A few months ago I asked for advice about starting a trial of T3 - after some thought I decided to obtain a new set of blood tests before starting so I could see where I was starting from. Oddly enough my T3 appears to be low and as this hadn’t been the case before I wondered why that might be? I have never ever felt worse in my life - dragging myself around by day and only getting intermittent sleep at night.
I am currently taking 150mg Levo and plan to introduce the T3 to this in the small doses recommended.
My current results are as follows
T3 3.3 pm/ low (3.5- 6.5)
T4 12.5 pool /L (9-24)
TSH 2.8 mU/L (0.35 - 5.0)
What would anyone’s advice be.
So many thanks in advance
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Steni
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Hello ! On quick inspection I’d suggest your t4 is quite low as well as your t3 being extremely low. Did you feel ok on 150 levo at any point in the past? Has something changed?
It might be that adding t3 alone will help, but you might want to add in some more t4 too perhaps. Is your doctor supportive?
Hello Steni, it’s just a little difficult sometimes to get it right so it’s best not to take it unless you need it. You don’t know if you need it at all until you’ve increased T4. Once you do that your T3 may raise too, as long as you convert T4 naturally to T3. You only need to take T3 if you can’t convert T4.
Thank you - I had assumed that as my T3 was low I wasn’t converting but in any case have been thinking of a T3 trial which my doctor had agreed to as I wasn’t and haven’t ever had any relief from symptoms using T4 only. I am surprised that both my T3 and T4 are lower than my last tests in January were however - despite no change in Levo dosage ( although I was slightly under medicated whilst on holiday and of my routine) I wonder what may have caused this?
You're under-medicated on T4. Your TSH is too high and your FT4 is too low. Which is surprising, given your dose. Have you perhaps slipped a little in the way you take your levo? Do you always take it on an empty stomach leaving at least an hour before eating or drinking anything but water, and wait two hour to take other supplements or medication?
Your conversion doesn't appear to be too bad, but we'll know better when you get that TSH down to around 1 or under.
Thank you - I was hoping to have your opinion, I think I got a bit careless over taking the Levo a month or so ago although been ok since. I feel so much worse, as though my body is in crisis and as though I might collapse at any point. I have had to sit under my desk at work in the afternoon to just try and get some respite from the fatigue until I pick up again - I don’t know how I am functioning at all. I have never felt as bad as this ever.
OK, so how did you feel when you were taking it correctly every day? Were you also fatigued? It is going to take time to build up again. Is your doctor going to give you an increase in dose? Or just waiting to see how it goes?
I felt bad but not as bad as I do now. I’m pretty much in charge of my own dosage so I’m taking 175 now to see if that helps. As I felt so little relief even when taking the Levo correctly I had always wanted to try adding the T3 ( which I’m almost sure I will do in the next few weeks) the drop in T3 my latest results showed encouraged me to think it could be a worthwhile exercise?
Yes, but if you haven't been taking your levo correctly for a while, that's why your FT3 dropped. An absorption problem would be just as bad with T3 as it would with levo. In those results there is nothing to suggest that T3 would solve your problems. Just taking your levo correctly could bring your levels up. So, how do you take your levo?
OK, so it's well away from everything else. Do you take it with a large glass of water to make sure it gets down into the stomach, and doesn't get stuck in the gullet?
Then you could have low stomach acid. Has your stomach acid ever been investigated? Or your gut? Are you gluten-intolerant? Do you have a leaky gut? Taking that much levo, your FT4 should be higher.
The above link is all about stomach acid, and there is a home test at the end.
The only way to find out if you're gluten intolerant is to cut out gluten 100% for a few months, and see if you feel any better.
To find out if you have a leaky gut, you would need gut investigation, and endoscopy, or whatever it's called. But, I would try testing your stomach acid and going gluten-free first.
Just at the moment I’m in bed most of the time ( if not at work) and I am having desperate ‘crashes’ of energy a odd times during the day, when I am overwhelmed with exhaustion and a feeling of weakness in my body as though another step will cause me to collapse- I sit for a while, and after a time the feeling passes and I can carry on or if I’m home then I go to bed and sleep for 2 to 3 hours. I feel hungry and crave carbohydrates or something filling to take away a knawing feeling. Some of the worst times are just after I eat.
These results show Levo dose is too low. TSH too high and FT4 too low, this should be towards top of range
Your FT3 was too low because Levothyroxine dose too low
Very unlikely to have any reverse T3 issues with such low FT4
Either need just dose increase in Levothyroxine to 175mcg and take absolutely EVERYDAY
You have to NEVER forget to take dose everyday
Or possibly adding a SMALL dose of T3 (2 x 5mcg ap and pm initially) with your 150mcg Levothyroxine
After 6 weeks need retest, before considering any futher dose increase. post results and ranges when you have them
But T3 is much more difficult to manage, often needs to be split dose 2 or 3 x per day and never forget. Always take any Levothyroxine or T3 on empty stomach and absolutely nothing but water for an hour after
Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have money off offers.
All thyroid tests should ideally be done as early as possible in morning and fasting. When on Levothyroxine, take last dose 24 hours prior to test, and take next dose straight after test. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, GP will be unaware)
If also on T3, make sure to take last dose exactly 12 hours prior to blood test
But essential to test vitamin D, folate, ferritin and B12 ASAP
If these are low they need supplementing to improve. T3 and Levo both need good vitamin levels to work well
If you have Hashimoto's then look at gluten free diet too
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