Adding in T3

[Jackiez]

Hi everyone, and happy new year! I've decided to try adding in some T3, as I'm still symptomatic. I'm non-autoimmune hypothyroid, have seen 2 endocrinologists, neither will prescribe T3, but wanted to reduce T4 as my TSH is suppressed. The problem is, my symptoms are getting worse. I've had private bloods done, and have some T3, but could do with some advice from you lovely people.

07565Hospital No.:Reference:Report Date: 29 December 2017 18:41:24HAEMATOLOGY Vitamin B12 401 pg/ml 197 - 771 Note amended reference range due to change toGen II assay.

BIOCHEMISTRY Folate (serum) 4.0 ug/L > 2.9Note new reference range effective 03/04/2017.If no change in dietary habits,a normal serumfolate makes folate deficiency unlikely.

FERRITIN 53 ug/L 13 - 150Optimum Ferritin level for females : >27 ug/L

C Reactive protein 0.7 mg/L <5.0

ENDOCRINOLOGYTOTAL THYROXINE(T4) 108 nmol/L 59 - 154

THYROID STIMULATING HORMONE * 0.05 mIU/L 0.27 - 4.2

FREE THYROXINE 17.6 pmol/l 12.0 - 22.0

FREE T3 4.4 pmol/L 3.1 - 6.825

OH Vitamin D 56 nmol/L 50 - 200

Interpretation of results: Deficient <25 nmol/LInsufficient 25 - 49 nmol/L

Normal Range 50 - 200 nmol/L

Consider reducing dose >200 nmol/L

IMMUNOLOGYTHYROID ANTIBODIES .

Thyroglobulin Antibody 14.3 IU/mL 0-115Method used for Anti-Tg: Roche Modular

Thyroid Peroxidase Antibodies <9.0 IU/mL 0 - 34 Method used for Anti-TPO: Roch

Thank you in anticipation.

[Jackiez]

Sorry, that's really hard to read, for some reason the screen shot won't upload, nor the PDF, so I had to copy and paste. I'm currently taking 125mcg of Levothyroxine.

[SlowDragon Administrator in reply to Jackiez]

You can edit. Click on small down arrow at bottom of your post

You need to get vitamins higher first

Vitamin D is much to low. Are you supplementing anything?

Ferritin slightly low. Eating liver once a week should help improve levels

B12 and folate are on low side. You might find supplementing Vitamin B complex and/or B12 sublingual lozenges helpful

Total T4 is only 108 and top of range is 154

So this suggests you have room to increase Levo.

Antibodies are low, so doesn't appear to be Hashimoto's

You might still consider trying strictly gluten free diet. Even without Hashimoto's some people find it helps

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, 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 articles from Thyroid UK email print it and highlight question 6 to show your doctor

please email Dionne:
[e-mail]

Prof Toft - article just published now saying T3 is likely essential for many, otherwise have to have high FT4 and suppressed TSH

rcpe.ac.uk/sites/default/fi...

[Jackiez in reply to SlowDragon]

Thank you SlowDragon, I've tried to edit, but it won't work. There's something wrong with my phone, as all the symbols on this site are in Chinese now😳! I already gave a copy of Dr Tofts article to the first endocrinologist, and she then referred me to the consultant. He refused to accept the evidence, and argued that my TSH was what they go by, and nothing else matters. He reduced my Levothyroxine from 150 to 125 , and said that if my TSH hadn't increased my prescription would be reduced to 100. This is why I decided to get my own blood test done and go it on my own.

Regarding the vitamins, I'm using Better you B12 spray, and the serum level has gone up considerably. I took folate for 3 months and that improved but has gone down again, so I'll restart that. Vitamin D has dropped dramatically, so I'll start supplements. The consultant poo-pood the idea of any vitamins making any difference, he also said I would do long term damage to my heart if I took more Thyroxine than was prescribed.

[SlowDragon Administrator in reply to Jackiez]

If you have the misfortune to see him again, give him a copy of this

See Box 1. Towards end of article

Some possible causes of persistent symptoms in euthyroid patients on L-T4

You will see low vitamin D, folate, ferritin and B12 listed

onlinelibrary.wiley.com/doi...

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, lowest FT4 and most consistent results

Is this how you do your test?

[Jackiez in reply to SlowDragon]

Thank you, yes, I always test first thing, 24hrs after last dose, and fasting. I'll work on getting my vitamins higher, and go gluten free before making any other changes. Thanks again.

[hendb]

Hi there, im following this post because im almost in the same situation... thank you SlowDragon for the documents...but there is one thing that surprises me, when the doctor says " 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)." What if one's TSH is almost supressed, T4 is in the highest range, but T3 still low?....

[Jackiez in reply to hendb]

I could be wrong, but I think it means you are not converting the T4 into T3 effectively. I'm sure someone will be able to help you😊

[greygoose in reply to hendb]

Jackiez is right. If your FT4 is at the top of the range, and the FT3 still low, it means you're a poor converter, and still hypo despite the high FT4. It's low T3 that causes symptoms.

The TSH is totally irrelevant once you are on thyroid hormone replacement, unless it goes high. It doesn't matter how low it goes. And to call a low TSH, on exogenous hormone, when the FT3 is still in-range, 'sub-clinical hyperthyroidism' is a little silly, in my opinion. If you take a decent dose of thyroid hormone, you can almost expect your TSH to be suppressed, it has nothing to do with hyperthyroidism, which is over-production by the gland itself.

When taking a decent amount of exogenous hormone, the TSH is low because it is no-longer needed. There is no way it can be dangerous, because the TSH is just a pituitary messenger to the thyroid, telling it to make more hormone. If there is enough hormone in the blood, the TSH is no-longer needed, so the pituitary more or less stops making it.

And, it is long-term over-range FT3 as seen in Grave's disease, that increases the risk of osteoporosis and heart disease, not the low TSH. Bones and hearts do not need TSH.

[SlowDragon Administrator in reply to hendb]

First thing is to check for low vitamins

Eg this post

Low vitamins causing low TSH high FT4

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

If Hashimoto's look at food intolerances, usually gluten, sometimes dairy

Then if FT3 still low, you are probably a poor converter.

Testing for DIO2 gene might help get you T3 on NHS, depending on your local CCG.

Though they should all follow Swale CCG in Kent who are now apparently offering DIO2 test on NHS and also consider altered gut biome due to hypothyroidism both as valid reason for needing T3 prescribed.

[Jackiez]

Thank you all for your input, so what I think I should do is get my vitamin levels up to optimal and see how I feel before trying T3. I've been so long on this road, and didn't have a single issue until I was in menopause, and then had a head injury. Then everything went haywire😳