Where should T3 sit in the range?

[rosserk]

Should T3 be at the top, middle or bottom of the range?

[Judithdalston]

You need a context. Thyroid blood ranges are really geared up to cater for taking T4 medication, and the conversion of T4 to active T3. If you take levothyroxin only you should feel good with FT3 c.5 ( assuming TSH and FT4 ok, say at under 1 and c19, depending on actual ranges). But if you are medicated with T3 or T3/4 mix it is not very relevant.... some people seem to feel good ( or bad) on a wide range of T3. You'll find hypo sufferers quite happy with FT3 in double figures!

[rosserk in reply to Judithdalston]

Thanks Judithdalston, that makes sense. If I’ve interrupted your explaination correctly then the top of the range or over would be an indication that someone was heading in the right direction if being treated with T4 only.

The confusion is when people say a doctor can’t lower a persons medication without knowing what someone’s T3 is. Can I ask what is c.5 and c19? I haven’t seen those figures used what does c represent please?

[Judithdalston in reply to rosserk]

c. means about/around , sorry I am a historian used as for eg c.1900, but it does have wider use too. For T4 only medication T3 best c. 5 plus say if range 3.10-6.8, so it also depends on ranges the lab uses. But there might be people who are happier on slightly different results, who feel better above or below these 'best c.5' type figures.

[Phoenix605]

Most people seem to feel well with TSH of around 1 or under, FT4 in the upper part if the range and FT3 mid range. There is no hard and fast rule, the right numbers are where you feel most well. The above numbers are good aiming points and you can then do little tweaks to find your personal optimal. My over medicated symptims are very similar to under with a narrow ‘well’ corridor to try and stay in.

[rosserk in reply to Phoenix605]

Phoenix605 thanks for taking time to reply. I’m a newbie trying to learn all I can so it’s really helpful when people are kind enough to take time to respond. Kindest regards 🙂

[T3sortedme]

As already said, it depends on your medication - T4, T3 or combo. Energy is derived from T3 in the cells (body tissue). T4 is the normal transporter and the breakdown to active T3 takes place in the tissues. So if you are on T4 the amount of T3 in the blood will not be high. However if you are on T3 only (like me) most of the T3 has to travel in the blood to get to the tissues (which slowly saturate with T3). So in the T3 only case, T3 will be high in the blood (we take T3 three times a day typically). In the T4 case it will be much lower. In a T3/T4 combo case it will be in between. Sadly we can only measure T3 or T4 in the blood and not the tissues. Also the ranges are the average for the normal population (not those which are hypothyroid) so that is not helpful. The true guide is how we feel (well, lethargic (low) or overactive/twitchy (high)) and our vitals (blood pressure, pulse rate, temperature etc.). Tests are an unreliable guide other than for monitoring yourself and what is right for you. Timing of blood tests also has a huge impact on results but that's a different issue. Hope that helps and isn't too confusing!

[rosserk in reply to T3sortedme]

Hi T3sortedme, I take it from the username you are currently taking T3 and it’s working for you?

I seem to be doing well on T4 at the moment but i don’t think I’ve reached optimal dose yet. I’m fine for a few weeks when my dose is changed but then I feel lousy again after a couple of weeks until my dose is increased giving me a couple of weeks respite inbetween. It concerned me that my last blood test showed T3 was 5.31, range 3.10 - 6.80 putting me close to the top of the range. In my mind that indicated I was close to optimal dose of T4 and would struggle to get doctors to increase my dose using T3 as an argument. Your explanation would indicate there’s still an argument for an increase in dose regardless of where T3 is in the range. Thanks for taking time to write such a comprehensive explaination. Kindest regards to you 🙂

[Judithdalston in reply to rosserk]

I hope you are not changing doses 'after a couple of weeks' - your body takes longer to get used to the medication, remember the converted T3 is not just needed in the blood to be detected in blood tests, but has to be active in cells too. Need 6 weeks of same dose, then blood tests, then decide whether you need more/less or alternative Thyroid meds. It's not a quick journey. Post your last bloods with ranges.

