When is T3 prescribed

[Janeymc]

After trips to my Endo I am frequently surprised that she insists that I am converting thyroid hormones, despite my T3 and T4 readings being right at the bottom of the range, or indeed, just out (e.g. last reading 3.9, range 3.10 upwards; T4 14.7, range from 12). I believe that this makes me subclinical. TSH currently 2 (Its highest). At what point is T3 medication considered an option, according to bloods and symptoms (cortisol also suboptimal at 255 (330 range). Thank you.

[ITYFIALMCTT]

It might be easier for members to comment if it's practical for you to share all of your recent blood test results (e.g., TSH, FT4, FT3 with their reference ranges) along with any vitamin and mineral levels that you've obtained (e.g., B12, vitamin D, iron, ferritin, folate etc. with their reference ranges).

As I read it, you have:

TSH 2 (no range)

T4 (presumably FT4?) 14.7 (12-X)

T3 presumably FT3?) 3.9 (3.1-X)

Do you have the results of any antibodies tests?

If you're taking levo., what is your current dosage?

Apologies for all of the questions - it's just that you'd be asked all of this and it's helpful if you have this information.

[Janeymc in reply to ITYFIALMCTT]

Thank you for your response. My vitamin and mineral results were all normal. The readings were indeed T3 and T4. My antibodies are well in range.

I guess I am asking a general question, however. Regarding T3 and T4 and conversion- how low does it have to be to merit a T3 medication prescription?

Thank you

[Janeymc in reply to Janeymc]

Indeed, is there a general recommendation as to when T3 is prescribed?

[Saggyuk in reply to Janeymc]

Hi Janeymc

They put me on T3 only when my T4 levels were high but T3 levels were rock bottom showing I was not converting T4 into T3 at all. Plus I was still clinically very hypo with slow reflexes etc. Many wont prescribe at all anymore though to be honest as many don't even know what it is or enough about thyroid and primarily because of the cost of T3. You need to post all your results together from the same date including tsh with both parts of the range for people to comment properly as depends what they show together and different labs use different ranges. Subclinical is normally used when referring to those with tsh in the range of 5-10 approx and kind of meaning slightly hypo but NHS won't medicate yet.

However, your T3 and T4 levels both seem on the low side going by common lab ranges and your tsh would be better at 1 or below and T3 and T4 nearer the top of the range so you could do with an increase in your meds which should increase both your T4 and T3 levels. So initially you are under-medicated - your t3 is low because your T4 is low. My last Tsh came in at 1.53, T4 was 4.4 and T3 was 5 and I was still given an increase in my meds as felt crappy (T4 low as take T3 primarily).

What dose of meds are you on also?

You didn't give your range for cortisol only one number and I don't know whether the 330 was bottom or top range? If the bottom of the range is 330 and your result is 255, then adrenals need to be looked into further but if 330 was the top of the range, then this is different and depends on the bottom range?

You may want to post your vit levels in another post for comments as NHS are pretty pants in this regard and you need them all to be optimal.

[Janeymc in reply to Saggyuk]

Thank you for your detailed response. At present my cortisol is being investigated. I had the Synacthen test because my 9 am morning cortisol was at 255 (<330 being the marked for further testing).

I am on alternating 50 and 100 Levo and am pushing for an increase

[Saggyuk in reply to Janeymc]

Yes if 330 is bottom of range that this won't be helping. What happened with the Synacthen test - did anything come up? Should be investigated more. Liver function tests can be useful for looking into adrenal problems if you have had one as things like addisons will cause problems with your sodium and potassium levels. I know many on here have looked at "adrenal fatigue" if nothing comes of further testing - there is lots you can do with helping to improve adrenals including things like eating enough and controlling blood sugar levels and many other things. My cortisol was also well below range a few years back and felt awful and would pass out and they were about to investigate for addisons - funnily enough it stopped after going gluten free - and now a little on the high side lol!

An increase is a good start but unfortunately, it's often more complicated than that

If your ferritin is just in range, you should have a full blood count to check for indications of anaemia and work out what treatment is required. Also up your liver intake - can't stomach the stuff myself but am happy to eat chicken liver pate mixed in a source but if you have problems with absorption or digestive issues it might not help much. I'm assuming you do as on many vits so you need to maybe look into stomach issues as well.

