Does Ft3/ft4 ratio always increase on levothyroxine?

[lisan1]

My ratio was approx 1/3 before starting Levo and 2 months ago 1/4.6 is this always the case after starting levothyroxine?

Antibody who knows?

[greygoose]

It depends how well you convert.

[lisan1 in reply to greygoose]

Thanks!

So if I had that change from without any meds to less good ratio I assume that will continue and I'm a bad converter. Will have a new blood test next week.

[greygoose in reply to lisan1]

To know how well you are converting, it is necessary to have both the FT4 and the FT3 done at the same time. If your doctor just tests the TSH, it won't tell you anything.

[lisan1 in reply to greygoose]

Yes, I've learnt that from you here. Latest results on 112.5 mcg levo was

Tsh 0.05(0.35-5.5)

Ft4 19.4 (10-19.8)

No ft3 done at GP

On lower dose (87,5) 6 weeks prior that result I did a medichecks test

Ft3 4.1 (3.1-6.8)

Ft4 18.6 (12-22)

All vits are optimal.

[greygoose in reply to lisan1]

OK, so you don't convert very well, then. So, I don't know if the ratio will get any worse, but it won't get any better. With your FT4 up near the top of the range, there, you'll be converting to rT3, rather than T3. What you need is a reduction in T4 and the addition of some T3.

Unless, of course, you're taking your levo before the test...

[lisan1 in reply to greygoose]

How much would you recommend reducing the T4 and how much T3 to add?

[greygoose in reply to lisan1]

You didn't answer my question. Did you leave 24 hours between the last dose of levo, and the blood draw?

[lisan1 in reply to greygoose]

Sorry yes I did.

I will not get my T3 pills for another week. Shall I reduce T4 now and add T3 when it arrives? And if you could please advice on dosage.

[greygoose in reply to lisan1]

No, stay on that dose for the time being, because if you reduce now, your FT3 will also reduce. Start on a low dose of 6.25 mcg (quarter of a pill) and increase by 6.25 in two weeks. Then reduce the T4 by 12.5 mcg.

Continue increasing the T3 every two weeks until you get to 25 mcg, hold for 6 weeks, and get tested.

[lisan1 in reply to greygoose]

Thank you so very much!

[greygoose in reply to lisan1]

You're very welcome.

[lisan1 in reply to greygoose]

Hi,

I've got my new results now

Tsh 0.05

Ft4 19.8 (12-22)

Ft3 4.9 (3.1-6.8)

Want to start adding T3 how to best proceed?

Thanks.

[greygoose in reply to lisan1]

Start with a quarter tablet - 6.25 mcg - for two weeks, then increase by another quarter. Continue like that until you get to one whole tablet.

When you get to one whole tablet, reduce T4 by 25 mcg, and hold for six weeks, then test.

[lisan1 in reply to greygoose]

Won't that be too much since my ft3 is already 4.9? And my ft4 it's rather high in range? How soon will I notice a difference and is it likely that I will have day heart rate and other symtomen off tio much? As you can see I'm a bit afraid to start...😬

[greygoose in reply to lisan1]

Your FT3 is only just mid-range. And, adding T3 won't have any effect on your FT4. And your T4 isn't converting to T3, otherwise, you wouldn't need to take T3.

There's no knowing when you will feel a difference. Some people feel it straight away. For others, it takes a while.

But, you don't have to follow the plan I laid out above, you can go at your own speed. You asked me for my opinion, but - as we're all so different - that won't necessarily work for you. You have to play if by ear, so how you feel, go slower - as long as you don't go any faster, that's ok.

You should be ok at least up to half a tablet, that's not likely to make your FT3 over-range. If you want, stop at half, reduce your T4, hold for six weeks and test. It's all trial and error. Nothing is written in stone.

[lisan1]

Yes, I've learnt that here. Latest results on 112.5 mcg levo was

Tsh 0.05(0.35-5.5)

Ft4 19.4 (10-19.8)

No ft3 done at GP

On lower dose (87,5) 6 weeks prior that result I did a medichecks test

Ft3 4.1 (3.1-6.8)

Ft4 18.6 (12-22)

All vits are optimal.

[humanbean in reply to lisan1]

lisan1, greygoose won't know that you've replied to her. For her to be alerted that she has a reply you have to press the Reply button on the post greygoose wrote that you are answering.

[lisan1 in reply to humanbean]

Thanks!

[diogenes Remembering]

I'm presuming that before you took T4, you were hypothyroid. When you become hypothyroid, the failing T4 output from the gland is partly compensated by increased T4-T3 conversion by the body to try to make up the T3 required. The body doesn't fully succeed of course but it tries. Therefore in this situation the FT4/FT3 ratio will be smaller. When you take T4, the original situation is changed - now you have sufficient T4 and the proportional conversion will fall to produce adequate T3 so the FT4/FT3 ratio will rise. However, your therapy ratio is still high indicating inaquate conversion.

[lisan1 in reply to diogenes]

Thank you so much for the explanation!

Will test again for ft3 ft4 and tsh before starting T3.

We'll come back with results when I get them.

[lisan1 in reply to diogenes]

Hi,

I've got my new results now

Tsh 0.05

Ft4 19.8 (12-22)

Ft3 4.9 (3.1-6.8)

Want to start adding T3 how to best proceed?

Thanks.

[diogenes Remembering in reply to lisan1]

First try very cautiously a very little more T3, keeping T4 where it is. Wait and see say a month for your response. If you have bad symptoms then try to reduce T4 a little. Wait and see again. Its a juggling act to find your sweet spot. Somewhere there is a optimal balance of T3 and T4 right for you. its a matter of fine tuning and watching your response.

[lisan1 in reply to diogenes]

Thank you very much for your advice. I'm not currently taking any T3 so do you think adding 6.25mcg T3 and keeping levo at the same amount would be an ok way to try?

[diogenes Remembering in reply to lisan1]

If you do, do the minimum to begin with and see what transpires over say a month.

[lisan1 in reply to diogenes]

Thank you! Think I will drop levo to 100mcg to take same amount every day and then add 6.25 mcg T3. Will keep track of heart rate and temperature. Hope this will help.

Thanks again!

[ChrisH100 in reply to lisan1]

Just reading your note - do you still have symptoms as your levels look good...

[lisan1 in reply to ChrisH100]

Yes, I do.