FT3

[Pheonix51]

Hi,

Could anyone tell me how do you know if you would benefit from FT3 .I have always been on LevoThyroxine but never felt as if it was helping me. I was just wondering if taking FT3 would make me better.thanks wayne

[SeasideSusie Remembering]

You don't take FT3 - that is a blood test that is part of a thyroid panel - Free T3. You are wondering about the replacement hormone T3.

You would know if you might benefit from the addition of T3 by your thyroid tests. First you would need to have optimal levels of vitamins and minerals so that your thyroid hormone can work properly, then if your TSH is nice and low in range (1 or below), your FT4 high in range and FT3 low in range, then it would show that conversion of T4 to T3 is poor and it's likely that the addition of T3 would help.

[Pheonix51 in reply to SeasideSusie]

Hi there.thankyou for your quick response. .my Tsh is 1.43 normal range is 0.27 to 4.20

My T4 is 80.7 normal range is 59 to 154

Free T4 is 4.9 normal 3.10 to 6.80

Reverse T3 is 21 normal 10 to 24

Reverse T3 ratio 15.19 normal is 15.01 to 75

I am seeing a haematoligist on Thursday cause I have hight ferritin levels.

I am taking my vitamins b and D magnesium tablets..iodine vitamins...chromium.....intsonil choline.....folic acid.

Kind regards

Wayne staton

[SeasideSusie Remembering in reply to Pheonix51]

It's essential to have FT3 tested at the same time as FT4 to see how well you convert.

You need optimal nutrient levels:

Vit D - 100-150nmol/L or 40-60ng/ml

B12 - very top of range

Folate - at leasthalf way through range

Ferritin is best half way through range

Why are you taking iodine? Have you tested and found to be deficient?

[Pheonix51 in reply to SeasideSusie]

I am going to stop taking iodine .thanks for the great advice.my folate was 2.26 normal range 2.91 to 50....my B12 was 301.2 normal range is 140 to 724 vitamin D was 39.93 normal was 50 to 200

[LAHs in reply to SeasideSusie]

Hi SSS. In order to measure the efficiency of conversion of T4 to T3 which combination of T4 and T3 should we use? Is it TT4/FT3 or FT4/FT3 or TT4 /TT3 ? I guess if one is taking NDT or Cytomel etc that would add to TT3 so that would rule that combination out for non-levo people. I wonder if FT4/FT3 = TT4/TT3 in euthyroid people and if not, what would that mean?

[SeasideSusie Remembering in reply to LAHs]

"I wonder if FT4/FT3 = TT4/TT3 in euthyroid people and if not, what would that mean?"

I don't know for sure because we're all individual and I expect we all convert at a different rate that is suitable for our own needs if we're euthyroid.

To see how well you are converting you measure the unbound hormone so FT4: FT3 and you can only do that if taking Levo only. So yes, if you add T3 in any form - NDT or synthetic T3 - then you can't measure how well you're converting because you're adding T3 that isn't being produced by your body and that will be included so you can't get an accurate result.

That's my layman's understanding, the best person to explain this in a more scientific way is diogenes if he's around.

[LAHs in reply to SeasideSusie]

Thanks SSS, Yes, that makes sense. FT4 and FT3 are the only two truly "in play". The Totals could be thought of as in storage and not processed yet. Thanks.

[diogenes Remembering in reply to SeasideSusie]

TT4TT3 ratios are only the same as FT4/FT3 ratios when the proteins that transport the hormones through the blood are close to average. The further away from average the proteins levels are the more the total and free ratios diverge (the extreme difference being if a person lacks the strongest binding transport protein thyroxine binding globulin altogether - about 1/8000 people are like this). FT4/FT3 ratios are only useful for assessing conversion if you take T4 only. Over 4/1 and a suspicion arises of poor conversion.If T3 is being taken by mouth, any such measure is meaningless.

