Thyroid UK
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Consistently low T3

Hello, previous results on previous posts. Had my levo increased by 25 to 150mcg 5 weeks ago. This was done based on my t3 which was low 3.2 (3.5-6.5) . It was checked this week has dropped to 3.0 despite the increase in levo. My GP said it was due to the Sertaline as that can cause it, but l have just looked at my t3 since 2014 and it has only been within range 3 times and has been tested a lot as I have had 2 pregnancies. I have been on Sertaline since Oct for alleged PND. Does my T3 level need investigating further?

Thanks

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Slappiduck,

I'd like to see the evidence that Sertraline causes low FT3. This link says SSRIs have no impact on thyroid function ncbi.nlm.nih.gov/pubmed/195...

I think GP is reaching. If GP really thought FT3 was low due to Sertraline s/he would have switched you to another another type of antidepressant. Ask GP to refer you to an NHS endocrinologist to prescribe some Liothyronine (T3) to raise FT3. Low FT3 can cause depression. If your FT3 was higher you would feel better and might be able to wean off Sertraline.

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I plan to speak to the GP about the T3. As it would seem to me that I have a long standing issue with low T3?

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Slappiduck,

It certainly appears so.

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Would an endo referral be a reasonable request?

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Slappiduck,

Yes, it would. Email dionne.fulcher@thyroiduk.org for a list of member recommended endos before you ask your GP for a referrral.

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I have contacted her, thanks again

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Hurrah! One in the list is at my local hospital. I’m seriously thinking of weaning off the Sertaline, as I really don’t feel any different on it. Which I’m not surprised by as I didn’t agree with the diagnosis in the first place. But I felt so desperate I took the pills. If I complete the 6m course suggested for treating PND I can start weaning in April.

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I also have low t3 and depression. I recently started on cytomel to raise t3 levels and the brain fog and depression went away. I believe low t3 causes depression and brain fog.

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You very likely need addition of small dose of T3

Did you go strictly gluten free yet? If not you may need to before starting T3

Vitamin levels need to be optimal too

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 at

tukadmin@thyroiduk.org

Professor Toft recent article saying, T3 may be necessary for many

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

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I haven’t as yet gone strictly gf as I was waiting to see what happened with this lot of bloods .

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You may be seeing the well known adverse effect of increasing T4, but getting no further and even going backwards with FT3. It's likely you converting T4 to T3 as best you can with the original dose, and trying to improve things further by increasing T4 dose simply encourages reverse T3 production at the expense of T3.

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Oh buggar! Why does that happen?

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Yes, many don’t convert the T4 well. Anytime physician tries to raise my Levo, my Free T3 drops and Reverse T3 rises and I feel more Hypo than ever, even if the TSH is low. Unfortunately many physicians don’t have training in this and don’t bother checking Rev T3 let alone Free T3. I have to keep my T4 med. pretty low to make the T3 med. work. I use a small amount of NP Thyroid in combo with some Liothyronine because my conversion is so poor. Best wishes, as I know how frustrating this can be.

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Thanks for explaining , it all seems a mystery to me. Is there any point asking for an endo ref if the NHS won’t prescribe T3? Also do you tell your GP that you are sourcing it yourself?

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I’m in th US and fortunately have a functional medicine physician who, while she doesn’t quite get the Rev T3/Free T3 issues, agrees that I’m a “very poor converter” and is willing to prescribe my Liothyronine and NP Thyroid in way that allows me to experiment and make minor adjustments in the meds to feel better. I had hoped to figure out and solve whatever was causing the conversion problem, but after addressing several of the usual suspects (e.g., adrenal, SIBO, insulin resistance, diet adjustments, ferritin) I still just can no longer convert T4 properly even though I was stable on Levothyroxine for 22 years before all fell apart a few years ago. Best wishes in feeling better.

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How much NP Thyroid and Liothyronine do you take? Just curious as I am taking the same combination, but with Nature-throid.

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Still not fully stable, but currently taking just a half grain NP Thyroid along with about 10 mcg Liothyronine. Seems low, but did a T3 only protocol a little over a year ago that cleared all RT3 out, and since then I seem to need only a modest amount of T3. May I ask your dosing?

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I am on 2 grains of NDT and 37.5 mcg of T3. Kind of wondering if I would be better off lowering the NDT. My rT3 was just below range on 2 grains of NDT only, but I imagine it went up some when adding the T3. I had a total thyroidectomy if that matters...

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I think that technically endos can prescribe T3, but they are getting a lot of pressure not to...so it is pretty rare right now. It would probably be easier to get your own.

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It's one of the failsafe controls that ensure too much T3 isn't produced.

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Nothing I can do about it then?

