Hi. I'm new to these forums and have never made a post before.
My GP has prescribed Levothyroxine at 100mcg for several years now, and throughout that time I have never felt energised, or had any weightloss without major effort on my part - 40 minutes of fast cycling on my exercise bike while sticking to a low calorie diet.
I've tried to discuss this with my doctor, and have presented evidence gathered online to show how T4 may not be converting to T3, etc. but at the last session he lost his patience, almost accused me of arguing against science with black magic and quackery, and refused to accept that T4 wasn't the be all and end all for treating hypothyroidism.
I've now had a private test done (£170) and the results are as follows:
Thyroid Function
TSH 2.87; range 0.27 - 4.20 IU/L
T4 Total 127.4; range 64.5 - 142.0 nmol/L
Free T4 18.87; range 12 - 22 pmol/L
Free T3 4.08; range 3.1 - 6.8 pmol/L
Reverse T3* H 40.0; range 10 - 24 ng/dL
Reverse T3 ratio L 6.64 >20 Ratio
Immunology
Anti-Thyroidperoxidase abs 12.0 <34 kIU/L
Anti-Thyroglobulin Abs 11.9 <115 kU/L
Vitamins
Vitamin D (25 OH) L 46 Deficient <25 nmol/L
Insufficient 25 - 50
; Consider reducing dose >175
Vitamin B12 388 Deficient <140 pmol/L
Insufficient 140 - 250; Consider reducing dose >725
Serum Folate 19.99; range 10.4 - 42.4 nmol/L
From these results it looks like the reverse T3 is pretty high, while everything else is within range.
I intend to present these to my GP, but I'm not sure what I should be saying to him, and what a high reading of RT3 means, if anything, with regards to still feeling like I have hypothyroidism. How do these numbers look, and is there anything I should be saying to my GP that contradicts his stance on the issue? Any help would be greatly appreciated.
Hi Starahelm and welcome
I can't help with reverse T3 I'm afraid but I'm sure someone else will come along with some advice.
As for the rest:
Good news - your antibodies are low so do not indicate autoimmune thyroiditis (Hashimoto's disease). One less thing to worry about
B12 is too low. The Pernicious Anaemia Society recommend 1000. You can supplement with Jarrows or Solgar sublingual methylcobalamin lozenges 5000mcg daily, and in a couple of months, when level is nearer optimal, reduce to 1000mcg as a maintenance dose.
When taking B12 you need to take a B Complex to balance the B Vits. Thorne Basic B is a good one and contains 400mcg folate which will help yours which is a bit low, it needs to be at least half way through range, ie 26+.
Vit D is low, needs to be 100+. Supplement with D3 and also take K2 or a K Complex which includes K2. Vit D aids absorption of calcium and K2 directs calcium to bones and teeth rather than arteries and soft tissues.
If you get all your vitamins and minerals at optimal levels it will help thyroid hormone to do it's job properly, ie help convert the T4 to T3 which is the active hormone. Your conversion, at the moment, isn't too bad but could be better. For normal converters the ratio should be FT4:FT3 - 4:1 or less. Yours is 4.6 so you might feel better if your ratio was less. It's possible optimal vits and mins will help there.
A treated hypo patient generally feels best with a TSH around 1 or below or wherever it needs to be for FT4 and FT3 in the upper part of their ranges. So your TSH is too high at 2.87. An increase in your Levo would bring that down and increase your FT4 and FT3 to higher in their ranges. I would try for a 25mcg rise, if GP is not willing then maybe compromise on 12.5mcg.
Here is some evidence that may persuade him, it is from a Pulse article written by Dr Toft who is past president of the British Thyroid Association and a leading endocrinologist so maybe that will hold some clout when discussing with your GP.
"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.
In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance.
But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.
This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."
If you email louise.warvill@thyroiduk.org.uk she will let you have a copy of the article which you can print out and show your GP.
At the moment, whilst you are not optimally medicated, exercising to lose weight is pretty pointless. You have a better chance of achieving weight loss when on the correct dose of Levo. Also, exercise will deplete T3 (and you don't have too much of that at the moment) and make you feel worse so you might want to ease up on fast cycling at the moment.
Hi Susie and thanks for the response. I'll certainly bring up the level of Levothyroxine with my GP when I go in this week. I may try an interim amount, about 112.5mcg rather than going up to 125; when the doctor was trying to get my dosage right in 2007, he put me on 125 for a few weeks, but I had constant palpitations, which disappears instantly when he lowered the dose.
I had a feeling vit D was going to be very low, as I work mostly indoors. I must make a bigger effort to get outside and enjoy what little sunlight we've had so far.
I will contact Louise and request a copy of the article to help with the figures. If the GP still insists everything is right and gets irate again, I'll look at joining another practice - something my wife has already done for unrelated reasons.
Once again, thanks a lot for your help and advice.
hi. please if you don't mind could you explain a bit more about exercise depleting t3. thanks
ovsa I can't fully explain, I only know from what I've read. Have a look through some old posts that talk about it healthunlocked.com/search/e...
thanks. still cant make out should one take extra t3 when exercising?
ovsa What sort of exercise are you talking about? Past posts have mentioned about excess or hard exercise depleting T3, obviously a stroll with the dog or something similar doesn't come under that.