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Thyroid UK
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Advice on Adding T3 to Levo

Hello, any info or advice would be greatly appreciated

Please see my latest results, do you think I should add T3 to my 100 Levo?

TSH, 1.63 mIU/L (0.27 - 4.20)

Free Thyroxine, 18.400 pmol/L ( 12.00 - 22.00)

Free T3, 5.48 pmol/L (3.10 - 6.80)

Reverse T3, 25.00 ng/dL (10.00 - 24.00)

Reverse T3 Ratio, 14.27 (15.01 - 75.00)

34 Replies
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Adametcartwright

Simple answer - no.

Free Thyroxine, 18.400 pmol/L ( 12.00 - 22.00)

Free T3, 5.48 pmol/L (3.10 - 6.80)

Your FT4 is 64% through range, your FT3 is 64% through range, they are perfectly balanced. Your FT4:FT3 ratio is 3.35 : 1 and again this is perfect, good conversion takes place when the ratio is between 3:1 and 4:1

What makes you think you need to add T3 to your Levo?

What you could do is increase your Levo a bit as the aim of a treated hypo patient generally is for TSH to be 1 or below or wherever it needs to be for FT4 and FT3 to be in the upper part of their respective reference ranges when on Levo if that is where you feel well.

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I am seeing an Endo so I will see what avenue that takes me down. I just hope I can get rid of these awful symptoms

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Adam

Just a thought, low nutrient levels can sometimes have symptoms that overlap with hypo symptoms. If not already done, I would test

Vit D

B12

Folate

Ferritin

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I'm bemused as to why your Reverse T3 is at that level and why your RT3 ratio isn't higher, as your conversion rate of T4 to T3 looks good and both fT4 and fT3 are reasonably high through the range. I'm tagging Kell-E as I know she reads up a lot on rT3. All I really know is that usually if you're not converting T4 to T3 very well (but you are) that the T4 can get converted to Reverse T3 instead.

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I am in a stressful job possibly that’s the cause of the slightly higher Rt3 (new job less stress) 😂😂

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If rT3 actually interferes with T3 being used by the cells (which Diogenes and Rudolf Hoermann both indicate that it likely does), then that high rT3 could account for a falsely elevated serum level of fT3.

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Thanks Kell-E,

I’m currently researching all avenues, I have read a couple of books by Paul Robinson and constant threads on all Thyroid issues/treatments/outcomes.

I am newish to this but I continue to gain as much knowledge as possible.

I am going to stick with my prescription of Levo until I see the Endo and have gained as much knowledge as possible.

I will reevaluate then.

Thank you for your reply it really is much appreciated from all of you

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Lowering Levo and adding T3 might be something to try. Don't expect your endo to suggest it though.

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I think you've said something to me before about how adding T3 can potentially mess things up, but I can't recall the whys and wherefores?

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Adding a little T3 can drop TSH significantly. A lowered TSH stimulates your thyroid less so it produces less T4 (some of which would have converted to T3). Lowered TSH also affects conversion so that less T3 is converted from the smaller amount of T4 that you now have. So you take a double hit to fT3. This can be overcome if the T3 you are taking is large enough to compensate.

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Well, I'm going to be controversial, here, and say that it would not be a good idea to increase your levo. If your FT4 goes much higher, your conversion will no-longer be perfect because the T4 would probably start converting to more rT3 than T3. Not going to get into a discussion on the pitfalls of rT3 - although my personal opinion is that it's not something to worry about per se - but the point is that your FT3 could decrease rather than increase.

So, why do you think you need your FT3 higher? How do you feel? Do you still have a lot of symptoms? If you feel well, then I would leave well alone, if I were you. :)

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I’m still not feeling good unfortunately 😭

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Hey Adam, have you had your VitD and B12 tested? Deficiencies in the two can make us feel unwell

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Thanks for the replies, I still have most of the symptoms I had at the beginning but have to admit that I have progressed, I’m back at work and doing slightly more exercise.

I have put on 4 stone over the last two years and have been treated with Levo for 1 year.

I am now pre diabetes!!

Can my higher RT3 be blocking my FT3 from entering my cells? Hence Metabolism is not working hence the weight gain hence the pre diabetes?

What do you think Guys?

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If you are prediabetes I don't think it's a good idea, T3 rise insulin( and can lead to weight gain, some kg), you results are good. You take metformin?

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No I don’t take any medication for Diabetes, I have been told to keep an eye on what I eat, although I have a pretty good diet to be honest.

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I'm not medical advisor butI tink in this case the diet not in enough. You need some medicines, if you intend to take T3, a small dose of metformin or berberine(natural). You need to measure your insulin level and HbA1c before and after you swap on T3.

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Adam

Can my higher RT3 be blocking my FT3 from entering my cells?

Your test results don't indicate there is a problem. Your conversion is perfect and your FT4/FT3 in balance.

