather my temperature feels quite normal. Do you decrease your dose in summer and increase in the winter?
I’m on low dose estrogen and do not get any hot flushes at all at the moment, although I was a bit in the summer but that could have been my thyroid dose being a bit high!
What dosages of thyroid medication are you on?
Ranges for the latest lot of tests are
TSH 0.27-4.20
FT4 12-22
FT3 3.1-6.8
It’s the same ranges as the previous tests which were done by medichecks.
How many times a year do you test?
My Thyroxine is compounded hence the 60mcg dose but I’m actually now on 72.5mcg as I’m adding half an Nhs tablet, which Endo said was ok to do because I’d started to feel cold.
Burning Feet, what a mystery! Nobody can explain it. I also take B12 and my levels have increased but like you it’s had zero effect on my burning feet. I consistently have haematocrit and haemoglobin over the reference range, do you know what your red blood cell levels are? I’ve seen a haematologist but he doesn’t seem to know why either.
I suppose I could try increasing estrogen to see if that helps with my aches, but I’m a bit loath to do so as my mood is good and higher doses make me anxious.
Yes my Vit D is ok -97, have just increased dosage for the winter.
My fatigue isn’t too bad now, certainly improved, I walk about 45 minutes each day but not up to doing gym work!
I didn’t know about Vitamin D and the constipation connection, but saying that my constipation was even worse when my Vit D was too low.
I take on board what you say about the increased thyroxine might help increase my FT3, but I will talk to my Endo about it and let you know what she says.
How does one feel if one’s FT3 is optimal??
Thank you Wrensong xx
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Hi Marchlove, sorry to be so late replying. A busy week. Sorry too that my lengthy, question strewn last post post made for a lot to deal with. It's just that detail can be important when the combination of hypothyroidism & menopause can make for a tangled mess, needing a magnifying glass to unravel! When I said about learning as much as poss I certainly didn't mean from me, but from reputable published sources & any expert medics we're lucky enough to encounter. Like most of us here, I'm very much still learning. And, no of course I don't mind questions.
Interested to know that your BMI is low like mine. That's one of the frustrating features that prevented me getting diagnosed in the first place & later getting tested for the conversion defect. No-one thinks of hypothyroidism as a possibility in skinny people. My first Endocrinologist told me that in fact many patients are underweight, confirming my intuition that my typically hypothyroid sluggish digestive tract was not helping me gain weight. It can be hard for us to eat enough weight promoting foods when food is so slow to move through, requiring a very high fibre diet that's by its nature not very calorific. It seems to be increasingly thought that when untreated hypothyroidism does cause weight gain, much of that is due to fluid retention rather than fat.
Unfortunately, being underweight can also slow down the metabolism as the body strives to conserve calories for essential functions. Getting the right thyroid balance is even more tricky for us because we need to take great care not to become overtreated on thyroid replacement, which could cause further weight loss we really can't afford. Not that there's anything good about being overtreated. You'll know that this can have serious adverse effects on bones & cardiovascular system if it goes on for any length of time. I'm sorry I keep stressing that in posts but anyone on replacement needs to be aware of it.
So we need to be very careful not to let our TSH go too low nor our T3/T4 too high. Can I ask has your BMI ever been significantly higher & if so were your symptoms such as coldness, fatigue & constipation less of a problem then? Wondering whether gaining weight might help your symptoms, if you can do so healthily. I just can't gain much & keep it on so I sympathise if you're the same.
Like you, I also feel worse on high doses of oestrogen & bloods have repeatedly shown that despite being on transdermal, these increase my need for thyroid hormone & that conversely, when my oestradiol dose/blood level goes down, my thyroid replacement needs tweaking downwards.
Do you decrease your dose in summer and increase in the winter?
No I don't, but my thyroid meds have been a work in progress while trying to find my best HRT fit, so they have been frequently changed according to my blood results & symptoms, whatever the season. I discussed seasonal variation with my Endocrinologist some years ago as I know some sources favour it, but he doesn't believe it's necessary.