[diogenes Remembering in reply to diogenes]

I should expand this a bit more clearly. The TT4/TT3 relationship will move smoothly with FT4/FT3 with average protein levels. But in numerical terms a TT4/TT3 ratio of about 50/1 gives rise to a FT4/FT3 ratio of only around 3.5. As the amount of the strongest transport protein declines then at zero TBG the TT4/TT3 ratio falls to about 25-30/1, with the FT4/FT3 ratio remaining as it was at 3.5/1. This is because T4 bids 10 times more strongly to the TBG than T3, whereas with another transport protein albumin, both bind equivalently. One can only work out the relationships knowing the relative strengths of T4 and T3 binding for each protein and how much of each transport protein there is in an individual's blood.

[helvella Administrator in reply to LAHs]

LAHs,

I wonder if FT4/FT3 = TT4/TT3 in euthyroid people...

The amount of bound thyroid hormone is strongly related to how much binding protein (thyroxine-binding globulin (TBG), transthyretin (TTR), and albumin) is present. The amount of such protein is affected by many things.

There is also variation in strength of binding, specifically for albumin and T4, depending on genetic differences.

[greygoose in reply to Pheonix51]

You must have an FT3 in there, somewhere, or they wouldn't be able to work out your rT3 ratio. And it's the FT4 compared to the FT3 that shows how well you're converting. So, we need to see that.

Why are you taking iodine? Have you had it tested and found deficient? If not, you should not be taking it.

[Pheonix51 in reply to greygoose]

Hi there.I was taking iodine to help my thyroid. In fact I bought a book of vitamins to try and self diagnose my mood swings.lack of energy and weight gains. I am seeing a haematoligist next week as my ferritin levels is high.I am just trieng to do the right thing...

[greygoose in reply to Pheonix51]

But it won't help your thyroid. Iodine is just one of the ingredients of thyroid hormone, not some magic super cure. Taking it when you're hypo could make you ten times worse. It used to be given to people with hyperthyroidism, to lower their hormone production. It can also cause a host of other problems in excess.

[Pheonix51 in reply to greygoose]

Ok thanks for your reply.

[greygoose in reply to Pheonix51]

But, where is the FT3 result? You must have one in that list of results. You need to post it.

[Pheonix51 in reply to greygoose]

Would T3 help me at all.

[SeasideSusie Remembering in reply to Pheonix51]

It's impossible to answer that question until your vitamins and minerals are at optimal levels, and FT4/FT3 tested at the same time to see how well you convert, as already explained.

[ShootingStars in reply to greygoose]

Or, if no FT3 was tested, then whoever tried to calculate the RT3 ratio got it all completely wrong. It appears that there was no FT3 tested, so the attempt at the RT3 ratio calculation is incorrect.

[greygoose in reply to ShootingStars]

They couldn't even have attempted to calculate it without an FT3 result. How would you calculate anything with half the data missing? In any case, the rT3 ratio is irrelevant, just proof that there must be an FT3 result that hasn't been posted.

[ShootingStars in reply to greygoose]

You'd be surprised the things that people do. It's possible they used one of the other test results to try to calculate it. No, I'm not going to try the RT3 Ratio formula to find out.

[Pheonix51 in reply to greygoose]

Hi there.my FT3 was 4.9 the range is 3.10 to 6.80. My T4 was 80.7 the range is 50 to 154. My Tsh was 1.43 the range was 0.27 to 4.20 .

Hope that gives a better picture.

Wayne

[SeasideSusie Remembering in reply to Pheonix51]

Wayne

This isn't making sense.

You've just said:

"my FT3 was 4.9 the range is 3.10 to 6.80."

In a post further up you said:

"Free T4 is 4.9 normal 3.10 to 6.80"

With that range the result will be FT3.

However you have said:

"My T4 is 80.7 normal range is 59 to 154"

That is not FT4, that is Total T4 and of no use when trying to see if you convert T4 to T3 well enough, it has to be FT4.

With all these results, somewhere there must be FT4 or maybe it's described as Free T4.

As already said you have to have FT4 and FT3 done at the same time.

