This is my email request to my Endo and her response. I have no thyroid so I'm confused why these test don't matter ? Should I be more worried about my health now?
Hi Dr. Vietor
You have me scheduled to do bloodwork for thyroid on March 18th and I have and Appt. to see you the following week. I'm sure this request will be strange but I would like to know what my reverse T3 is along with my Free T4 and Free T3.
Hi Grace,
Thanks for the message - I typically do not order free T3 and reverse T3 for patients on synthorid and cytomel and will not make dose changes based on these values but if you want to see these labs for interest sake, we can get them. I've added them to the order. TSH and Free T4 are already ordered.
Most of us do think the FT3 test is important. It helps us understand what is going on and many say it's where the FT3 sits that makes a difference to how we feel. In other words, we need enough to feel well and be symptom free.
The Endo however, as is the case with most Endo's, will dose according to TSH and maybe FT4. The Endo will want to keep FT4 and TSH within the lab range so they won't be concerned about where FT3 is. They will assume that the body will produce enough FT3 if FT4 is not below lab range. I'm not sure they are bothered about how we feel, they are more concerned about supposed side effects of low TSH like heart problems.
They really seem to not be concerned by how patients actually feel, only dosing by the numbers. And if the numbers are in range, then they claim that your symptoms must be from something else.
At least she is humoring you by ordering the ft3 and rt3. When you get them post all the results here and it will likely be revealing.
I will certainly post those results. I'm just unsure why she feels those numbers aren't necessary
I think the poster is in the US. My first endo tested only TSH and T4, but when I complained of symptoms he did run an fT3. My new endo tests TSH, T4, and TT3.
For some reason she does not like fT3. So I talked her into ordering an fT3 and an rT3. She agreed, then the lab nixed her TT3 saying it wasn't needed due to the fT3. lol
She claims it is not accurate. I asked Diogenes about it and he said that under certain conditions the fT3 is problematic, but not for the most part. She studied in Mexico, so maybe they were actually paying attention to the controversy?
It is one thing, the accuracy of a test at what it measures. Apparently the TSH test is extremely accurate at what it measures. But what it measures is of limited value. TT3 is considered a more precise test for what it measures, but of limited value also because of variations in binding proteins. My endo has accuracy of test confused with value of test, I believe.
It is deeply annoying their reluctance to test T3.
The way I see it is that it all ties in with vitamins and minerals and is supplementation needed. If levels are still dire then there is the question of testing for activity of gene DIO2.
To trot out my usual story.: Thyroid blood testing is akin to picking up a book, getting into the plot (TSH & T4) and then suddenly finding the last pages (T3) have been ripped out and you never find out what happens. It's an incomplete picture.
My endocrinologist ordered FT3 everytime but my TSH was very high and the labs follow guidelines as to when to include FT3 only really testing it when TSH is way out of range
Might the reason that doctors evaluate and prescribe based on TSH and T4 is because this is the way the healthcare system says it should be done and,at least in the US, covering themselves legally by not deviating from the norm often takes precedence over what may work better for the patient? Just a thought!!!!! My money is on this agenda. irina1975
YOU HIT THE NAIL RIGHT ON THE HEAD IRINA - I BELIEVE THAT THIS IS SO ' DOWN UNDER' AS WELL - I FEEL FOR DOCTORS THEY ARE BEING TRAINED THE WAY THE AMA, TGS AND PC's WANT THEM TRAINED. IT IS ALL REVOLVED AROUND THE ALMIGHTY DOLLAR.
My endo is aware we can easily alter T3 result by not taking it before the test. So he adds in shbg test which can't be affected by skipping a dose. Healthy tissue saturation of T3 shows a result of between 70-90 shbg, after 18 months of 75-100 mcg daily T3 only mine is still only 58 so a way to go yet for me, I seem quite resistant to t3. My endo more interested in tissue saturation than what is sloshing about in my blood. Well done for getting rt3 done I have always been refused and had to have it done privately.
Hi my endo asked for a t3 test at my request and it was refused by the lab because my tsh was in range. After quizzing him about the fact that a lab rat had power to overrule an endo he just said what can I do if they won’t run the test. Helpful not
I would say you are lucky. My GP refused to order those tests, as well as thyroid antibodies.... said I will have to go privately and even the private doctor may not order them for me.....
I had a physician say the same thing to me because I was still feeling crummy. I switch doctors to someone that treated me based off of how I felt and now am feeling 100%!!!! If you can, change doctors!
