Thyroid UK
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Optimizing Free T3 to resolve symptoms?

Hi All

Im currently taking 25mcg of Levothyroxine as prescribed by my GP. My results are as follows:

January 2017 - TSH 1.9 mIU/L, Thyrglob antibodies 244 IU/mL, Thy Perox antibodies 80 IU/mL.

31/07/17 - TSH 1.16 mIU/L, Free T4 21.7 pmol/L, Free T3 3.8 pmol/L.

15/02/18 - TSH 2.38 mIU/L, Free T4 19.9 pmol/L, Free T3 3.88 pmol/L, Thyrglob antibodies <10 IU/mL, Thy Perox antibodies 21.4 IU/mL

After taking the levo prescription and making lifestyle interventions(diet,minerals, exercise etc) my symptoms(tiredness, feeling cold, underweight, hair loss, brain fog) are still persisting. I believe symptoms will resolve when my Free T3 has been optimized. I informed my GP I pay to have Free T3 levels checked and that they are low, and he denied it having to do with the cause of symptoms and will not adjust my medication.

I have purchased liothronine online and have started to take 12.5mcg with the levo, after the most recent results above. May I ask anyone reading this post if this is the best way to approach the matter discussed, or suggest an alternative based on the info I have posted please? I really need the help.

Reference Range, Optimal Reference Range

TSH - 0.4-5.5 IU/L, 0.5-2 IU/L,

Free T4 - 9-23 pmol/L, 15-23 pmol/L

Free T3 - 3-7 pmol/L, 5-7 pmol/L

TPO Antibodies - <35 IU/m, <2 IU/m

TG Antibodies - <35 IU/m, <2 IU/m

16 Replies
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It would appear that, yes, you do have a conversion problem, so adding T3 is the best way to go, and your doctor is very ignorant! It is low T3 that causes symptoms. However, one can't be 100% sure about those results without the ranges. Could you edit your post to add them in, please. :)

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Hi greygoose thanks for your reply. I have edited the post and added the reference ranges....all results have gone normal to optimal apart from Free T3...

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OK. So, yes, you do have a conversion problem.

Have you had your nutrients tested? Vit D, vit B12, folate, ferritin? These all need to be optimal before your body can use thyroid hormone. :)

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Hi..yes they are well in the normal range. I also take a zinc supplement with my lunch as this mineral is required to convert. Do you think if i took it in the morning with the levo and selenium it could aid conversion or will this worsen absorption?

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It will more than likely worsen absorption. Remember conversion isn't done instantly, it has to get to the liver, or some other cell where it is going to be converted, first.

Just being in the normal range isn't good enough. Most people need their FT3 up the top of the range to feel well, and yours is right down the bottom.

It's not just zinc needed for conversion, it's also vit D, vit B12, folate and ferritin. But, you need to get those tested before starting to supplement. :)

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grey goose thanks for the input. Yeah of course conversion takes place in the liver and kidneys. Here are my results for the minerals and vitamins you highlighted:

ACTIVE B12 - 92.800 pmol/L Range 25.10 - 165.00

FOLATE (SERUM) - 19.98 ug/L Range 2.91 - 50.0025

OH VITAMIN D - 78.1 nmol/L Range 50.00 - 200.00

Any thoughts?

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Vit D is a bit low. It should be more like 100.

No ferritin?

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FERRITIN - 95.2 ug/L Range 30.00 - 400.0

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That's not too bad. So, it's the vit D that needs attention. :)

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hey thanks for the reply just sent you a message

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Why is GP only giving you half the standard starter dose, no wonder your FT3 is low

Recommended dose to start on is 50mcg see NICE guidelines saying how to initiate and increase. Note that most patients eventually need somewhere between 100mcg and 200mcg Levothyroxine

cks.nice.org.uk/hypothyroid...

What supplements are you taking and what are results for vitamin D, folate, ferritin and B12

As you have raised antibodies are you on strictly gluten free diet?

Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels

Low vitamin levels affect Thyroid hormone working

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

But don't be surprised that GP or endo never mention gut, gluten or low vitamins. Hashimoto's is very poorly understood

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

Ideally ask GP for coeliac blood test first

thyroidpharmacist.com/artic...

thyroidpharmacist.com/artic...

amymyersmd.com/2017/02/3-im...

chriskresser.com/the-gluten...

scdlifestyle.com/2014/08/th...

drknews.com/changing-your-d...

thyroidpharmacist.com/artic...

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Hi SlowDragon thanks for the feedbac, really appreciate it. My antibodies have gone down significantly as you will see in the first post I made. I have been following Dr Izabella Wentz work since I was first diagnosed and found her protocol has helped out a great deal.

My Free T4 seems to be optimal on 25mcg of levy. If I was to double the dose to 50mcg, wouldn't this then produce too much T4 hormone causing overactive symptoms?

The supplements I'm currently using daily are here goes:

Morning on empty stomach hours before breakfast- Levo 25mcg, Selenium 400mcg, Vitamin E 400iu, Plant Enzymes, Megaspore Probiotic,

Lunch after meal - B complex 100, vitamin C 1000mcg, Vitamin D 3000iu, Iron 18mg, chromium 200mcg, vitamin b12 1000ug once a week, biotin 5000mcg, Betaine ccl after all meals, glutamine

After Evening meal - Magnesium 400mg

My diet is gluten, dairy, and soya free.

Results are as follows:

ACTIVE B12 - 92.800 pmol/L Range 25.10 - 165.00

FOLATE (SERUM) - 19.98 ug/L Range 2.91 - 50.0025

OH VITAMIN D - 78.1 nmol/L Range 50.00 - 200.00

FERRITIN - 95.2 ug/L Range 30.00 - 400.0

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When you have a conversion problem your FT4 is high and your FT3 is low so FT4 high, if you were converting that to T3 then your FT4 would be lower and your FT3 higher so you need to supplement to get your Vit D, B13, folate and Ferritin optimal, see SeasideSusie's excellent post on that. It does take time but then when your levels have settled then your doctor should be able to see you need more medication.

Have a look st the Thyroid Uk site you run this forum for lots of good info. Shout out if anything you don't understand

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Hi silverfox thanks for your reply..thats really useful to know. I will supplemement Vitamin D, B12, and Iron accordingly...on a side note i have been taking a 50mcg Zinc Picolinate daily and i think i might be taking too much as excessive zinc can deplete iron and copper...i believe Dr Izabella Wentz suggests 30mcg daily max..will reduce the zinc dosage soon.

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It sometimes needsabit of juggling to get it right but then its how you feel as well and what the tests show

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yeah thats it...self experimenting...listening to the body and paying close attention to lab results. thanks for your support, I have found all the information provided by you all really helpful...from my latest results I was puzzled as to why my TSH has risen from 1.1 to 2.38 in the past six months.....any thoughts on this?

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