Results help please....specifically T3 conversion problem?

I've just received these results from a private test. I did this as doctor said she couldn't test T3... apparently lab won't has never been tested and I'm trying to get to the bottom as to why despite eating clean and exercising I am not losing weight...infact since my increase in Levo 11 weeks ago I've started to gain a little. BH had a offer on so got others done too.

CRP 4.50 <5.0 mg/L

Ferritin 81.9 20 - 150 ug/L

Thyroid Function TSH L 0.15 0.27 - 4.20 mIU/L

T4 Total H 144.8 64.5 - 142.0 nmol/L

Free T4 H 26.24 12 - 22 pmol/L

Free T3 4.11 3.1 - 6.8 pmol/L

Anti-Thyroidperoxidase abs H 62.6 <34 kIU/L

Anti-Thyroglobulin Abs 13 <115 kU/L

Vitamin D (25 OH) L 38 Deficient <25 nmol/L Insufficient 25 - 50 Consider reducing dose >175

Vitamin B12 442 Deficient <140 pmol/L Insufficient 140 - 250 Consider reducing dose >725

Serum Folate 11.77 8.83 - 60.8 nmol/L

I'm on Levo 150 mcg. This was increased from 125 mcg ten weeks ago.

Had TSH and T4 tested by my doctor three weeks ago and results then were

TSH level


0.4 - 4mIU/L

T4 level


10 - 25pmol/L

Doctor said then I was overmedicated and wanted to reduce my levo back to 125mcg but I argued that as I was feeling much better with no hypo symptoms could I stay on 150mcg and see how it goes. She reluctantly agreed warning of heart implications.. agreed to test 8 weeks from then.

Fast forward a few weeks, Ive had one or two heart flutters, vivid dreams and broken sleep and a little weight gain. Got an appointment with doctor but not for a couple of weeks. I'm intending to reduce my dose now i.e. 150 mcg one day, 125 mcg the following.

Any thoughts please?

Does it look as though I may be a poor converter of T4 to T3? I realise that I need to get my folates, ferritin and Vit b12 and D optimal.

Any advice gratefully accepted.


35 Replies

  • Ollysmum,

    You are a bit over medicated because FT4 is over range but some patients do need high FT4 in order to convert sufficient T3. Read Treatment Options in Email if you would like a copy of the Pulse article to show your GP.

    If you feel over medicated on 150mcg then you are right to reduce your dose but your FT3 will likely drop too.

    Despite high FT4 and low TSH your FT3 is low in range which indicates you are a poor converter. It would be better to add some Liothyronine (T3) to a reduced Levothyroxine dose but NHS England is trying to ban prescribing of T3 so you might have to buy your own and self medicate.

  • Thank you very much Clutter. Just as I thought a poor converter...Yes I very much doubt I'll get past the doctor on this one. Do you know of any reputable source of T3 please? If so would you PM md please. Im unsure of dosage etc.

    Thanks again.

  • Ollysmum,

    I would reduce Levothyroxine to 100/125mcg alternate days and add 6.25mcg (1/4 tablet) T3 and see how you tolerate it. If good, you can add a 2nd 6.25mcg dose two weeks later. I would stick with 12.5mcg for 6-8 weeks and have a FT3 test before increasing further.

  • Thanks so much for your teplies Clutter. You've given me a lot to think about. In the current climate I doubt if I'll ever get T3 on the NHS!

  • Just as Clutter mentioned I think this might be the case that you're converting poorly. I had very similar results to yours and had to add T3 to lower my FT4 and raise my FT3 and only then did I start to improve.

    Also if you raise your b12 and vit d you might find you convert better.

    Question: do you feel hypo and hyper kinda at the same time? That's how I felt when my FT4 was over range and my FT3 was low.

  • Thanks dang.Thats good to know. Yes I'm working on my b12 and its definately improving from my last result. Just starting to supplement vitamin d with K2.... Yes funnily enough i do feel symptoms of hypo and hyper.wide awake during the night sometimes...and the odd day tired. Are you self medicating your t3 dang?

  • Sorry dang...just read through your previous post and can see you were prescribed by an endo. Hope you're feeling better. 😊

  • Yes my Endo is helping me through it, and it has helped greatly. Along the way I've also been working on improving my vitamin results, I'm still low in ferritin, I have another test coming up in June so I'm wondering how much it will help my conversion. I only take 10mcg of T3 so I'm wondering if eventually I won't need that amount, but the 10mcg took my FT4 from over range and sent it down to halfway in the range, and my FT3 went from bottom of range to top, so sometimes a small tweak in medication is all that's needed.

