Is it worth testing t3 and rt3?

[Auntbessy]

Is it worth testing t3 and reverse t3? GP’s only do tsh and t4 these days and I have been told that to get the other tests then I would have to wait for a referral to an endocrinologist. My TSH was 0.2 when last tested. But I am always mildly symptomatic and cannot shift excess body weight. So want to check that I am converting properly. Do people routinely test their t3 and rt3? I’m thinking about paying privately and am interested in peoples general approach.

[SeasideSusie Remembering]

Auntbessy

To know how well you are converting you needed to test TSH, FT4 and FT3 at the same time. RT3 isn't worth bothering with and is rather expensive.

But it's advisable to also test thyroid antibodies if not already done (both types, thyroid peroxidase and Thyroglobulin) plus vitamins and minerals

Vit D

B12

Folate

Ferritin

That gives the full picture.

[Auntbessy in reply to SeasideSusie]

Do you routinely check these things or only check if symptoms change?

[SeasideSusie Remembering in reply to Auntbessy]

Auntbessy

If you are diagnosed hypothyroid and on Levo, you should have routine annual blood tests. If you have a dose change you should be retested 6 weeks later to see if any further change is necessary.

If you have antibodies tested and they are raised, confirming Hashimoto's, there is no need for further testing.

If you are on prescribed supplements for low nutrient levels, one would hope that the GP would keep an eye on levels whilst prescribing, but that doesn't always happen.

If you have privately tested nutrient levels and are supplementing, you should test periodically to ensure that you are supplementing at the correct level.

[Auntbessy in reply to SeasideSusie]

Hi Seaside susie just tried to reply but not sure it worked?! Basically I thought it would be worth me checking over my old results when my old GP was happy to test t3 and t4. Back in April 17 my results were:

T4 17.3 range 12-22

T3 3.9 range 3.1-6.8

There is no record of my tsh as the most recent one has masked the old one but if I remember it was around 3.

Does all of that look ok to you? I know my tsh was a little higher than I like and I try and keep it below 1. I would appreciate you thoughts and thank you in advance!

[SeasideSusie Remembering in reply to Auntbessy]

Auntbessy

With those results, if your TSH was around 3 then you were undermedicated. The aim of a treated hypo patient generally is for TSH to be 1 or lower with FT4 and FT3 in the upper part of their ranges if that is where you feel well.

[Auntbessy in reply to SeasideSusie]

So potentially I could still have a t3 problem at the moment. My TSH is 0.9 but like I said before the doc would not test T3!

[SeasideSusie Remembering in reply to Auntbessy]

Auntbessy

You can't guess with FT3. To know if you are converting well enough you need TSH, FT4 and FT3 tested at the same time. When TSH is around 1 or below you will know from the FT4 and FT3 how well you are converting. If your GP won't test FT3 then you will have to do what hundreds of us here do and that is a Thyroid panel, and vitamins and minerals if not already done, with Medichecks or Blue Horizon.

[Auntbessy in reply to SeasideSusie]

Yes I’m going to order the test from medichecks. I just need to check if my doctors surgery will take the bloods. Thanks

[Roadrunnergreg in reply to Auntbessy]

Assuming you've typed it correctly your TSH is below 1 and your FT4 is ok at 17, if you were converting properly your FT3 would be 6.0-6.2 where you need it.

You need to check both selenium and zinc, selenium is needed for conversion of FT4<>FT3

Hope that helps

[SeasideSusie Remembering in reply to Roadrunnergreg]

Roadrunnergreg

Auntbessy said that is she remembers correctly then her TSH was around 3 back in April when her FT4 was 17.3 and FT3 was 3.9 and it's her current TSH that is below 1 but GP won't test FT3.

[Roadrunnergreg in reply to SeasideSusie]

Well it needs checking really, if FT3 is still low, there's a problem somewhere, other clue will be low selenium, the nutrient required for T4-T3 conversion...

[SeasideSusie Remembering in reply to Roadrunnergreg]

Which is what's been advised - TSH, FT4 and FT3 all at the same time.

[Auntbessy in reply to SeasideSusie]

I just can’t afford to check selenium as well as everything else. I supplement with it every day. I don’t know how other people manage!

[SeasideSusie Remembering in reply to Auntbessy]

It wasn't me who suggested testing selenium Auntbessy. If you are already supplementing with it then your level won't be low. It's advisable to take a little holiday from it from time to time, say finish one bottle and have 3-4 weeks off before starting the next. Or when you can afford it, check to see that your level isn't over range.

[Baggiebod in reply to Auntbessy]

The medichecks private blood tests offer a finger prick option which you perform yourself, alternatively you can pay an additional £25 and have the blood draw at a 'partner clinic/hospital' which you can choose from local hospitals. I have had several private blood tests done by Medichecks, I find it difficult to get sufficient blood using the finger prick method, and think the £25 worth paying. Medichecks have been a God send for me.

[Judithdalston]

Do you take any thyroid 'meds'? FT3 100% yes, Reverse T3 no, but to be of real use better if FT3 taken with same blood draw as TSH, FT4 and Total thyroxin tests too to allow comparisons of results. Gps tend to test TSH only; best to do the 4 above when changing doses every 6-8 weeks if taking levothyroxin. Ever had thyroid autoimmune antibodies tested for Hashimoto's- worth getting done? The majority of hypothyroids are Hashimoto's...it is characterised by poor gut absorption and consequently low nutrient levels whether from food, drink or supplements. So just as important as FT3 is the testing of essential VitD, B12, folate and ferritin , and supplementing and monitoring optimum levels regularly. If your doctor won't test , and it is unlikely he/she would do all, then members rely on private labs like Medichecks and Blue Horizon....a better way to spend money I think than a private endocrinologist! This forum members are very helpful and have considerable expertise to improve your thyroid health.