Your rT3 is 1 point over range, it's not caused by high FT4 creating rT3 rather than FT3, you can see that. Your FT4 isn't high - it would need to be top of range of over range for that. And your FT3 isn't low, it sits very nicely at 64% through range.

rT3 can be caused by other things, here are a couple of articles worth reading:

verywellhealth.com/the-role...

restartmed.com/reverse-t3/

If you want to see tissue exposure to thyroid hormones over a 24-hour period then do a Genova urine thyroid test.

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Thank you

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So, Susie gave you a very good reply, there, but no. rT3 does not block your receptors stopping T3 getting into the cells. That's what people used to believe, but it's now been shown that rT3 has its own receptors, so doesn't stop T3 getting into the cells.

So, why do you still feel bad? Could be several things. Something is causing your high rT3, and if it isn't high FT4, it has to be something else. And, it could be that something else that is also causing you to feel bad. Have you had your vit D, vit B12, folate, ferritin tested? How about your cortisol?

Is this the first time you've had rT3 tested? If not, was it high before? Have you had an infection recently? Are you on a low-calorie diet? Lots of avenues to explore. Something is not right, and if it's not your FT3 level, then you need to do more testing to find out what it is.

On the other hand, you might have thyroid hormone resistance. In which case, you would need a higher level of FT3 to feel well. If you feel so inclined, you could procure and add in some T3 - there is room for an increase in level without going over-range - and see if it helps. If you're going to do that, I would suggest you start on 6.25 mcg T3. Stay on it for six weeks, then retest and see how you feel. It might just do the trick. But, you would still need to check out the other things, because there's definitely something else not quite right. :)

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Thanks Very much, I will be exhausting all avenues to make sure I get as close as possible to be normal me again.

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You're welcome. Good luck. :)

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It was my first Rt3 I will have a look through my previous bloods to see what has beeen tested and post the results on here. Thanks

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I have recently started the Pre-diabetes programme,which is low-carb and it is slowly beginning to work. My BP and cholesterol have both lowered and my HbA1c is also beginning to lower. I have only lost about 3 kgs since March, but am pleased with other blood results. My FT3 has also risen a bit, but, like you, My rT3 is a little over what it should be.

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Hi, thanks for the reply, what was your HbA1c?

My Bp and cholesterol is fine..

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Hi Adam, I've been reading your threads and it is puzzling. Most people would love those numbers in your results but it's not working for you. One thing about reverse t3 which seem controversial...some think it s not important and others say it is very important. You stand at less than 15 and I think over 20 is the goal.

There is no real test to see if your T3 is working at a cellular level except to take your temperature. We hypos burn fewer calories per hour than most people....18 calories average. I know, it's totally unfair. Have you ever taken your temperature to see if you are under the normal. It's a hint that your metabolism is too low.

I agree with greygoose that adding more T4 is probably not a great idea. If you are insulin resistant you could try to go on a ketogenic diet, high fat\ low carb to see if you break the cycle. I don't like the idea of Metformin unless you are desperate and you shouldn't be.

I'd rather try a little T3 first.

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Sorry, but I do not have my HbA1C to hand, but in May it was 43 and then my cholesterol was 6.2. My cholesterol is now 5.4 and my TSH has come down from 1.26 to 0.54, so am assuming my HbA1C is much lower now. All I was told at last appointment was that I was now back in range. As far as the thyroid side goes I am feeling a little better.

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Thanks, yes mine was 43 also, trying to shift this extra weight is tough though...

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I personally think my TSH needs to be slightly lower or a small amount of T3 needed to shift the RT3... I will see what the Endo says when I get to see them. Thanks again. Adam

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Hi Adam, just so you're aware - when you add a comment to a post rather than reply to someone's reply, noone gets a notification, so it can largely go unread. It's not one of Healthunlocked's best points! :p

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Thanks for the heads up 👍

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The reply next to the thumbs up is the one you hit before responding. Then you click the Reply button under your message to send.

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Hi, just to add the following from my tests..

Ferritin, 399 Ig/L (400 is classes as high)

B12 , 336 ng/L (180-2000)

VitD is now 74 after taking 1000 iu tablets (75> optimal) it was 43

Cortisol, 362 nmol/L (145-619)

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Hi Adam, I'd be inclined to take a larger dose of D3 for a while to get your vit D up more quickly. I took 5000iu a day. Some people take 10,000iu if their level is very low. You need to be a bit careful with Vit D as it can be toxic if your level gets too high. I think the recommendation is to get it retested after a year. I've also been told to take Vit K2 Mark 7 if you're taking D3 - it helps to direct calcium to the right places. Some people say to take it together but I've also read that it's better to take it 8 hours apart from D3. However, I'm not an expert on this at all!

You might be better posting these results, perhaps with a link to this post, as a new post, as more people will see it that way, and you'll get more feedback. New comments on existing posts don't tend to get seen as much.

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