Thyroid UK
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Advice please on latest blood test results now on T3/T4 combination treatment

Having successfully appealed to the CCG to be allowed to get prescribed T3 in addition to the Levothyroxine treatment, as my Consultant Endocrinologist diagnosed that I do not convert T4 to T3, I have now had the first blood test results since starting the combination treatment. Although I feel an improvement since the change of medication, I still have some symptoms - anxiety, weight gain, loss of outer hairs of my eyebrows & eyelashes, dry fine hair (on my head - unlike my hair before getting the UAT) and tiredness especially in the afternoon. Before introducing the T3, I was on 75mcg of Levo and my blood test on that medication i was below range for both T3 and T4 but my TSH was also considered too low. My new results are;

Free T3 3.30 so just below range (3.50 - 6.5)

Free T4 11 so just in range (10 - 20)

TSH 0.27 so just below range (0.35 - 5.50)

The Endo has advised continuing the current dosage of 50mcg of Levo and 10mcg of the T3. I would appreciate the opinions of other under active Thyroid patients, as I think I could benefit in an increase in the dose.

19 Replies
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Congratulations on your success! How long were you taking your current dose before this test was done?

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Thank you for replying! It was taken 5 weeks since starting the combination of T3 & T4. Do you think that it's too soon to tell if it is working?

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Seems you are still under medicated, why is the endocrinologist sticking at the 50 mcg levothyroxin and 10 mcg T3 dose when your T3 is still so low, even below the 'normal' range, never mind a test result of nearer 5 that might make you feel better? How long were you on this combo before testing? Have you the results of when you were levothyroxin only to post here; strange they did not bump that up to 100 mcg- presumably your 'too low ' TSH was under your current 0.27?

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Thanks for replying! The draw was after 5 weeks of the combination treatment. The Endo took blood tests and came to the conclusion that I do not convert T4 to T3, because the results on 75mcg levo have a higher RT3, lower FT3 and lower TSH than when I was taking 50mcg of Levo. The latest results on the T3/T4 combo gave a higher TSH, FT3 and FT4 than on 75mcg of Levo. I think the addition of T3 is helping, but either it's too soon to get the full benefit or I need an increase in my dose. What do you think?

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It gives a higher TSH because your FT3 is under-range! What's the point of that? Of course you need an increase in dose! The man's an idiot!

The TSH is irrelevant once you're on thyroid hormone replacement, unless it goes high. It can go as low as it likes. This idiot idea that a low TSH causes osteoporosis and/or heart attacks, is keeping people sick and - in actual fact - more in danger of osteoporosis and heart attacks, because bones and hearts need good levels of T3, not TSH. Personally, I would not stick with an endo with such medieval ideas. You'll never be well with him.

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Hi Grey, Many thanks! I know you are not medically trained, but having read lots of your excellent advice over the past few years, I value your knowledge and opinion very highly. Do you think I should reduce my Levo and increase the T3? Also, as I am prescribed only 10mcg (half a 20mcg T3 tablet) per day, any additional T3 would have to be source my own. I look forward to hearing from you.

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No need to reduce your levo, but if you want your FT3 to rise, I think increasing the T3 is the only way to do it.

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Thanks Grey, please could you tell me, should I take the additional T3 at the same time as the 10mcg prescribed, or later in the day? And do you agree that a quarter of a 25mcg tablet would be a reasonable increment to start with? I understand that most of the T3 available without prescription is in the form of 25mcg tablets. Also, do you know of a reputable on line supplier for T3? If so, please can you PM me? Thanks in anticipation, BB x

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Whether or not it would be best for you to take all your T3 at once, or split it, only you can tell. You'll have to experiment to find which make you feel best. Myself, I always take all my T3 in one go.

You should only ever increase by 1/4 tablet at a time, every two weeks. And, yes, I think all T3 available on-line without a prescription, comes in 25 mcg tablets. :)

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You are definitely under-medicated. The endocrinologist 's logic re. blood tests figures seems weird - of course you had lower TSH on 75 mcg levothyroxin than on 50 mcg. It is a bit worrying he seems to be medicating you by the TSH results and not by the active FT3 hormone that your organs, cells etc actually need. Do you know the ratio of FT3 to FT4 for Levothyroxin only? Post your results with ranges.

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Hi Judith, my FT3 was much lower below the range when I was taking Levo only, and the ratio of FT3 to RT3 was 11 - significantly lower than the normal range of above 20. When my Levo was increased my FT3 dropped further. My TSH has increased to 0.27 from 0.16 and when on 75mcg of Levo my results were;

FT4 6.3 (10 - 20)

FT3 2.8 (3.5 - 6.5)

So the introduction of T3 has helped a bit.

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I asked for the T3:T4 ratio; you will see RFt3 is not used as a means of diagnosis on this forum( it is a 'waste' product from various sources, and doesn't seem to have a diagnostic ratio with T3 or T4). I am not aware of a normal range re FT3 :RFT3. The ratio I was looking for doesn't show you were a poor converter FT4 to active fT3, just very undermedicated with neither meeting the minimum range. You hit the nail on the head re cost of T4 v T3, which makes it even more surprising the endocrinologist did not raise your Levothyroxin. Your dose needs increasing, whether cheap T4 or costly T3, your FT3 needs almost doubling.

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My T3 to T4 ratio was -23.33% to 37% on Levo only, is that what you were looking for? I guess it shows that my T3 is more deficent than T4.

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That is minus 23.33%

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No it was the ratio FT4 to FT3 results I had in mind, not %, ie 6.3 to 2.8= 2.7 : 1. It doesn't show poor conversion at 75 mcg levothyroxin just very undermedicated.

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According to Medichecks the RT3 ratio range is 15.01 - 75.00 although a lot of other forums recommend a ratio higher than 20 otherwise what they deem functional hypothyroidism is present. This measures FT3 to total RT3 (from memory) which makes it difficult to interpret. It does look like Baggiebod needs an increase in either levo or T3 as you say to improve the ratio as FT3 is low. TSH is very low considering FT3 is also under range.

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Hi there, I had my RT3 checked by a blood test via Medichecks, and they advised me that their Doctor had looked at my result and concluded that my RT3 was high due to my FT3 is very low.

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Yes exactly. The ratio will be low given your very low FT3. So you need more meds now not when endo feels like it.

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What an idiot! I would have increased your Levo till FT4 was in the top third of its range then compare it with FT3 to see if you have any conversion issued. That would have been easier and quicker to see where the problem lay though I suspect it's down to not being on enough medication and trying to treat you by your TSH. It doesn't often show a meaningful result. Levo only works by the majority of thyroid patients but they need enough to make it successful.

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