[Auntbessy in reply to Judithdalston]

Thanks. I have been attempting to find a way to get all the tests mentioned by seasidesusie done by my regular GP but it seems impossible whereas 6 years ago when I was first diagnosed with Hashimoto’s, it wasn’t. Because I am not as ill as some of the people in this forum, I tell myself that I don’t need to test privately and can manage with the patchy care provided by the NHS. It’s also expensive!

[Judithdalston in reply to Auntbessy]

Yes I agree it is expensive, but doing it privately tends to mean you can progress much more quickly in trying to get better... if you add up the waiting to get appointments before and after tests, extended periods between tests of 8 plus weeks, incomplete tests or badly informed results as 'normal' ..... it can string out to many months or years. I had to give up working when my thyroid problems were diagnosed and left poorly treated. 12 years ago I was only tested for TSH by the NHS so always had to go down private route...unfortunately it led me to an endocrinologist who was a diabetic specialist, and at that time no advice from wonderful Thyroid Uk members. Remember Thursday Medichecks and Blue Horizon labs often have 20% off some thyroid kits

[Angel_of_the_North]

Free t3 is essential; total t3 and rT3 largely a waste of money.

[punkyb]

I privately checked my free T 3 and free T 4 and my general practice dr. Gave my cytomel to help me with my weight issue.

Good luck with it. I just began my regime 6 days ago.

[Auntbessy in reply to punkyb]

Did you have a bad t3 result though or did they base that on your weight issue?

[punkyb in reply to Auntbessy]

greygoose on HU was helping me and I went to get my own test. the results were in normal range however the results were reversed to where the FT4 was higher than the FT3 indicating a problem with conversion.

[SeasideSusie Remembering in reply to Auntbessy]

punkyb is in the US so how and why they prescribe T3 will be different from the UK. You can't get T3 prescribed in the UK for thyroid issues so you certainly wouldn't get it prescribed for weight issues.

[Auntbessy in reply to SeasideSusie]

So everyone buys t3 medication themselves these days in the uk?

[Auntbessy in reply to Auntbessy]

I also have other thyroid related issues including the weight thing : (

[SeasideSusie Remembering in reply to Auntbessy]

Auntbessy

Many of us on the forum do.

Some members were prescribed T3 originally a few years (or more) ago when the price was reasonable. Now the price has risen by about 6000% and a box of 30 tablets costs about £258.00, many health authorities are deprescribing T3 and putting patients back on Levo. ThyroidUK and other people are fighting to stop this. So as patients who have already had T3 prescribed are now having it taken away from them, there is very little hope of new patients being prescribed it.

Some members manage to get a private prescription.

[Auntbessy in reply to SeasideSusie]

That’s madness. Is it a hard drug to manufacture?

[SeasideSusie Remembering in reply to Auntbessy]

Depends who you ask. The manufacturers of the only UK T3 when the price hike happened will say yes. But considering that the Greek and Turkish T3 at the time was the equivalent of about £1 for 30 tablets over the counter, then they would disagree I imagine.

[Auntbessy in reply to SeasideSusie]

Out of interest do you know many people on here who privately source t3 meds and roughly what do people pay for it per month?

[SeasideSusie Remembering in reply to Auntbessy]

Auntbessy

That's impossible to answer. We have 83,000 registered members, over 8,500 active members in June, not everyone posts regularly or tells us what thyroid meds they're taking and, of course, it depends on what dose of T3 they're taking, some take just 5mcg/6.25mcg daily (1/4 of a tablet) and that's enough, some take 50mcg or even more daily, usually if they take T3 only.

I don't know if a private prescription for 30 tablets (20mcg), if using UK T3, would cost around £258 per month, the same as it costs the NHS, it might cost more and then of course there is the cost of a private doctor and private presctiption and that could be quite a lot of money. A private prescription that can be sent to a pharmacy in Germany would be a lot less for the actual tablets but I don't know how much. Self sourcing T3 without a prescription from overseas might work out around £7-£10 per month for the same amount, but you'd actually source more than one month at a time that way.

[helvella Administrator in reply to Auntbessy]

No.

Evidenced by the much lower prices in Greece and Turkey - and even Germany and France.

There have been issues with UK produced liothyronine and Mercury Pharma say they are investing in new facilities. But I don't think there is anything particularly difficult. My take is that they have been getting it manufactured in crummy facilities and that is why the MHRA have demanded that they test every batch.

[Auntbessy]

Further to this thread. I have now organised a medichecks ultra Vit thyroid test and blood draw at a clinic in Bristol. What would people do before this blood test? Should I not take my morning Levo dose and should I stop B12 tablets a week before? I also take iron, selenium, Vit D, tumeric and general multi vitamins. Thanks in advance. Everyone has been so kind ☺️

[SeasideSusie Remembering in reply to Auntbessy]

Auntbessy

Advice always given here is

1) Take your last dose of Levo 24 hours before blood draw, don't leave it any longer or you will get a false low FT4, if you take your Levo before blood draw you will get a false high FT4.

2) Fast overnight - as in have your evening meal and then delay breakfast on the day until after the blood draw. You can drink water.

3) Have blood drawn as early as possible, no later than 9am. That will give the highest TSH if that result is important when looking for an increase in dose or to avoid a reduction.

There's no point in stopping B12, to get a baseline you would need to be off it for about 4 months.

As ferritin is tested in the UltraVit test, leave off iron for 5 days. If your multivitamin contains iron, also leave that off for 5 days (also if it contains Biotin - B7)

If you take a B Complex supplement, or a separate Biotin supplement, leave off for 3-5 days as that can give false results.

Apart from those supplements where you need to leave off for a few days, with any others don't take them before the blood draw on the day, take them after.