[rosserk in reply to Judithdalston]

Hi, I am not changing doses after two weeks although I’m tempted and the temptation is hard to resist. I was diagnosed January and put on 25mcg. After 8 weeks doctor refused to change my dose because I was back in range. TSH 2.9 (0.27 - 4.2) I then had to wait 2 weeks for appointment to persuade another doctor to increase me to 50mcg. They made me wait a further 8 weeks and when TSH was 3.7 they again refused dose change of dose and I had to wait a further to weeks for appointment to argue for increase to 100mcg which I’ve been on for 2 weeks. So I’ve had to wait at least 8 weeks for dose increases. After 7-10 days on 25mcg, 50mcg and 100mcg I’ve started to improve but by two weeks I start to feel hypo again. My symptoms are extreme, low heart rate, profuse sweating, low temperature, drop in blood pressure, chest pain, difficulty walking lots of pain. It’s so extreme I’m literally suicidal. Have my elderly mother living with me who during that time has broken her hip and last week broke her shoulder and wrist. She’s also in the early stages of dementia which seems to be getting steadily worse at an alarming pace. I think Levo will work for me once I reach the optimal dose but the waiting inbetween dose increases is a real struggle. 😟

[thyr01d in reply to rosserk]

hi Rosserk, I'm surprised at this because I believe it usually takes about 6 weeks for an increase in T4 to build up ... might be worth you posting a question to see if anyone has any ideas.

[rosserk in reply to thyr01d]

Hi someone answered that question previously, saying some people do feel better within a few days/weeks and it was not unusual to get a good result quickly that soon wore off. I can actually document the results. I wear a fit bit that tracks my heart rate. I also wore a heart monitor for ten days and the results from the fit and heart monitor were comparable. If you look on the graph from the fit bit you can see a 7-10 day increase in hr which declined when I started to feel symptomatic again. The increase HR corresponds with increase in Levo. I’ve actually taken the odd extra tablet here and there when I couldn’t stand the symptoms and trust me I definitely felt better. It might take that long for it to build up in the blood/tissue but I’m not sure that corresponds with how fast it relieves some symptoms. But then again I’ve always been extremely strange! Kindest regards 😊

[Judithdalston in reply to rosserk]

Sorry Rosserk have we seen your last two full thyroid blood results on 25 mcg and 50 mcg T4? A jump from 50 mcg to 100 mcg was quite a leap; I would also be concerned that you admit to 'the odd extra tablet here and there'- of which dose tablet 25,50 and 100mcg? Hope you are not fluctuating between hypo and hyper as Phoenix has had similar symptoms when been both above and below ideal ranges.

[rosserk in reply to Judithdalston]

Hiya! When diagnosed I was put on 25mcg my TSH was 13.8 and my T4 was 8.8. The next test I had was at 8 weeks after and my TSH was 2.9 they didn’t do T4.

They initially refused to change my dose but after 10 weeks one Doctor agreed to increase to 50mcg. Then after further 8 weeks my TSH went up to 3.7 and they again refused to increase although my TSH increased on the higher dose. I couldn’t get an appointment for two weeks and this was the first time I took the extra tablets. I had 25mcg tablets so I took extra tablets making my dose 75mcg.

I admitted to the Doctor I had been taking 75mcg over the course of a few weeks sporadically and she agreed to increase my dose to 100mcg because I was still feeling hypo and my heart rate had dropped again to 45Bpm and the chest pains were back which she could clearly see.

My dose was changed on the 9th of May and I haven’t taken extra this month (although if I am honest I’m a stones throw from doing so). I absolutely understand everything you’re saying and I’m really trying this month not to take ‘an extra tablet’ here and there but it’s hard particularly when I don’t have the energy to function and I have an elderly dependent. I certainly haven’t had any hyper symptoms to my knowledge my symptoms are the same as they’ve been for the last three years. I know people say it’s not possible to notice a difference in such a short space of time but I 100% do which is why it’s difficult to wait. 😭

[Judithdalston in reply to rosserk]

Ok. Only other suggestion I could make is get private tests done before the NHS ones after 8 weeks, ie after 6 weeks on present dose to quicken things up. You could then get the full thyroid TSH, Total T4, FT3 and FT4 done, even both antibody tests and perhaps the matching B12, D3, folate and ferritin from the same blood draw, rather than piecemeal. Would your Gp accept this though ie increase T4 dose if it showed that is what you need? Or alternatively if you then show poor conversion T4 to T3 you could go down the adding T3 privately route. Have you searched Dr Lowe's archive on Thyroid Uk to see if he ever came across someone who seemed to have problems with low pulse etc while T4 dose being raised? I think It was Dr Lowe who reported in the context of fibromyalgia and hypothyroidism he had a few patients whose BP never really recovered with correct T3 dose and stayed on BP pills afterwards ( I think in this context it was high BP) .

