Bloods after 1 month T3 trial

[rodrob]

Hi,

I would be grateful for advice. On 100mg T4, I was still hypo, but top of T4 range, bottom half T3 range , and so called 'normal' per Endo. Private testing shows RT3 at top of range and ratio to T3 of 14 (under the bottom range , being 15).

Felt slightly better on trial of 75mg T4, 10mg T3, but still low basal temp, no weight loss. Latest bloods now show as follows:

TSH *0.173 mIU/L 0.27 - 4.20

FREE THYROXINE 13.06 pmol/L 12.00 - 22.00

FREE T3 3.84 pmol/L 3.10 - 6.80

THYROGLOBULIN ANTIBODY 42.500 IU/mL 0.00 - 115.00

THYROID PEROXIDASE ANTIBODIES *169.4 IU/mL 0.00 - 34.00

I feel undermedicated, but dont know whether I should up T4, or considering my previous high RT3, maybe up my T3. Would say 75mg T4 + 15mg T3 be an acceptable 'next test' ratio? If I aim for say a NDT ratio of 4:1, then if i take 15mg T3, would my T4 need to be 60mg? But then I might drop below the T4 'norm range' . Bit confused as to what to try next. Bascially want to add more T3, but not sure how much T4 to take with it. I'm doing this without Endo (she is still angry at even prescribing T3, and with my TSH supressed, its pointless asking her.

Thank you kindly for any advice

[Clutter]

Rodrob,

TSH isn't suppressed until it is <0.1. Currently your TSH is low but you aren't over replaced because both FT4 and FT3 are also low.

If rT3 is top of range increasing Levothyroxine dose is likely to increase rT3. I would increase T3 dose by 10mcg as FT3 is low in range. T4:T3 ratio in a healthy human thyroid gland is 13:1 which is why many doctors think the T3 in NDT is too high in ratio.

[rodrob in reply to Clutter]

Thank you Clutter, that's very helpful, much appreciated