    I think an addition of T3 might work for you, I personally don't know how to recommend it. Other members can suggest lowering Levo while adding T3. My Endo didn't do it that way. He first added 5 mcg of T3 to my 75 mcg of Levo (I didn't feel well on 100 because of the symptoms). But it didn't bring my TSH down enough and my symptoms were better but not great, so then he brought it up to 100 Levo and 10 T3, this ended up being just right, even tho my TSH is now suppressed he doesn't mind. So I didn't need a decrease in Levo in the end, just an addition of T3.

  • Thanks very much dang for that informative post. It's helping me understand t3 a little more and encouraging to know you're doing well on it. Its helps I guess having an Endo you can work with...that's a big plus. Interesting also, how your Endo tweaked your meds...i.e. didn't lower your Levo to start with...a different approach is always something to consider.

    Hopefully you will have done enough to improve your vitamin levels and ferritin. Post and let us know how you get along. I've tried eating liver to improve my ferritin, but to be honest I don't like it and it took me a good while to eat a portion of it and don't think I could perservere with it. Will., carry on supplementing. Like you, I did wonder if after managing to get vitamins etc optimal, how much it would help with conversion. Time will tell...working towards though! Thanks again.

  • You're welcome! I will definitely update my experience with optimizing vitamins and minerals.

    Good luck to you as well! Don't be afraid to try T3, as long as you do it sensibly and start at a low dose and increase slowly over time you should be just fine to find out if it suits you.

  • Thanks dang. Much appreciated I will give it a try. :-)

  • Ollysmum Oooh, there's a big clue there! Isn't it great that we can get our own tests done and find out the problems the doctors miss, and what a pity they don't see the importance of all these tests.

    Firstly, ferritin is pretty good, it's over 70 (tick :) ), it's almost half way through range (that would be 85), and the easiest way to maintain it or raise it slightly​ is to eat liver.


    B12 - 442. Supplementing with 1000mcg sublingual methylcobalamin will be enough to raise that, aim for top of range, even 900-1000. Your folate needs to get up to about 35 (half way) so the B Complex that's needed when taking B12 will help there. Thorne Basic B is highly recommended.


    Vit D - 38nmol/L. This needs to be 100-150nmol/L ideally. D3 softgels 5000iu daily should be fine. Retest after 3 months then when you reach the recommended level you can reduce to possibly 5000iu alternate days, probably less in the summer. Retest once or twice a year.

    Don't forget D3's important cofactors K2-MK7 and magnesium. D3 should be taken 4 hours away from thyroid meds, as should magnesium.


    So optimising your nutrients should help.

    Also, you have autoimmune thyroid disease aka Hashimoto's, as your TPO antibodies are positive. Adopting a strict gluten free diet has helped many members reduce their antibodies. Also supplementing with selenium L-selenomethionine 200mcg daily and keeping TSH suppressed helps reduce them. Selenium also helps with conversion.


    Thyroid Function TSH L 0.15 0.27 - 4.20 mIU/L - irrelevant when on thyroid replacement so don't worry about this.

    T4 Total H 144.8 64.5 - 142.0 nmol/L - lots of T4 sloshing about

    Free T4 H 26.24 12 - 22 pmol/L - over range so probably taking too much Levo

    Free T3 4.11 3.1 - 6.8 pmol/L - very low in range considering how much total T4 you have, and your FT4 result. So your conversion is poor. Good conversion takes place when FT4:FT3 ratio is 4:1 (even 3:1) and yours is 6.38 : 1

    My opinion (I am not medically trained but this is what my results and conversion were like) is that you need to reduce Levo and start adding T3. Whether your doctor will agree is another thing!

  • Thank you very much SeasideSusie for your reply its very helpful. Nervous about adding T3....but easy does it! 😊

  • Believe me, there's nothing to be nervous about T3. It is the only active Thyroid Hormone and is required in every cell in our body. Our brain contains the most. Levo has to convert to T3 and some doctors keep our dose too low concentrating only upon the TSH and not relief of all our symptoms.

    I take T3 only and it has changed my health/life from bad to brilliant. Of course, not everyone would have the same effect.

  • Thanks Shaws..thats reassuring. Would you please PM me where you buy your T3 please. Time for me to take control.

  • I buy mine when I go on holiday from the pharmacist so put up a new post asking for details as I don't know any. Some people have also found a benefit with NDT.

  • Thanks shaws.

  • I would also check Iron levels and Ferritin levels and have your cortisol levels evaluated too . I would also add 200mcg of Selenium and Zinc that helps with conversions .