But with these nutrient levels:

folate was 2.26 normal range 2.91 to 50

B12 was 301.2 normal range is 140 to 724

vitamin D was 39.93 normal was 50 to 200

then no way is your thyroid hormone working at the moment so you must improve those to optimal levels (which I've given above) before you can see whether you convert T4 to T3 and whether you need the addition of T3.

So for now, forget whether or not you need T3. Concentrate on optimising your vitamins and minerals.

It would also be a good idea to have thyroid antibodies tested - Thyroid Peroxidase (TPO) and Thyroglobulin (TG).

[Pheonix51 in reply to SeasideSusie]

Hi Seaside susie. Thsee are my results as it says on the test.

Thyroglogulin antibody

Result 104.900

Range 0 to 115

Thyroid peroxide antibody

Results 44.43

Range 0 to 34

Inflammation marker

CRP -high sensitive result

0.7 range 0 to 5.0

Ferritin

Result 718.1

Range 30 to 400

Tsh result 1.43

Range 0.27 to 4.20

Free thyroxine

Result 15.49

Range 12 to 22

Total thyroxine (T4)

Result 80.7 range 59 to 154

Free T3 result 4.9

Range 3.10 to 6.8

Reverse T3 result 21

range 10 to 24

Reverse T3 ratio

Result 15.19

Range 15.01 to 75

Hopefully this is a clearer picture

Have a good day.thanks for all your helpful advice

Wayne

[SeasideSusie Remembering in reply to Pheonix51]

Wayne

Ferritin:718.1

(30 to 400)

This obviously needs sorting with your haematologist.

**

Tsh: 1.43 (0.27 to 4.20)

Free thyroxine:15.49 (12 to 22) This is your FT4 and is 34.9% through it's range

Free T3: 4.9 (3.10 to 6.8) This is 48% through it's range

Your TSH is fairly close to 1 so we can see roughly how well you convert. Looking at where the results lie in range, your FT3 is higher through it's range than FT4 so you convert well. Your FT4:FT3 ratio is 3.16 : 1 and good conversion takes place when the ratio is 4:1 or less, so again this confirms good conversion. You have no current need for T3 but you should have an increase in your Levo to bring your FT4 and FT3 up to the higher ends of their ranges as per thyroiduk.org.uk/tuk/about_... > Treatment Options:

According to the BMA's booklet, "Understanding Thyroid Disorders", many people do not feel well unless their levels are at the bottom of the TSH range or below and at the top of the FT4 range or a little above.

The booklet is written by Dr Anthony Toft, past president of the British Thyroid Association and leading endocrinologist. It's published by the British Medical Association for patients. Avalable on Amazon and from pharmacies for £4.95 and might be worth buying to highlight the appropriate part and show your doctor. However, I don't know if this is in the current edition as it has been reprinted a few times.

Also -

Dr Toft states in Pulse Magazine, "The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance.

But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."

You can obtain a copy of the article by emailing [e-mail] print it and highlight question 6 to show your doctor.

**

Reverse T3 and ratio are fine.

**

Thyroglogulin antibody: 104.900 (0 to 115)

Thyroid peroxide antibody: 44.43 (0 to 34)

TPO antibodies confirm autoimmune thyroiditis aka Hashimoto's which is where antibodies attack the thyroid and gradually destroy it. The antibody attacks cause fluctuations in symptoms and test results.

You can help reduce the antibodies by adopting a strict gluten free diet which has helped many members here. Gluten contains gliadin (a protein) which is thought to trigger autoimmune attacks so eliminating gluten can help reduce these attacks. You don't need to be gluten sensitive or have Coeliac disease for a gluten free diet to help. Supplementing with selenium l-selenomethionine 200mcg daily can also help reduce the antibodies, as can keeping TSH suppressed.

Gluten/thyroid connection: chriskresser.com/the-gluten...

stopthethyroidmadness.com/h...

stopthethyroidmadness.com/h...

hypothyroidmom.com/hashimot...