Thanks for the ref ranges for your latest test. I see the FT4 range doesn't go up as high as it does with the lab that does my testing, so your last FT4 result isn't as low down the range as I thought, which probably explains why your TSH looks fine.
How many times a year do you test?
Before HRT when my thyroid levels were more stable I used to have TFTs on the NHS every 3 months as my then GP preferred that frequency, though that's more often than is usual for patients established on thyroid replacement. But I was never well on Thyroxine alone & my levels were not that stable, so it made sense to keep an eye on it. Now my thyroid care is necessarily private as the NHS won't monitor T3 replacement, so I time tests to have results ready for reviews, which are currently roughly every 3 months. If I feel my dose is wrong in the interim I tweak it myself & my Endo is happy with that as he knows I understand how it works & have been on replacement long enough to know how I feel when my dose is wrong either way. That said, HRT that's a work in progress can make for a confusing picture.
My Thyroxine is compounded hence the 60mcg dose but I’m actually now on 72.5mcg as I’m adding half an Nhs tablet, which Endo said was ok to do because I’d started to feel cold.
So you're adding half a 25mcg tablet to your compounded T4. Do you know you can get 12.5mcg Thyroxine on the NHS? TEVA brand make it & these are scored so can be halved to give just over 6mcg for fine tuning. Have you ever been on standard thyroid replacement, as opposed to compounded? Would be cheaper for you.
I consistently have haematocrit and haemoglobin over the reference range, do you know what your red blood cell levels are? I’ve seen a haematologist but he doesn’t seem to know why either.
Again like you, my MCH (haemoglobin) is usually slightly high & my last RBC was at bottom ref range. There can be various reasons for high MCH, including low B12 as you'll know & also being a bit dehydrated. If bloods are done early morning it's possible fluid levels are suboptimal if we haven't yet drunk enough to compensate for fluid loss overnight, so that could skew the haemoglobin result. I expect you've already looked into that, but the link here is interesting for anyone in a similar situation.
https://www.medicalnewstoday.com/articles/318050
I suppose I could try increasing estrogen to see if that helps with my aches, but I’m a bit loath to do so as my mood is good and higher doses make me anxious.
I think it makes sense not to increase if you feel better on less. If you can establish what dose of thyroid replacement works best with your current HRT then over time hopefully you'll feel better.
I take on board what you say about the increased thyroxine might help increase my FT3, but I will talk to my Endo about it and let you know what she says.
Yes, I meant the increase you said you'd already made - please don't increase further without discussing with your Endocrinologist. The extra 12.5mcg daily you've added might actually prove too much as your last TFT looks OK-ish, just the T3 a bit low together with the concern over the possibly related residual symptoms - the fatigue, coldness, constipation. A small tweak to T4 dose can change levels quite a bit over time.
How does one feel if one’s FT3 is optimal??
It's a long time since my FT3 has looked optimal on paper - it's always below range. T3's short half life means on a low dose, not much is left if the TFT is done 8 hours or more after last dose - my Endocrinologist's preferred conditions. But when I was first on T3 many years ago, a higher dose than my body can tolerate now, the most noticeable effect was like having someone flick a switch to start up my digestion & remarkably soon after commencing T3. It was a huge relief to start to feel well. I just felt more normal in every way. If replacement is suboptimal in any way we can continue to have some of the many hypothyroid symptoms & if we need T3 & can find the right dose to balance with T4, those should improve/resolve. But it can be tricky to balance the 2 & trickier with HRT in the mix in my experience & judging by posts from the few other members who are on T4+T3 & HRT. Most hypothyroid patients don't need to take T3 as their body's conversion of Thyroxine is efficient enough to provide all they need. Only about 15% are said to need T3 as well.
I hope your appointment goes well.
Wx
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Hi Wrensong
Thank you for your kind and thoughtful reply. It’s given me much food for thought and comes at a timely juncture as my appointment is this Wednesday.
I will respond later in the week after my appointment so I can incorporate my specialist’s advice in my response.
Thank you once again :)
M x
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No problem. An afterthought - if you're on compounded thyroid replacement is it an Endocrinologist who's prescribed these? I hope all goes well on Weds.
Wx