My GP told me she could not request a test for T3 and would only ever measure how well the thyroid was functioning by the TSH result! So, not even T4! My endo also said she would have my T3 tested but that even if it wasn't in range, she was unable to prescribe T3 anyway!
So, my question is ~ why do the test if they can't do a thing to help when it's out of range? They are well aware that it IS an appropriate and valuable part of the bigger picture but once again, it's down to the lab giving them the figures, then even if JUST within the "normal range" which seems to often be the case, they are satisfied and send patients off regardless of symptoms!! So, statistics win! Patients lose! Government turns a blind eye as T3 unavailable anyway!
I have no thyroid now, my T3 just scraped through into the low end of normal at 3.7 (3.3-6.1) and I didn't even get a comment or follow up to discuss!
I am now working on nutrition and taking supplements to boost the T4/T3 conversion as I feel at a loss with the medics. I think when you have had a total thyroidectomy, EVERYTHING should be tested until a patient feels that they are the best they can be.
Sometimes I feel like doing this thyroidectomy was the worse choice I ever made and I have no problem telling my Endo this very fact. She gets irritated when I say this and says you had cancer you had to do this and I respond no I didn't she rolls her eyes.
But, I agree all thyroidectomy patients should have everything tested until we feel better.
This is an especially weird situation because you're being prescribed T3, yet she's saying she won't dose based on freeT3. What is she intending to achieve with the T3 tablets?
This is still the second best answer you could have had to the question. At least you will get the results, even better if you leave the office with the printout in your hand!
Silver Avocado, This is one of the reason I wanted these test FT3,FT4 and reversed T3 so I proof and on top of having no thyroid I also have had surgical menopause for ovarian cancer (14 yrs ago) and Im having hard time understanding how or if these 2 issues could be playing off each other. I read too much it all says yes and these Endos all say no and she said my estrogen levels should be adjusted every 10 yrs and in email above (didn't include) she says no female hormone testing necessary...Im not sure if shes messing with me or im just over concerned and I have to move on.
Do you have any idea why she would ignore the FT3 result ?
She probably just doesn't know how to read them. She as good as admits it when she says she won't adjust your dose based on the results. A person who could understand them, and saw that your needed a dose change, would be behaving very strangely if they then ignored it!
Unfortunately doctors know very little about thyroid. They are usually just checking for one or two things, and that's the only thing they know about. My Endo doesn't really know what T3 is, and I'm sure has never heard of rT3.
It's obvious she doesn't know how to dose T3 or what the point of prescribing it is. The goal of taking T3 is to get your freeT3 into the top part of the range, and more importantly, to reduce symptoms. But the blood tests give a guide.
I'm not very familiar with tendonitis. Being hypothyroid can definitely cause joint and muscle pain, and causes inflammation. There is also a condition called plantar fasciitis in the foot which sounds very similar to tendonitis - this is pain along the bottom of the foot and up the heel.
Because every tissue and organ in the body requires thyroid hormone being undermedicated can cause all kinds of different symptoms.
Yes! I had that (tendonitis) when I was under medicated. As soon as I bumped my dose up it went away. When I obeyed my Endo and reduced my dose back down (because my TSH was "too low", all the muscle pains came back.
Yes, this is what has been happening she reduced my synthyroid and it's aggitated my tendonitis it now hurts 24/7 and I've had this issue for over 14 months but ALL 3 endos say it not thyroid related...funny I didn't have this issue before the thyroidectomy.
Yes, sadly we have to have the courage to self medicate. It's not easy, it's easy to believe and obey the Endo until we find we hurt so much that we can hardly get out of bed. Then we realize that we either do what is right or we resign to being ill for the rest of our lives. Sorry to sound dramatic but that was my personal experience. Your pains are most likely thyroid related and it is as simple as being under medicated. It's a bit expensive to begin with (the blood tests that is), but within a few months you will feel well and you only need to test once a year, if that.
I saw my endo on Monday, still trying to get a diagnosis, and he said when I mentioned FT3 that it's only relevant for hyperthyroidism! But he would order it if I wanted it. He also wanted me to have the bloods taken there and then, at 4pm which I politely refused. Going to give him one more chance and then go it alone....
They are almost all idiots unlike the wonderful people on this forum.
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Got my new FT3 and FT4 results. What's now?
Response from nhs endo - what do I do now?
Conclusion of paper comparing response to FT4, FT4/FT3 combination and NDT
Response from endo 
Why are my FT4 and FT3 levels still low?