Good luck

[Janeymc in reply to Saggyuk]

Thank you for your response. Endo appointment for discussion but also prepping myself for adrenal fatigue self- work. Acupuncture has been focussing on my liver and Yes, I have asked for a full break down of my full blood count .

I hate liver!! Unfortunately offal is about the only foodstuff I cannot stand, yet I have also read it is hugely beneficial in adrenal health. Also liquorice supplements as well as ginseng.

interesting what you say about gluten. I have been on Candida (anti fun!) diets before but do think the gluten free is worth persuing.

plenty to think about there.

Thank you

[Janeymc in reply to Saggyuk]

As an extra note on that...thankyou once again. I am deliberately not posting all my results as I am satisfied with the vit/ min readings and in all honesty, believe that what is required is a very slight increase in my dose, which you have helped me with with your comment regarding both low T4 and T3. If only the Endochrinologist would actually explain things properly!! I am currently also focused on my cortisol levels which again I suspect are low possibly due to intermediation of levothyroxine , putting me out of whack as a whole. I am sure you agree that the whole picture of any thyroid patient is complicated. I am therefore trying to focus on the bits which I now know to be problematic. Thank you again

[whispers in reply to Janeymc]

Is that a doctors "normal'? Because that is often not good enough. There is no general answer really to your question as there are so many other factors to be taken into consideration. So without the other results The nearest you can get is Saggy's reply.

To answer this question "Indeed, is there a general recommendation as to when T3 is prescribed?" Unfortunately No, there is no general recommendation

[Janeymc in reply to whispers]

Thank you for your reply..Those are my normals. I am mid range for those things with the exception of ferritin which is just in range.

[SlowDragon Administrator in reply to Janeymc]

Ferritin must be half way through range or thyroid hormones can not work

Vitamin D needs to be around 100nmol

Magnesium supplements can help too

Vitamin B12 toward top of range and definitely over 500

[Janeymc in reply to SlowDragon]

Hi Slow Dragon. I agree..I am looking at upping my ferritin as well.

[humanbean]

despite my T3 and T4 readings being right at the bottom of the range, or indeed, just out (e.g. last reading 3.9, range 3.10 upwards

Can I just point out that 3.10 is the same as 3.1 - the 0 (zero) adds no information to the number when it is to the far right of the decimal point. And 3.1 is < 3.9. So 3.9 was low in range but it was in range.

It is a common mistake to look at 3.10 and think "Well, 10 is higher than 9, so my result must be under the range". Quite a few of us have misread numbers that way.

[Janeymc in reply to humanbean]

Thank you for your response. The difficulty I have is understanding the functionality when the readings are in range but indeed very low..Yes , I am converting but not very well?.Or is that irrelevant?

[SlowDragon Administrator in reply to Janeymc]

It's very relevant, if vitamins are improved it can help, adding selenium supplements too

If you have Hashimoto's then strictly gluten free diet likely to help

Avoiding all soya including soya lecithin if possible may give noticeable improvements too

[Janeymc in reply to SlowDragon]

I take: selenium, iron, magnesium, B complex and B12, probiotics, zinc, vit D and evening primrose oil. Am looking into cortisol boosting supplements at the moment

[fibrolinda in reply to Janeymc]

What exactly? As in dosages Also you need the cofactor with vitamin d, k2 ,you already take magnesium. Which Iron and you need to take high dose vitamin c with it. Please post your results theres so much knowledge on here it would be a shame not to.

[SlowDragon Administrator]

What are your actual vitamin results? Normal or in range is very often inadequate

Always get actual results and ranges, post them here if you have them

Do you know if you have Hashimoto's, also called autoimmune thyroid disease, diagnosed by high antibodies

What are you actual thyroid results, TSH should be around one or slightly less, FT4 towards top of range

If you can't get full thyroid and vitamin testing from GP

thyroiduk.org.uk/tuk/testin...

Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have money off offers. DIY finger prick test or option to pay extra for private blood draw or

All thyroid tests should be done as early as possible in morning and fasting and don't take Levo in the 24 hours prior to test, delay and take straight after. This gives highest TSH and most consistent results

[Janeymc in reply to SlowDragon]

Yes, all tests done when fasting with no Levo that day. T4 is too low as is T3 . TSH too high at 2. I am pushing for an increase. Endo says I am perfectly replaced and risk heart issues etc by increasing (no heart history). I am talking about a tiny increase!!