Going back to the endo should be the first step. But, even if you have to buy it privately, dosing is not a problem. You follow the rules for replacing hormones : start low and increase slowly. So, for T3, you would start on 1/4 pill - 6.25 mcg or 5 mcg, depending on the pill - and increase by 1/4 pill every two weeks until you arrive at one whole pill, then hold for six weeks and retest.
Many people do still have antibodies after RAI or thyroidectomy.
Trying strictly gluten free diet is something to consider.
Definitely get vitamins tested too
You could start with vitamin D via vitamindtest.org.uk £28 postal kit
If endo refuses to prescribe small dose of T3
You could try just increasing your Levothyroxine. TSH is not too low, there's room for small increase in FT4 and FT3 is definitely low
Perhaps try adding 12.5mcg Levothyroxine (25mcg on alternate days) and retest in 6 weeks preferably including B12, folate & ferritin and vitamin D if not tested separately
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 otherwise we need high FT4 and suppressed TSH in order to have high enough FT3
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