Low T3 so Endo is proposing 5mcg of Liothyronine

[Trademole]

I am a 54 year old male who first posted in the group 2 years ago. At the time i was suffering from severe fatigue, irritability, brain fog and anxiety. I managed to get to see an Endo who diagnosed Secondary Hypothyroidism, low Vit D and low testosterone. Two years ago my readings were

Vit D 50 (>75)

TSH 1.8 (0.3 - 5.00)

FT4 11.8 (8.8 -18.8)

FT3 4 (2.8 - 6.5)

Testosterone 9.4 (9 - 30)

I had other tests that showed a multi-nodular goitre with no suspicious features, an MRI of my pituitary which didnt show anything unusual and a short synacthen test for my adrenal function which was slightly on the low side - i took Hydrocortisone 10mg for a month but it had no real impact and cost a fortune!

For the past 2 years i have been receiving testosterone jabs every 10 weeks, taking Vit D and have been on 150mcg of Levothyroxine. Although my Vit D and Testosterone readings have responded i feel no different than i did 2 years ago.

My latest readings are

Vit D 140 (>75)

TSH 0.6 (0.3 - 4.2)

FT4 18 (12 - 22)

FT3 3.3 (3.1 - 6.8)

Testosterone 33 (9 - 30)

My Endo has basically said "I think you have Chronic Fatigue Syndrome but maybe you arent converting T4 to T3 so we could try Liothyronine 5mcg and see if that does anything".

He may well be right but i thought i would see in any of the knowledgable folk in here have anything to add.

Thanks a lot

Mark

[ITYFIALMCTT]

Well, it's good to see that some endocrinologists are still willing to prescribe T3. I'd hope that 5mcg is a dose from which it's expected that you will titrate until you find your appropriate level - i.e., you're not expected to stick with that dosage and then base whether or not you continue from just that because I doubt that it will have much influence.

[ITYFIALMCTT]

If you have the results of your recent vitamin and mineral levels like iron, ferritin, folate, vitamins B12 and D, plus the full blood count (FBC) please post them, along with their reference ranges, as it will help members to comment. You mention your vitamin D level - and that looks like it has improved but it's tricky to comment on other items without similar results and ranges.

If you don't have the results, please obtain a copy by contacting your GP's reception, and then post them, with details of your anything that you're taking, along with their dosages and for how long you have been using it. etc. and that might allow members to make helpful observations or suggestions.

If you don't have some vitamin or mineral test results because you've never had them, please request them when you talk to your GP or whomever you see to discuss these results.

[SeasideSusie Remembering]

Trademole Well those latest results definitely show a need for T3 to be added, your conversion is very poor. But be warned, your endo is starting you on 5mg, which is fine; however, that dose is unlikely to do very much, you will need it increasing but endos like to set us up to fail so they can stop prescribing it, so if he says something along the lines of it's not working so we'll stop it, and you're still on 5mg, then make sure you ask for an increase. Then if 10mg hasn't made much difference and he wants to stop it, ask for 15mg.

What you need to do is keep your eye on the FT3 result, if it doesn't get tested then tell your endo that as you are taking T3 then it is essential to check your level. You can increase to whatever is needed to alleviate your symptoms as long as FT3 stays in range. But again, be aware that the NHS wants to de-prescribe T3 due to it's cost so your endo will most likely argue that it's not helping, or worse still you will see a different one who will take it away because he doesn't support it!

Your Vit D is good, you need a maintenance dose to keep it at that level, and are you taking D3's important cofactors vitamindcouncil.org/about-v... particularly magnesium and K2-MK7.

What about B12, folate and ferritin? All are important and should be at optimal levels. If not already tested, ask for them to be done, ferritin must be at least 70 for thyroid hormone to work, preferably half way through it's range. B12 should be at the top of it's range and folate at least half way through it's range.

Have you had thyroid antibodies tested? Something else that's important.

[Trademole in reply to SeasideSusie]

Thanks for the advice Susie, i had the antibodies tested 2 years ago and there was no problem with those at all. I've not had Ferritin, Folate or B12 tested and have no idea why he wouldnt test those at the same time - seems very odd. I will get them done.

What would your suggestion be in terms of D3 cofactors? How much and what type of magnesium and K2-MK7?

Fortunately he is a private Endo so im not battling the NHS with this

[SlowDragon Administrator]

For full evaluation you need TSH, FT4, FT3, TT4, TPO and TG antibodies, plus vitamin D, folate, ferritin and B12 tested

If you can not 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.

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

[Nanaedake]

I don't know much about secondary hypothyroidsm but can you tell me what reason your Endo diagnosed secondary hypothyroidism? The reason I ask is that I thought that TSH, FT4 and FT3 all needed to be low to indicate secondary hypothyroidism but as I say, I don't know much so I'd be interested to know more about it and understand how the diagnosis was reached.

As SeasideSusie says, it's important to have thyroid antibodies tested. TPO or Thyroid Peroxidase and Thyroglubulin or TgAb.

[Angel_of_the_North in reply to Nanaedake]

TSH just needs to be lower than you would expect given the Free T4 and free T3. So under range frees with a TSH of 2.5 could indicate secondary or central.

[Trademole in reply to Nanaedake]

According to my Endo "my "hypothyroidism is due to pituitary TSH insufficiency i.e. secondary hypothyroidism"

[shaws]

You are definitely not converting T4 to T3 and that is what it is supposed to do. 5mcg is a very small dose You can see you aren't converting so why give you T4 if you cannot convert? You should be on T3 only although there's been restrictions but you have a medical need.

[Trademole in reply to shaws]

Im not sure why i have been on T4 for 2 years before he came to the conclusion that im not converting it into T3

[Trademole]

Thanks, if ferritin, folate & B12 turn out to be low what is the best method of boosting?