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

**

Hashi's and gut/absorption problems tend to go hand in hand and low nutrients are often the result, as yours are:

folate: 2.26 (2.91 to 50)

B12: 301.2 (140 to 724)

vitamin D:39.93 (50 to 200)

So first thing to do is optimise these results. If you post what supplements you are taking and the dose, we can see if you are taking enough of the correct thing or whether you need to change anything.

However, you should address the absorption problem according to the information and links in SlowDragon 's reply to this post so that your supplements can do their job healthunlocked.com/thyroidu...

[Pheonix51 in reply to SeasideSusie]

Hi there..my supplements are as follows.

Evening primrose oil 1000mg. ...D3 3000iu......chromium 200 mcg. ..K2 200ug....coQ10 100 mg....advanced B complex 1 capsule....inositol and choline 400 mg each....Magnesium malate 425 mg and probotic high strength 10 billion probotic.

Thanks wayne

[SeasideSusie Remembering in reply to Pheonix51]

Wayne

vitamin D:39.93 (50 to 200) D3 3000iu

As you need to aim for 100-150nmol/L (recommended by Vit D Council), then you should increase your D3. Don't know the brand you're using but as you have Hashi's then for best absorption change to an oral spray. BetterYou do 3000iu and 1000iu doses. I suggest you take 2 x 3000iu so your daily amount is 6000iu for the next 3 months then retest.

When you've reached the recommended level then you'll need a maintenance dose which may be 2000iu daily, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. You can do this with a private fingerprick blood spot test with City Assays vitamindtest.org.uk/

(I am assuming you are in the UK)

There are important cofactors needed when taking D3

vitamindcouncil.org/about-v...

D3 aids absorption of calcium from food and K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems.

D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds.

Magnesium helps D3 to work and comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds

naturalnews.com/046401_magn...

Check out the other cofactors too.

BetterYou do a D3 single supplement, they also do a D3/K2-MK7 combined supplement which would mean you only have to get the magnesium separately.

**

folate: 2.26 (2.91 to 50) B12: 301.2 (140 to 724) advanced B complex 1 capsule

You are folate deficient and your GP could be prescribing folic acid for that. Also, check to see if you have any symptoms of B12 deficiency (it's not unknown for them to be present even with a level in the 300s) b12deficiency.info/signs-an... If you have any symptoms then you should post on the Pernicious Anaemia Society forum for further advice b12deficiency.info/signs-an... otherwise you can self supplement.

I have read (but not researched so don't have links) that BCSH, UKNEQAS and NICE guidelines recommend:

"In the presence of discordance between test results and strong clinical features of deficiency, treatment should not be delayed to avoid neurological impairment."

And an extract from the book, "Could it be B12?" by Sally M. Pacholok:

"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".

"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."

To self supplement for your level, I would suggest sublingual methylcobalamin lozenges 5000iu daily then when the bottle is finished change to 1000iu daily as a maintenance dose.

We need a B Complex when taking B12 to balance all the B vitamins. I don't know what is in yours as I'm not sure of the brand. However, if it doesn't contain 400mcg methylfolate I would change to Thorne Basic B.

I don't know the reason for you taking inositol and choline, but Thorne Basic B does contain choline in balance with the other B vitamins.

**

So if you can optimise your nutrients with good quality supplements, and by addressing the absorption problem then you should be able to absorb the supplements well enough to get your levels up, then your thyroid hormone should be able to work better.

[Pheonix51 in reply to SeasideSusie]

Hi susie.thankyou very much for your advice.

So I will start taking selenomethione 200 mcg daily....methylcobalamin lozenges 5000iu until I use up all the pack....throne basic b.....better for you spray which I have but stopped using it cause I didnt think it worked.I probably never gave it chance.I can take three magnesium tablets a day at 425 mg each daily,do you recommend a dosage,I have been taking 1....K2...I work nightshift 5 nights a week driving a tanker.I live in the uk.