[rosserk in reply to Judithdalston]

Hi again, I’ve had the blood tests done with medicheck from the same blood draw I had NHS test done. My Doctor only tests TSH. See below link. The problem is I can’t get appointment with my Doctor for two weeks after blood test making it 8 weeks before I can see Doctor to persuade her to increase dose. My Doctors will only allow you to book on a Friday and appointment is then two weeks in later. I’ve been trying to co-ordinate the blood draw and the Doctors appointment but it’s nigh on impossible!

healthunlocked.com/thyroidu...

[Judithdalston in reply to rosserk]

Ridiculous re appointments. Have you asked if your surgery does Patient Access for booking online, at my surgery it bypasses receptionist who seem to have their own agenda sometimes, and you get a good choice of times/ doctors perhaps over next 2-6 week period? Yes it make sense to get Medichecks blood phials filled at the same as NHS blood draw. I can only advise patience, and good luck.

[rosserk in reply to Judithdalston]

Lol yes we have patient access but there’s no appointments on there. On the odd occasion there is you still have to wait two weeks. Available appointments go on the list on a Friday to book appointments for two weeks away. It’s a total nightmare. My surgery is bottom of the ratings list and was lambasted in the local paper as being inadequate. There’s only one other surgery in my catchment which is just as bad. Thanks for all your help I really appreciate it 💐

[Judithdalston in reply to rosserk]

Any phone appointments on patient access? Suppose the two surgeries have a monopoly and quite happy to make folks wait on the principle , those barely Ill will get better without intervention. But then patients just don't turn up. Do they advertise how many patients fail to attend GPs, nurses, healthcare assistants appointments? My surgery has been doing it for about a year, but it has made little difference to people cancelling slots no longer needed and I have to get appointments 4-6 weeks before needed.

[rosserk in reply to Judithdalston]

No you have to ring for a telephone appointment but even then you wouldn’t get to speak to a Doctor, it would be the triage nurse. If she doesn’t think you’re dying you have no chance of speaking to a Doctor.

Yes my practice does do the missed appointment list it’s on reception when you go in and it’s usually quite a few that don’t attend. My surgery is a total joke. I’ve cried on the phone begging for an appointment before now and it makes absolutely no difference.

[thyr01d in reply to rosserk]

Hi again Rosserk, found this after the other message and it's so interesting. If you find an explanation I'd really like to hear it.

[rosserk in reply to T3sortedme]

No that’s brilliant, you’ve explained that in a way I’ve never considered before which makes it easier for me to understand. When a Doctor makes a decision on starting dose it has a huge impact on how quickly someone reaches the optimal dose. In my case I was started on 25mcg so getting to my optimal dose is taking longer than someone who was started on 50/100 mcg. My doctors don’t test T3 only TSH so once in range he refused to increase my dose, meaning I had to try another doctor at my surgery but she’s not going to keep increasing it if my TSH doesn’t climb back out the range regardless of how I tell her I feel. So it maybe I have to look at taking T3. Thanks again for your brilliant advice.

[thyr01d]

Hello again Rosserk

It's not actually that simple. If a person has been undiagnosed and therefore untreated for many years they need to start on a low dose and gradually increase. Also 'optimal dose' varies between people, there isn't a set ratio or formula.

I haven't read your history but T3 is not an easy answer, I am prescribed T3 and find it very, very difficult to take the correct amount every day, and, because unlike T4 it's effect is quick and short-lived, this is a problem. It has to be taken one hour away from food and one hour away from tea/coffee/chocolate/caffeine but most of us need three separate doses a day. If your iron levels are not good then caffeine must be avoided within one hour of a meal, and if you need magnesium and/or iron they must be 4 hours away from the T3. If you don't work I expect that's pretty easy but if like me your job also means not eating at certain times, it becomes very tricky.

So, I guess I'm saying, if I could have stuck to T4, I would have, and if I can go back I will.

Very best of luck.

[rosserk in reply to thyr01d]

Thanks thyro1d, I’m so glad I asked the question. If I hadn’t then I wouldn’t have even thought about the practicalities. I also wondered why it needed to be three doses per day. I certainly think 🤔 I’ve been given information I would never have considered about T3. I’m determined to take my time and give T4 a good chance of working for me. Kindest regards, hope the rest of your day goes well. 😉

[thyr01d]

You are very welcome and I hope you soon start to feel improvement.