Thyroid UK
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Recent results after starting on small dose of T3

Hello, I recently (six weeks ago) started taking cytomel (only half a pill of 0.025mcg) along with 75mcg L-thyroxin-Henning. Here are the latest results, I am not sure how much it has changed how I am feeling! Would someone be kind enough to pass a knowledgeable eye over them and comment.( I have put values from the previous test in brackets for comparison)

T3 Free .......... 3.5pg/ml........ ref 2.5-3.9................. (3.1)

T4 Free.............9.8ng/L ...............ref 6.1-11.2............. (11.4)

TSH .................0.12mUI/L ..... ref 0.4-3.5 ........... (1.15)

Many thanks

Brodie

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Brodiebrodie,

How long did you leave between last T3 dose and blood draw?

FT3 3.5 is in the upper third of range which is good for most people. TSH is low but not quite suppressed and FT4 is probably lower because taking T3 direct can improve conversion of natural T4 to T3.

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Hi, thanks for replying,

I left approx 24hrs between last T3 and blood draw.

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Brodiebrodie,

Extrapolating FT3 3.5 by +20% = 4.2 so your normal circulating dose is probably top of range or just over. It doesn't allow scope for increasing dose if you are to keep FT3 within range.

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Thank you, Does that mean I would have to decrease T4 to increase T3, or does it mean I am converting sufficiently well and adding more would be pointless?

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Brodiebrodie,

Taking T3 direct gets around poor conversion. As FT3 is top of the range it is pointless increasing T3.

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Thank you so much for your expertise. I suppose there may be a chance that the doctor moves to decrease the T4 because of the low TSH, should I resist this?

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Brodiebrodie,

Yes, I would. As long as FT4 and FT3 are within range you are not overmedicated. Reducing dose to raise TSH will cause FT4 and FT3 to drop. Read Treatment Options in thyroiduk.org.uk/tuk/about_... Email dionne.fulcher@thyroiduk.org if you would like a copy of the Pulse article to show your GP.

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Brilliant, I will do thanks, although he is French and may not read it! However he is open to discussing treatment , and so far we seem to be reaching an accord

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Brodiebrodie,

I wouldn't bother showing him an article from a UK endocrinologist he will never have heard of.

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Hello, I have been emailed a copy of the Pulse article and I am slightly confused, It seems to say that whilst taking T3 and T4 , the suppressed level of TSH is not a good thing

"While taking both hormones it is important serum TSH is normal and not suppressed. If the patient is still dissatisfied it should be made clear that the symptoms have nothing to do with thyroid disease or its treatment and perhaps issues at home and in the workplace should be addressed."

I am sure that this would help my case.. Can you shed any light for me? Many thanks Brodie

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I should add I have an appointment with the doctor tommorow !

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Brodiebrodie,

It does seem a contradiction but apparently it's because it may be necessary to suppress TSH when taking Levothyroxine only in order to have sufficient T4 and T3 but when taking T3 direct suppression shouldn't be necessary.

Read Diogenes explanation:

diogenesin reply to Marz

2 months ago

The problem with using T4 only as therapy (with no thyroid) is that when you had a working thyroid gland, it was producing both T4 and T3. The body tissues then took more of the T4 and converted it into additional T3. This means your T3 came from two different sources - direct from the thyroid and and indirect from T4 conversion. With no thyroid, and given only T4 the body has to do all the work converting T4 to sufficient T3. This means that to get the same FT3 as you had in health, proportinately more T4 has to be given, which suppresses or partially suppresses the TSH. With combined T4/T3 therapy, of course you are supplying T3 direct and the T4 doesn't matter so much. So you can achieve a correct FT3 with much lower combined FT4/FT3 levels. This doesn't inhibit TSH as much so suppression isn't necessary.

healthunlocked.com/thyroidu...

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