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Yes, there is. You can reduce levo and add T3. You may need to source it yourself, but many here do.

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Where would I get it and what is the cost?

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Hi, I reduced my levothyroxine and added T3 and it really made a difference. I felt horrendous on an increased dose of levo and think it was converting to rT3 rather than fT3. I can PM you where I get my T3 from. You could also write a post asking people to PM you with details of where they get it from (best kept off the public forum). Good luck :)

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Thank you very much. I didn’t realise you couldn’t post publicly. Doh!

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Hi can you PM me as well on info of where to get T3 thank you Pam

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Yes you can source your own NDT and take that.

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Hi, do you eat foods rich in Selenium (Brazil nuts, whole grains) or supplement with selenium?

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Also, are you eating enough. Starving yourself can cause lower T3 levels.

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Hi, I do eat whole grains and nut butter daily ( I’m not a Brazil nut fan). I also love my food 😝

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Hi

Please can I ask where are your t4 levels?

I totally agree- I’d take some t3 as you are not converting and MAY have a reverse t3 situation. Would I bother with a referral- probably not as even private ( most) can prescribe t3. 5 of my friends have all have decent endos myself a sixth and we all have to either have a private prescription which is v expensive or source our own.

Have you had your vitamins and adrenals tested too? Ndt is also a consideration.

Good luck

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My T4 this week was 9.8 (10-18.7). I am on vitamin D supplements as I was deficient. Adrenals tested, I don’t think so. What does that involve?

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Hi

Yes that’s low considering the t3 levels.

If it were me I’d have a private blood test ( medichecheck or blue horizon and have the thyroid plus 10-12 vitamins tested. It would be handy to know if you have reverse t3/ hashimotos- and all the levels of vitamins too.)

I was v lucky I picked the right specialist who said at 0 my t3 was the lowest she’d seen. I’d spent 12 yrs working but being really ill. To be fair it’s taken ages to address but I still felt tired to tested my cortisol over 5 times in the day/ night and dhea( see dr Sarah Myhill. com- the adrenal gear box)

I used to be a v healthy female athlete so all the results were a shock. No dhea and cortisol so high. The outcome was easy for dhea - I take pregnenelone which helps fatigue and adaptagens- holy basil to try to block the spike of cortisol and mess up my sleep.

I’ve learnt so much from my specialist and she has helped me help myself. Sadly she’s full. To be honest my friends all had their full results- I read them made a few suggestions and the endos agreed on the thyroid, clueless re adrenals and vitamins tho.

It’s so unfair to have to pay for meds and tests but it was the only way I could step forward.

£250 consultancy fee buys a test and for me nearly a year of ndt as I have swapped over recently. ( for the most part)

I’ve learnt to try different things and be more proactive- I’d be dead now if I’d waited for my gp to get a grip!! The week b4 I got my T3 levels one ( now sacked gp) told me I was depressed and had rheumatism. I snapped and told him he could shove him antidepressants somewhere- he never bothered me again as I changed gp. No depression no rheumatism. Just low t4 and no t3.

Good luck- strike out- you can always take test results to a specialist but for now I’d definitely source some t3./ndt.

Hope you are taking k2 mk7 with vit d.

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I think it's worth asking for a referral. You're definitely entitled, as you've consistently had a blood test pattern your GP can't understand and can't treat. You've had a GP try to deal with it, and their solution has just made it worse.

This is a perfect paper trail. Those historical blood tests showing low freeT3 are gold dust. Many members haven't ever had freeT3 tested so don't have the evidence.

As others have said, there's a good chance that once you get to the Endo they won't help you. Although you've got some of the best quality evidenced, most clear cut case of needing it I've seen.

But don't pin your hopes! Although its always best to be inside the system. However, if you're money rich and time/hassle poor you might prefer to just go down the self medication route immediately. You might have to do so anyway.

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Thanks, you are saying exactly what I am thinking . I’d rather get it sorted and am not adverse to paying to do so ( although it may take some time to save up depending on the cost!) I am extremely time poor with. 3.5year old 15m old and a job so anything with less hassle is a win in my book.

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I have screen shots with my historical results but can’t work out how to upload them in a post/profile?

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I've got a friend who went this route because he didn't have the energy to be assertive with doctors, and had already wasted a year or so pursuing a sleep disorder that turned out to be a red herring.

He didn't even ask for T3, just went straight to buying his own. It's not ideal, but it is understandable.

I'm not sure about screen shots for anything except starting a brand new post. It's always clearer to type them out anyway, as people may be using all kinds of screens to see the picture.

If you type them up make sure to include TSH, freeT4 and freeT3 wherever you've got all 3, note what dose you were on as well as the date, and most importantly include the range for each, which is the 2 numbers usually in brackets after your number.

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