Time to start T3?

[TheresaBlack]

Posting for a friend who is getting no serious support from her doctor despite having recently been checked and told her thyroid nodules have significantly changed in shape and size....she is awaiting a scan and her tests came back as below:

Vit D (75.00-200.00nmol/L) - 60

Free T4 (9.00-24.00pmol/L) - 15.2

Free T3 (3.50-6.50pmol/L) - 4

TPA (0.00-50.00iu/mL) - 555

To me, that's a pretty terrible set of results but all the GP has done is refer for a scan and increase her thyroxine to 175 from 150 daily. She has been told 20 minutes in the sun every day should improve her vitamin D levels.... would anyone out there who is more knowledgable than me agree she needs T3 supplementation as well as Vitamin D?

Any other ideas would be gratefully received, as would the contact details for whoever has the most up to date list of helpful endos.

Thanks in advance everyone x

[shaws]

Some doctors make stupid comments. Why cannot he provide Vit D3? How long would she have to be in the sun to up her D to 200 or is he prescribing an exotic holiday in the sun?

FT3 bottom of range and she isn't converting T4 to T3 but I doubt her doctor will prescribe T3 due to UK guidelines. She could source some herself if she puts up a post asking for a private message to be sent but I know it is very difficult at present.

[TheresaBlack in reply to shaws]

Thanks. I know it's difficult to get T3 but I think it's worth a try to find someone. Thanks for your help.

[Clutter]

TheresaBlack,

Your friend's results aren't terrible. FT4 and FT3 are both euthyroid (normal) but on the low side. Increasing dose will raise FT4 and FT3. What is your friend's TSH?

Thyroid peroxidase antibodies are positive for autoimmune thyroid disease (Hashimoto's). There is no cure for Hashimoto's which causes 90% of hypothyroidism. Levothyroxine treatment is for the low thyroid levels it causes. Many people have found that 100% gluten-free diet is helpful in reducing Hashi flares, symptoms and eventually antibodies.

chriskresser.com/the-gluten...

thyroiduk.org.uk/tuk/about_...

Vit D is sub optimal, optimal is around 100 but I doubt anyone would feel ill with vitD 60. Your friend could supplement 5,000iu D3 daily for 6 weeks and then reduce to 5,000iu alternate days and retest in 3-4 months. VitD should be taken 4 hours away from Levothyroxine.

Email [e-mail] for a list of member recommended endos.

[TheresaBlack in reply to Clutter]

Thnaks for the links. Her TSH is 5.8 (0.35-5.00mu/l) so a bit elevated. I understand about hashimotos as I have it myself but she is in a very poor state and feeling terrible. Thyroxine alone is not helping and the nodules seem to have increased in size recently. Her doctor has mentioned the possibility of surgery. But I can't help thinking she needs to see someone who will be prepared to consider other treatment strategies.

Thanks for your reply.

[Clutter in reply to TheresaBlack]

TheresaBlack,

Thyroxine isn't helping because 150mcg wasn't enough. She should have a follow up thyroid test 6-8 weeks after the increase to 175mcg in case she needs another increase. She should be aiming for TSH 0.35 - 1.0 with FT4 in the upper quadrant and FT3 in the upper third of range.

If the nodules are compromising nearby organs surgery is the only option currently. Levothyroxine sometimes shrinks nodules but obviously not in your friend's case.

[TheresaBlack]

Thanks. I'll tell her to ask for a test in a few weeks.

[SlowDragon Administrator]

She also needs B12, folate and ferritin checked. Likely to be too low as well

Gluten free diet for 6 months to see if it helps too.