  • Your T3 is not high enough to support much exercise, because exercise uses it up, and as you are only taking T4, you are entirely dependant on conversion to replace it, which you don't do very well - does that make sense? lol In other words, you are making yourself more hypo by exercising, and will therefore put on more weight. Just gentle walking, swimming or yoga until your FT3 is optimised. :)

  • Thanks very much greygoose. Yes that does make sense to me. I had wondered about the exercise. Think I'll taper it down a bit and see what happens. Mind you my exercising consists of swimming and at least I've got that right. 😊Around 30 miles each week with the walking.

  • That sounds a lot to me. But, then, I've always hated walking!

  • One energetic pooch greygoose...and its my thnking time...been doing an awful lot of that lately.😊

  • Hope you've got somewhere nice to walk, then. :)

  • 100% Gluten free diet, plus supplements for improving low vitamin D, B12 and B complex may be enough

    As SeasideSusie says selenium can also improve conversion of T4 to T3. (Personally I take Solgar vitamin E with selenium)

    Zinc is very important for thyroid function too

    Vitamin C good for adrenals

    A good probiotic can help increase gut bacteria & fermented foods like kefir good too. It's common with Hashimotos to tend towards high yeast, candida in gut- probiotics can help fight this

    Lots of us also find it important to avoid ALL soya - including soya lecithin

    Important when taking B complex, if it contains biotin (most do) to stop taking it 4-5 days prior to any TSH test or you may get misleading result

  • Thanks very much SlowDragon for yiur very helpful reply. I'm already on my way with the supplementing but need to add in a few more. 😊

  • Yeah, it does look like you could do with some t3. Probably not that you are a poor converter, but on t4 only, we have to super cconvert to make up for the t3 that a normal thyroid would make, in addition to the stuff made by conversion.

    Its a common problem and here is a paper about it.


  • Thanks very much galathea...I'll definately read that paper. So pleased I found this site and the abundance of helpful informative people 😊

  • Hi do you have access to the complete paper or just the abstract ? It looks quite an interesting one and I have seen a link to it before. Many thanks

  • When I was on Levo , I a had a private test , the result was T4 33 (12-22) but T3 5.5 (3.1- 6.8) TSH 0.02 I felt like crap.

    No one could explain to me why my T4 was effectively over range by 50 % in order to achieve the T3 level , and further more , why the TSH , whilst low , still suggested the body was wanting some more.

    I have read medical literature stating that when a number of people who were on levo had full blood test's it was not uncommon to find over range T4 in order to achive the suppressed TSH and an in range T3. I have also read somewhere, reverse T3 can present as free T3 and be counted as such unless specifically testing to find reverse T3.

    Now , my amateur theory : does excessive amounts of T4 eventually convert to reverse T3 and present as normal free T3 in blood tests, making me more hypo, and then the TSH eventually rising again despite excessive T4 because it's trying to get some actual T3 made direct from the gland and not from conversion.

    Anyhow , moved to thyroid -S and levels look a lot more sensible. Good luck .

  • Yep,. Unused t4 is broken down so it can be disposed of. It breaks down into t3, t2 t1,. If it were allowed to break down into the very active t3 you would become hyperthyroid so it breaks down into the inactive rt3.


  • It looks like your over medicated. My doctor refused t3 so I got mine done with blue horizon last week and they got back to me stating my Free T3 is low 4.2 (optimal range on Thyroid UK is 4 -8.3) so I'm in the low range like yourself . I've been working out 3 hours a day and couldn't lose a pound! I've started to self medicate myself with T3 thats howndesperate i am and already in 2 days I feel great, no brain fog, alert and already lost 2 pounds....Yes only in 2 days!!!! It's been a rollercoster for past 2 years since having underactive thyroid!! Your TSH should also be around around 1.00 mark so 0.2 is low so I don't think you will benefit taking more levo. You need T3

  • Beepi "blue horizon last week and they got back to me stating my Free T3 is low 4.2 (optimal range on Thyroid UK is 4 -8.3)"

    Can I just point out that what it actually says on ThyroidUK is

    "The approx. reference range for Free T3 is 4 to 8.3"

    That is a generalisation and ranges vary from lab to lab.

    You have to use the range from the lab that does your test and with Blue Horizon the range for FT3​ is 3.1-6.8. So with a result of 4.2 you are 29.7% through the range.

  • Is that good or bad? And if so I feel better by adding T3?

  • Beepi Most people feel best when FT3 is in the upper quarter of the range so with the Blue Horizon range that would be about 5.9+ so yours isn't good. But we are all different on where we feel best and where we need our TSH/FT4/FT3.

    The thing to remember when using T3 is to stay within the range.

  • Thanks Beepi. Ive just sent you a PM.

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