[SeasideSusie Remembering in reply to Pheonix51]

Wayne

I'm not sure you need 3 x magnesium at 425mg each. The normal dose for magnesium is between 350 and 450mg a day, depending on brand. Be careful what time you take your magnesium, it can be calming and you don't want to be too relaxed when you're driving!

K2-MK7 at around 100mcg is the usual dose.

And only self supplement with B12 if you have NO symptoms of B12 deficiency, if you have you need to post on the PA forum for further advice.

[Pheonix51 in reply to SeasideSusie]

Ok thankyou.my B12 was classed as insufficient.

[SeasideSusie Remembering in reply to Pheonix51]

It will be at that level, but have you checked the list of signs and symptoms of B12 Deficiency which is extremely important.

[Pheonix51 in reply to SeasideSusie]

When I went to the doctors, the result came back as insufficient.

[SeasideSusie Remembering in reply to Pheonix51]

Yes, but that's just a number on a piece of paper or computer screen. What's important is if you have any symptoms and you haven't said whether or not you have, or whether you've checked the list of signs and symptoms.

As already stated above, the BCSH, UKNEQAS and NICE guidelines recommend:

"In the presence of discordance between test results and strong clinical features of deficiency, treatment should not be delayed to avoid neurological impairment." So if you do have any signs of symptoms they need investigating and treatment started.

And an extract from the book, "Could it be B12?" by Sally M. Pacholok:

"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".

"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."

and these are the levels to aim for.

[SlowDragon Administrator in reply to Pheonix51]

Correcting vitamin levels as outlined by SeasideSusie is essential

Plus going absolutely strictly gluten free helps very many (over 80%) with Hashimoto's

You may find antibodies slowly fall as result

Your high ferritin obviously needs looking at

Slightly high ferritin can be connected to Hashimoto's

But your level is very high.

Once you have all this sorted you may find you need increase in Levo

Retest in month or two

You probably don't need to pay for Reverse T3 test again.

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.

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

[LAHs in reply to greygoose]

Excellent observation gg! (re must have FT3 to calculate FT3/rT3 ratio). Sorry, my reply is about 3 yards down from your post.

[cjrsquared]

As greygoose has said you need TSH, ft3 and ft4 to see how well you are converting the prohormone (t4) to the active hormone (t3). If you are high in range with ft4 and low in range ft3 you may have a conversion problem BUT if vit d, vit b12, ferritin and folate are low it might just be that your body cannot convert due to these being low. The first thing to correct is these deficiencies then if there is still a discrepancy between ft3 and ft4 it would be ok to consider adding some additional t3.

[Pheonix51 in reply to cjrsquared]

Ok thankyou. I am taking my vitamins and I am seeing a haematoligist next week.so hopefully he will give me another blood test to see if my vitamin levels have improved.I will get a private test if they don't. Many thanks once again wayne

[ShootingStars in reply to Pheonix51]

Have him re-run your TSH, FT4 and make sure he runs FT3, all together. Run the RT3 also, if you want. Only then will you know the status of how well your thyroid functions and if you need to supplement T3 or not.

[Dodie26 in reply to ShootingStars]

The T3 test will probably be named liothyronine on your blood test results? 🙂

[ShootingStars in reply to Dodie26]

Liothyronine is the medication that some of us take. Triiodothyronine is what is tested in T3 tests.

[shaws Administrator in reply to Pheonix51]

All blood tests for thyroid hormones have to be at the very earliest and fasting (you can drink water) and allow a gap of 24 hours from your last dose and the test and take afterwards. This gives the best results for us.

[Irishcurls]

I was taking Levothyroxine for about one year and started having muscle aches and foggy thinking and depression. I asked my doc for T4/T3 combo and it made a huge difference! Just make sure you don’t get T4 depleted or it will get worse. I take 48.75 mcg of Naturethroid and add 50mcg of Tirosint to keep my T4 in the mid range. So essentially I take 78.50 T4 and 6.75 T3.