T3 Endo Appointment

[YSpencer]

Hi. This is my 2nd post. I have been hypothyroid for several years and my results have never been stable. I still have lots of symptoms especially feeling tired all day and feel tired even when l get up. I have had a full range of bloods done last year and all vitamins etc are good. In Sept 2011 my results were TSH 1.24. T4 18.6. T3 4.6 taking 125 of Levo every day. Readings went up and down to below and above normal range and the amount of Levo l was taking was altered several times. In 3/8/14 my TSH was 1.3. T4 16.8 T3. 4.2 Levo changed to 125x3 and 100x4 days per week. 27/10/14 TSH 0.76 T4 17.1 Levo changed to 125x2 and 100x5 days a week. 23/1/15 TSH 1.85 T4 16.2. 23/3/17 TSH 0.6. T4 17. 25/9/17 TSH 3.5 T4 17 . 13/10/17 T3 3.3 Levo changed to 125x5 100x2 days . 3/1/18 TSH 1.1 T4 17. I have an appointment with Endo tomorrow. T3 was not done last week as GP forgot to tick ✅ the box so I’ve been back for another blood test this morning. My T3 is slowly decreasing and l really want to try to supplement with T3. Can anyone give me any advice on how to approach things with the Endo tomorrow. Thanks Yvonne

[SlowDragon Administrator]

Point out that your FT3 always remains on low side on all your test results

You continue to have many symptoms and your severely affected by this

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

thyroiduk.org/tuk/about_the...

When you say your vitamin levels are good can you add the actual results here for members to comment on

Do you have Hashimoto's also called autoimmune thyroid disease diagnosed by high thyroid antibodies?

Can you also post most recent antibodies test

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

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

So to feel better you either need increased Levo, running a suppressed TSH to keep FT3 high enough for normal function

Or, which you would prefer to try after many years still struggling , the addition of small dose of T3

[YSpencer in reply to SlowDragon]

Thank you for all of this. I don’t think I have Hashimotos as l was over active at the start and had Radio active iodine treatment and then became under active. Yvonne

[shaws Administrator]

When you give your results it is also necessary to give the ranges. The reason being that labs differ in their machines and ranges can be different and it enables members to respond.

Checking the 'Frees' gives a better overall view than T4 and T3 alone, i.e. FT4 and FT3 and I shall give you a link which has the explanation.

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

[greygoose]

Looks to me like your doctor is dosing by the TSH, and that is utterly wrong. There was absolutely no reason to change your dose in August. But if it had been changed, it should have been increased, not decreased. Your GP has absolutely no idea what he's doing!

[YSpencer]

Sorry all of my results are for free T4 and free T3. Below are the range which have changed over the years.

30/9/11 FT3 4.6 (3.1-6.8) 125x7

FT4 18.6 (11-20)

TSH. 1.24 (0.3-5.0)

24/2/12 FT4 22.5 (11-20)

TSH. 0.14 (0.3-5.0)

23/4/12. FT4. 20.7 (11-20) 125x5 100x2

TSH. 0.079 (0.3-5.0)

31/8/12 FT4 20.6 (11-20)

TSH 0.72 (0.3-5.0)

28/11/12 FT3 4.3 (3.1-6.8) 125X4 100X3

FT4 21.4 (11-20)

TSH 0.22 (0.3-5.0)

18/3/13 FT4 16.9 (11-20)

TSH. 1.73 (0.3-5.0)

17/714 FT4. 19.0. (9-23) 125X3 100X4

TSH. 0.69 (0.55-4.78)

3/9/14 FT3 4.2 no range given

FT4 16.8 (9-23)

TSH 1.32 (0.55-4.78)

27/10/14 FT4 17.1 (9-23) 125x2 100x5

TSH 0.76 (0.55-4.78)

26/8/16 FT4 15.0 (9-23)

TSH 1.5 (0.55-4.8)

25/9/16 FT4 17.00 (no range given)

TSH 3.5 (no range given)

13/10/17 FT3 3.3 (no range given) 125x5 100xw

3/1/18 FT4 17.00 (11-22)

TSH 1.1 (0.27-4.2)

I hope this makes things easier to understand.

I have already printed off the symptoms list from the website. If there is any more advice l really would be grateful.

Yvonne

[SlowDragon Administrator in reply to YSpencer]

your FT3 results since 2011 show falling FT3 at every test. This shows you are under medicated

30/9/11 FT3 4.6 (3.1-6.8) Dose 125x7

28/11/12 FT3 4.3 (3.1-6.8) Dose 125X4 100X3

3/9/14 FT3 4.2 no range Dose 125X3 100X4 ?

13/10/17 FT3 3.3 - no range Dose 125x5 100xw

obviously impossible to say for sure without ranges for 2014 and 2107.....but assuming same range this FT3 is much too low.

You can also see it's been dropping at each subsequent test.

FT4 results over time

30/9/11 FT4 18.6 (11-20) Dose 125x7

24/2/12 FT4 22.5 (11-20)

23/4/12 FT4. 20.7 (11-20) Dose 125x5 100x2

31/8/12 FT4 20.6 (11-20)

28/11/12 FT4 21.4 (11-20) Dose 125X4 100X3

18/3/13 FT4 16.9 (11-20)

17/7/14 FT4. 19.0. (9-23) Dose 125X3 100X4

3/9/14 FT4 16.8 (9-23)

27/10/14 FT4 17.1 (9-23) Dose 125x2 100x5

26/8/16 FT4 15.0 (9-23)

25/9/16 FT4 17.00 (no range given)

3/1/18 FT4 17.00 (11-22) Dose 125x5 100xw

You either need dose increased to 125mcg every day - possibly 125/150mcg alternate days .....or need addition of small dose of T3

03/01/18

TSH 1.1 is almost certainly too high. Most feel better with TSH below one

Can you add your actual vitamin results.

As outlined in this article by Prof Toft - we either have to have levo "too high" and suppressed TSH to get good enough conversion or have small addition of T3

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

Final summing up .....

"As I see it, we have three choices for those patients convinced that their present LT4 treatment is inadequate.

1. We can carry on with the current advice and be plagued by patients who do not achieve their anticipated quality of life as a result, surely a non-starter.

2. We can prescribe doses of LT4 which do result in TSH suppression, but are associated with unequivocally normal serum T3 concentrations as I am unaware that this combination of results has ever been proved a risk factor for atrial fibrillation or reduced bone mineral density, and why should it if the level of the active hormone is normal?

3. We can prescribe a combination of LT4 and liothyronine"

[Marz in reply to SlowDragon]

I cannot find the vitamin results - can you ? I saw you mentioned a Low B12 ....

[YSpencer in reply to Marz]

I didnt post all individually as they were all good including the B vits.