Advice needed

[cahod6103]

Hi, I’m on Levo and Liothyronine combination, can anyone tell me what my T4 level should be while on this combination please. Thank you.

[MaisieGray]

Both your FT4 and FT3 should be optimally within range in order for you to feel well on mono-T4; but when you take T3 in either synthetic or natural form, this generally has the effect of lowering your TSH and your FT4. Some find that their FT4 is just lower in range than it is on mono-T4, whilst others find it is much lower. Whether that suits you is a very individual thing; and if you are well & symptom-free with a lower FT4 when your FT3 is optimal, that's fine; otherwise you may need to add in some extra synthetic T4.

[cahod6103 in reply to MaisieGray]

Thank you MaisieGray, my T4 is down to 13, ref range is 11 to 27, T3 is 1.8, ref range is 1.3 to 3.8, TSH is 2.6, ref range 0.3 to 5.0. I feel my T4 is maybe too low, but Endo is wanting me to stay on the same dose of Levo 75mcg and Liothyronine 15 mcg, 10 in am with Levo, then other 5 around 5 to 6 pm. I’m feeling awful just now, headaches, aching all over and generally feeling unwell.

[MaisieGray in reply to cahod6103]

So your results are:

T4 13 (11 - 27)

T3 1.8 (1.3 - 3.8)

TSH 2.6 (0.3 - 5.0)

Can you clarify that the T4 and T3 are Total levels rather than Free levels - the T3 in particular looks like a Total T3 reference range. If they are in fact, FT3 and FT4, your results would seem to indicate that you are under-medicated and could increase your Levo - we might generally expect a TSH level of around 1 or just under, whatever is required for you to achieve hormone levels that make you feel well. You might find that you are a person that doesn't do well splitting their T3 into small doses, and you could try taking it in a single dose. I used to take my T4 and T3 together at night to avoid my other meds, and now take T4 at night and T3 mid-morningish, and it makes no difference to me, but I've never split my 20 mcg T3 - as with everything else thyroid, it's trial and error to see what works best for you. You also are advised to take your meds on an empty stomach away from food and drink, and separated from vitamins & minerals, are you doing this? Likewise have you tested your vit & mineral leels and addressed any shortages?

[cahod6103 in reply to MaisieGray]

Hi MaisieGray, it says Free T4, only says T3, so don’t know if it’s Total or free, sorry. I take vit D, I take it about 4 hrs after am dose and about 3 1/2 hours before next dose, I leave about 30 mins after taking them, before eating anything.

[SeasideSusie Remembering in reply to cahod6103]

Are you in Scotland? I believe they test Total T3 there and not Free T3. I believe it would say Free T3 if that is what they tested.

Total T3 isn't a useful test, you need to know the amount of Free T3 that's available to get into your cells. Total T3 is the total of bound to proteins and unbound (free) T3. As yours is very low in range, it's unlikely there'll be much Free T3 anyway.

In any case, your TSH is too high indicating you are undermedicated. Taking T3 tends to lower, even suppress TSH.

It never ceases to amaze me that doctors prescribing T3 don't seem to know the basics of including the most important test of all when on T3 - testing Free T3.

[cahod6103 in reply to SeasideSusie]

Hi SeasideSusie, yes I am in Scotland, I think you will be right, it says Free T4 on the results, but just says T3. I feel I’m not getting enough T4 or T3 really, I’m certainly feeling worse since being started on the combination of the 2, but could be because I’m not on the right dose. I received a letter from the Endo on Friday, to say I’d to stay on the same dose, check TSH in 2 months ! . I’ve got an appt with him on Fri, I don’t think he realises that when he has sent me a letter. You’re right, my GP hasn’t a clue about levels, as long as I’m in range I must be fine was her comment, but I’m not sure about the consultant either, he increased the Liothyronine in Oct, latest results from then, TSH has went up, T4 down and T3 down by a point, so I don’t understand why I’ve to stay on the same dose. Thank you.