I'm currently taking 100mg Levo daily and 20mg on a morning and 10mg at lunchtime. I'm still feeling extremely fatigued and still have all the usual symptoms of being hypo. I have managed to lose 14lbs in 7 months which I'm ecstatic about as before I was gaining. Unfortunately the weight is creeping on again. My most recent bloods are as follows
Serum TSH. 0.01. (0.27-4.2)
Serum free T4 4 (11-22)
Serum free T3 4.1 (3.1-6.8)
Any advice greatly received
How did you do this test?
No Levo in 24hours prior and no T3 in 12 hours before? Test early in morning and fasting?
FT4 is far too low
You need 25mcg dose increase in Levo and retest in 6-8 weeks
What about vitamin D, folate, ferritin and B12?
Do you have Hashimotos? Diagnosed by high antibodies?
Are you self medicating or under an endocrinologist?
It was an emergency blood test so I had taken my liothyronine that morning but not had my thyroxine. Non of the others were tested as my test wasn't for my medication review and that's the only time they do check B12 and ferritin. I haven't been checked for antibodies. I've got a drs appointment in a fortnight
Unfortunately as you had taken Lio before the blood test the results may well be skewed but, in fact both your FT4 and FT3 are too low and need to be nearer the upper part of the ranges. Request a new blood test and follow the recommendations.
Well, what a surprise. Endocrinologist (not my usual one as he's on his hols) says I'm over medicated. Ought seek advice from gp to test for other causes for my symptoms 😔
Is a very low T4 anything to be concerned about, thank you
The Endocrinologists is taking account of your TSH alone to pronounce you over-medicated.
All endocrinologists and doctors seem to have been told or have assumed that if our TSH is very low that we are in danger of heart or bone problems. These are rumours I am sure. Before blood tests were introduced we were given NDT until we were symptom-free so there were no blood tests to restrict our dose. NDT contained T4, T3, T2, T1 and calcitonin.
As levothyroxine (T4 only) became the only hormone replacement to be prescribed along with blood tests so when T3 is added (Active hormone) our TSH will be lower than if on T4 alone. I don't quite understand how supposed to be experts cannot figure that out.
If our T4 is low, it cannot convert to sufficient T3. I think Big Pharma has made millions £s through blood tests as well as 'extra' prescriptions for the remaining symptoms we may have with the doctor treating the 'symptom' as apart from thyroid hormones. They know no clinical symptoms nowadays, it appears to me.
T3 was prescribed by Endo
Should I be concerned about my T4 being so low?
Endocrinologist says my results are okay and could be slight over medicated. He thinks my symptoms are nothing to do with my thyroid.
Do you take both your levo AND your T3 on an empty stomach, and leave at least one hour before eating or drinking anything other than water? You say you take 10 mcg T3 at lunchtime, so that made me wonder if you're taking it with food. 
You probably also need to increase T3
Perhaps try 3 x 5mcg T3 in divided dose. Waking, early afternoon and bedtime
Any ideas why my free T4 is so low. Dr's are reluctant to increase my thyroxine due to TSH levels
Have you had vitamin D, folate, ferritin and B12 tested recently?
If these are low they can cause suppressed TSH
But taking T3 tends to suppress TSH
Its FT4 and FT3 that are important on Thyroid replacement hormones, not TSH.
Your results show you are under medicated
You need dose increase in Levo
Previous post suggests you have Hashimoto's
Are you strictly gluten free?
No, I'm. It gluten free. Had vit D, folate and ferritin checked late last year and they were all within range according to the dr
Not gluten free
Suggest you get actual results and ranges on these vitamins
Vitamin D needs to be around 100nmol
In range is often nowhere near adequate
Strongly recommend trying strictly gluten free diet for 6 months, if it helps stick on it
I've just seen dr and her concern was my tsh being below range. She thought I was over medicating. She is now seeking advice as she is totally confused with my results.
Do you have Hashimotos? Also called autoimmune thyroid disease. Diagnosed by high thyroid antibodies
Absolutely essential to test
With Hashimoto’s Gluten free diet is essential for very many of us, especially on T3
Do you always take Levo and liothyronine on empty stomach and then nothing apart from water for at least an hour after
Taking Levo at night can be more effective
Your FT4 is far too low
Also taking liothyronine in split dose 2 or 3 times per day can give more even T3 levels - eg waking , mid afternoon and bedtime
On combo treatment it’s the FT4 and FT3 that are important
Plus antibodies and vitamins
In range for vitamins is not necessarily adequate, especially for B12. Always get actual results and ranges on all tests
Suggest you get Medichecks or Blue Horizon full thyroid and vitamin test
All thyroid tests should be done as early as possible in morning and fasting and don’t take any Levo in 24 hours prior to test or any T3 in 12 hours prior, delay and take straight after
Will mention hashimotos, when I see her next. Feel as though I'm going backwards not forwards 😔
I recently had a TSH of 0.045 and felt dreadful. In fact I felt like I was hypo again, only worse.
Some math: I was taking 88 mcgs of T4 and 10 mcgs of T3 a day. The doctor said it was too much for my body. He said that 10 mcgs of T3 is = 40 mcgs of T4. For my BMI he said I only need 100 mcgs of replacement hormone, and I was taking 128 mcgs. I reviewed my labs and saw that I do convert T4 to T3 though so I didn't need the T3, dropped it, and am feeling WAY BETTER on T4 only.
I'm not sure what to tell you to do, there are others on here who are more versed than I am with what path you should take. Your free numbers are low and if you are converting OK they should be higher. But I can tell you that mediation-induced hyPER made me feel just as sick as being hyPO, with similar symptoms to boot. It's worth listening to your endo for a bit to see if she can steer you on the right course.
Dr is seeking advice, asked to give surgery a call in a month to see what’s recommended. I can’t carry on like this for another 4 weeks. My get up and go has got up and gone 🤢😴
T4/T3 Ratio
T3 / T4 test Results.
T4 & T3
Help with New bloods - and level of medication
