Advice on test results please

[Dotty1340]

I started taking of 6.25 of T3 (self sourced) in September along with 125mcg of Thyroxine. I started feeling better than I had for a long time but after a few weeks started with very fast heart rate, almost like palpitations. However at the same time I was going through a very stressful time at work and having previously suffered with palpitations caused by stress did not know if it was the medication or my stress. Therefore I erred on the side of caution and reduced my Thyroxine to 100mcg. I have felt quite poorly as a result of this and some of my original symptoms pre diagnosis returned, in particular tiredness and taste distortion and night sweats.

I didn’t want to change my meds until I’d been tested again and I’d managed to convince my doctor to include T3 levels. Astonishingly I was tested this morning after fasting , taking T3 12 hours previous and no Thyroxine for 24hours. The results came back the same day. I am going to go back to 125 Thyroxine but didn’t know if I should increase T3.

I believe the doctor also tested for Calcium and other bits and pieces I don’t understand but those results are not back yet.

So my long winded question is....should I increase T3, taking 6.25 of T3 has improved my conversion rate tested previously from 3.6 to 4.8. My serum free T4 used to be at 21-22 so that appears to have reduced but I don’t know why or if this is good or not.

Many thanks in advance.

Results below cut and pasted....

Thyroid function test Aim for TSH towards the bottom of the reference range for T4

replacement in primary hypothyroidism, targeting to around

1.0mU/L for symptomatic patients.

Further info at: british-thyroid-association...

Measurement of FT4 is of little additional value in patients

stabilised on thyroxine. Please monitor using TSH.

Serum TSH level 1.6 mU/L [0.27 - 4.2]

Serum free T4 level 17 pmol/L [11.0 - 22.0]

Serum free triiodothyronine level 4.8 pmol/L [3.1 - 6.8]

FT3 is of little additional value in patients on thyroxine.

Serum total 25-hydroxy vitamin D level 61 nmol/L [> 51.0]

Vit D concentration > 50nmol/L adequate for optimal bone health

[Judithdalston]

Unfortunately I found adding T3 to levothyroxin was very much a trial and error process. Some have been successful ‘swopping’ 25 mcg of levo. for 10 mcg of T3, but it didn’t work for me as doing this actually decreased my FT3, and I had to increase the levo again. Then increased the T3 very slowly - currently 37.5 mcg for last 6 months. Adding even small quantities of T3 affect your bloods; adding or replacing to T3 usually results TSH goes down, so does FT4 and T3 hopefully goes up ( in itself not necessarily improving conversion...tho ‘ strange’ things can happen to the FT4 /FT3 as I experienced). despite what the blood-test Dr.said your vit D could be more 100-150 range; what about folate, ferritin, B12 levels?

[Dotty1340 in reply to Judithdalston]

Many thanks for your reply, I don’t believe the doctor tested for the others you mention (Folate etc) but I am waiting on these other results just in case. Yes it does seem to be trial and error from what I can see. I guess everyone is different.

[SeasideSusie Remembering]

Dotty1350

"taking 6.25 of T3 has improved my conversion rate tested previously from 3.6 to 4.8."

Your conversion rate hasn't improved. You are now taking T3 and your FT3 is now higher because of the T3 that you are taking. Once on T3 you can't work out your conversion rate.

Serum TSH level 1.6 mU/L [0.27 - 4.2]

Serum free T4 level 17 pmol/L [11.0 - 22.0]

Serum free triiodothyronine level 4.8 pmol/L [3.1 - 6.8]

TSH generally lowers when taking T3, and is often suppressed. Your FT4 is 55% through range and your FT3 is 46% through range. We're all different where we need our FT4 and FT3 when on levo/T3 combination so that's something you need to work out by tweaking your doses. For someone on T3 your FT3 is a bit low so you could increase that by 6.25mcg as a first step, see how you feel in 6-8 weeks and maybe retest to see where your levels are then. I wouldn't increase Levo at this point, you shouldn't change both at the same time and I think increasing T3 might be what you need.

[Dotty1340 in reply to SeasideSusie]

Thank you for taking the time to reply. Your insight is always welcome! I understand what you are saying re the T3 conversion. Trial and error!

[radd]

Dotty,

You are on a small dose of T3. Both TSH and T3 test results allow for a T3 dose increase of another 6.25mcg.

Considering you recently suffered palps, it may be beneficial to multi-dose to reduce the rapidity of T3 onset and prolong the duration of its action. I take my meds 6.30am and 3pm.

Palps are common in people (medicating thyroid hormone) with low iron. Have you had ferritin checked ? What about Vit B12 & folate ? Vit D looks low.

Hope you feel better soon.

[Judithdalston in reply to radd]

I got palpitations/ high bp etc when starting T3 added to T4, which did not go till n the full 25 mcg T3 tablet, though had reduced my T4 down from 125 to 75 mcg...think palps were hypo symptoms, as went onto 100 mcg levo and 37.5 mcg T3 to feel ok.

[radd in reply to Judithdalston]

Judithdalston,

Oh poor you. I too suffered terrible palps for four years when medicating only T4. It was very frightening. Fortunately mine stopped soon after introducing T3.

[shaws in reply to radd]

So did I - what we have to go through - due to the guidelines - but when we come out at the other end, due to help advice from TUK and the forum we're angry that we weren't listened to or understood by those who are supposed to 'know' how to treat patients who're hypo.

[shaws]

I have read that when patients take a combined dose that a 3:1 or 4:1 has proven successful (T4/T3).

You can also increase by adding 1/4 tablet every 2 weeks always taking note of your pulse/temp to judge your dose.

I really do not understand this sentence:-

"FT3 is of little additional value in patients on thyroxine".

Because it is T3 alone which is needed in our T3 receptor cells. T4 is an inactive hormone and it has to convert to T3 the Active Hormone and we have millions of T3 receptor cells which need T3 in them.

[Angel_of_the_North in reply to shaws]

It's a "swallow the Kool-Aid" phrase, as is "Measurement of FT4 is of little additional value in patients stabilised on thyroxine. Please monitor using TSH." - no one needs T3 so no need to test it and TSH is the "gold standard" so don't waste the lab's time.

[Dotty1340]

Many thanks for responding. It is appreciated and will start my tweaking!