Low T3 and below mid-range thyroid hormones - do I need medication?

[Cofy]

Hi All! I am new here, and hoping to find a solution via your helps.

I am 25 (female). It has been hard to lose weight and even maintain my weight for last 2 years. I do exercise regularly. I tried low carb, more exercise, better sleep etc... nothing seemed to help. I had some other hypothyroidisim symptoms + a bad thyroid history in my family. So I started visiting endocs. In 5 different lab tests over last 9-10 months, my T3, T4, FT3 and FT4 has been always much below the mid range, mostly nearly on the low edge. Docs refused medication because my TSH has been normal too. Then anpther endoc found out I have insulin resistance - despite my not-too-bad eating habits and routine exercise. He prescribed me metformin 2 months ago. Normally what Inread online, people use metformin to lose weight even if they don't have any health problem. But it didn't help me in that way, but just made it a "little" easier to maintain my weight (if it's not placebo But weight loss is still very hard for me,my hair loss increased, and I can still say that this is body was tottally different 2 years ago.

I missed a period last month, which was very frustrating to me as my periods are very regular. I visited a gynecologist. He wanted to see my thyroid hormones as everything seemed normal. Here are my final results;

FT3 3.60 (range 3.10-6.80)

FT4 13.90 (range 12.00-22.00)

T3 0.75 (range 0.80-2.00)

T4 6.02 (range 5.10-14.10

TSH 1.30 (range 0.30-4.00)

Gynecologist said it's okay, but I have my shmptoms, and what I know is, these hormones are optimal when they are above their midranges. Unfortunatelly I couldn't find a lab that tests reverse T3 (RT3) in the city I live. I only found one that sends the blood to US and beings the results in 3-4 weeks. I got it done 3 months ago. So the results from that time:

RT3 18 (range 10-24)

I read that if RT3 is higher than 15 (in another source it says 12) it is mot a good sign.

I suspect that I have Low T3 Syndrome (Euthyroid Sick Syndrome) actually. Again, I read that a stressfull health condition in the oast and a very low calorie diet/yoyo diet history may cause this - which applies to my history. And also, I read that it may cause insulin resistance and other hormone problems (reminds me of missed period) too!

What to you think about my condition? What should I do?

Thank you in advance!

[greygoose]

I think you should be :

a) Testing your nutrients : vit D, vit B12, folate, ferritin

b) Testing your cortisol : 24 hour saliva test

c) Considering Central Hypo, where the problem is not with the thyroid gland, itself, it's with either the pituitary or the hypothalamus, meaning that not enough TSH is being produced to stimulate the thyroid to make hormone.

Your thyroid hormone results have nothing to do with your rT3, because your FT4 is too low. The high-ish rT3 could be because you have a bug, or something, or low iron.

I doubt it's Low T3 Syndrome, because your FT4 is also too low. Your Totals are also very low. In short, your thyroid just isn't producing enough hormone because it's not being sufficiently stimulated by TSH.

[Cofy in reply to greygoose]

Thank you so much for your answer Greygoose, I appreciate this!

My ferritin, vit D and B12 are always low. I take supplements, and then it doesn't take long from them to turn back to the low levels. My ferritin has never reached to mid-range, actually doctors tell me to stop taking ferritin supplement before it can reach to the midrange. The latest time I had taken supplements for vit D and ferritin was for 6 weeks, and 2 months ago. They were not great but they were okay the last time I checked them. 5 days ago, I started taking ferritin, vit D and B12 again. I am planning to maintain this cure for 1 month, and then I will keep taking B12 and ferritin another 2-3 weeks.

Do you think low B12, vit D and ferritin causes low levels of totals or do low levels of totals cause low B12,vit D and ferritin?

I will go to another endoc 2 days later, for one last time. I am so tired of trying to convince them I want to give a try to a thyroid medication. 4 of them refused medication before but my results were slightly better. Could you advise me medication if the next doctor doesn't accept medication too? Otherwise I will try to find a drug by myself - which makes me scared as it is a serious thing.

[greygoose in reply to Cofy]

OK is not good enough. They need to be optimal. But, never listen to doctors when it comes to nutrition, because they know nothing about it! You are going to need to get your levels to optimal, whatever your doctors say, and keep taking maintenance doses for the rest of your life.

No, low levels of nutrients don't cause low levels of thyroid hormone, but they do affect the way your body uses the hormone that it's got. They also affect the conversion of T4 to T3.

It's not medication and drugs that you need, and you mustn't call them that. What you need is thyroid hormone replacement. But more than that. You need to convince your endo to consider Central hypo and test for it. Because the pituitary doesn't just produce TSH, it produces a lot of other hormones, with regulate other glands in your body, which could also be low, causing more problems. If that is the case, just replacing thyroid hormones won't be enough to make you well. So, suggest to them that your results are typical of Central Hypo, and could they please do the right tests.

If the pituitary tests come back negative, then we can talk about self-treating.

[Cofy in reply to greygoose]

Such a great explanation! Thank you so so much. I have been reading a lot, but I've got confused at the end of the they. You really enlightened me! I will try my best to convince the next doctor for the pituitary tests. And I will ask for your help if they come back negative for the next step. I hope you don't mind it

[greygoose in reply to Cofy]

You're more than welcome.

Just write a new post, and let us know how you get on, and you'll get plenty of help.

[SlowDragon Administrator]

Are you in the U.K.?

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

See if you can get full thyroid and vitamin testing from GP.

Private tests are available

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. This gives highest TSH and most consistent results

Link about antibodies

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

Link about thyroid blood tests

thyroiduk.org/tuk/testing/t...

Print this list of symptoms off, tick all that apply and take to GP

thyroiduk.org/tuk/about_the...

The fact that your ferritin, vitamin D and B12 are always low indicates a definite gut problem

Could be coeliac, or low stomach acid or Hashimoto's with causes low stomach acid and gluten intolerance

[Cofy in reply to SlowDragon]

Thank you for your advices about aditional tests. Unfotunatelly I am not living in the UK.I will primy ask about all these tests to the endoc I will see on Saturday. I see on one of these links that I have other symptoms that I have been complaining about for a long time.

I have always complained about my gut sensitivity, since I have known myself. I will also ask the doctor about low stomach acid and coeliac too. Everyone seems gluten intolerant these days. I will find the way to check if I have it too.

Again, thank you for these informations.

[SlowDragon Administrator in reply to Cofy]

USA typically leads the way in gut, gluten and thyroid connection

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

But don't be surprised that GP or endo never mention gut, gluten or low vitamins. Hashimoto's is very poorly understood

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

thyroidpharmacist.com/artic...

thyroidpharmacist.com/artic...

amymyersmd.com/2017/02/3-im...

chriskresser.com/the-gluten...

scdlifestyle.com/2014/08/th...

drknews.com/changing-your-d...

[Angel_of_the_North]

I think you should ask endo to consider central hypothyroidism - esp if sex hormones and/or cortisol are also low. GPs don't understand it and don't test for it. But low normal everything with symptoms suggests secondary or central hypo.

[Cofy in reply to Angel_of_the_North]

Oh god they definatelly don't know about anything! Not only GPs but also endocs in my country, sadly. I remind and ask them to test most of the hormones and nutritions. I am sick of doing loads of research before I go to a doctor. When they see you alive with make up, they don't consider many of the problems. Even if he doesn't ask for other pituitary hormones tests, including sex hormones and cortisol, I will pay the extra amount and get them done this time. I have been chasing after for a solution for more than a year by visiting 4 different endocs...

Thank you very much for underlining these other hormones and central hypo!