Most recent results are TSH 3.19 (0.55-4.78) T4 9.4 (11.5-22.7) T3 6 (3.1-6.9)
Sample drawn first thing 24 hrs after Levo & 12hrs after T3. I can't understand why my T4 isn't even in range and my TSH is going up I presume in an attempt to produce T4?
Any ideas welcome
TIA
Simple answer, you're not taking enough Levothyroxine
As gut starts to heal, vitamins improve and addition of small dose of T3, you are probably doing more, feeling better and need higher dose of Levothyroxine
Increase in Levothyroxine by either 25mcg alternate days initially for 6-8 weeks and retest. Or put dose up 25mcg every day to 100mcg and retest 6-8 weeks later
Typical combined T4 plus T3 dose is 100mcg Levothyroxine plus 20mcg T3
Thank u for response.
I did find with 125 mcg Levo that I had flushes and my BP was raised but I would like to try and get my T4 into range.
Do folk on T3 only generally have T4 in range?
Well we are all different
Personally I need FT4 about half way in range.
My endo initially dropped my Levothyroxine by 25mcg (from 125mcg) to 100mcg, when added 20mcg T3. (T3 was Split dose x 3. 10mcg waking, 5mcg noon and 6pm)
I found my FT4 dropped almost below range. Many hypo symptoms returned. I put dose back to 125mcg
Since changing T3 to every 8 hours 6 months ago (waking, 3pm and bedtime) I have been able to slightly reduce Levo to 112.5mcg
More info on profile
Thanks, I’ll have a look.
I have some symptoms back now T4 below range but my T3 is really good and I thought that would make me feel better as it’s the ‘active’ hormone?
We usually need both, (unless unable to tolerate any Levo, and on just T3)
Adding small dose of T3 is not to replace the FT4, but simply helps keep levels stable so that it all works better
On T3 only, mine hovers round the bottom of the range, sometimes just in range, sometimes under. (in a range of 12-22, most recent test was 12.26 and previous test was 10.87).
On T3 only you'll eventually have virtually no t4 and from what I've seen, on 2 grains armour, total t4 will be at the bottom of the range. The free number will usually correspond.
I was taking 75mcg Levo &12.5 T3 but my T4 wasn’t even in range which I found strange and my TSH went back up
that could be a few things:
t4 has a week half life - so if 75 is a new dose, you need to give it a month or so.
You might need a little more t4. t4 isn't absorbed as efficiently as t3, so there's a different ratio pre and post absorption.
Make sure you take the t4 away from caffeine, iron, and calcium - meaning, preferably on an empty stomach.
tsh can vary a little throughout the day.
Follow doctors orders, of course, but whenever I find my t4 low, I double up the dose to get it back up. The long half life plays into this. My wife will do this as well, although I did overshoot it once and felt wired all day.
best of luck to you.
I'm struggling with ratios at the moment and not much help from GP. Both my T3 and T4 are below range and TSH suppressed. I take 100 mcg T4 and 30 mcg T3 split into 3 doses. Have been having palpations and dizziness on and off and generally not feeling good. Wondering if this is because my levels are not right. Have had investigations and nothing found. So hard to get the right doses x
That's a pretty large dose. That's enough T3 to fully suppress natural production but not enough t4 alone to get you above bottom of the range.
That particular dosing is also tough to regulate with testing as you've shut down your markers.
I would suggest you slowly lower your T3 dose to get your tsh up to. 5 about 12 hours after your last T3 dose, although this could still be tough to interpret.
You could also check your rt3 and see if it's elevated. If it is, I would interpret this as being over medicated.
I don't know your stats but you might want to wean the T3 down to 20 mcg and see if you notice anything. It could take a few weeks for t4 to gradually rise given the long half life. Then reassess.
Maybe you need to increase your t4 and decrease the t3. Some are very sensitive to t3. I personally cannot take a lot of t3 because it causes several palpitations, dizziness and fainting for me, maybe 30 mcg t3 is just too much for you.
I meant “severe” lol
It's quite usual for Free t4 to drop when taking T3, but some people need free T4 at least 50% of range. To get that you'd need to take more levo. Levo (T4) converts to T3, not the other way round. The higher T3 (which is a good result) is because you are taking T3)
Thanks for reply. I understand the T4 to T3 conversation but not sure why my TSH would rise trying to make T4 when the active T3 hormone was already good?
I'm only into this a year, with but a few months on T3 exclusively, but I would guess that your TSH is rising because there is more reverse T3 from your conversion of T4. When I was taking levothyroxine and not converting it well (unbeknownst to the endocrinologist), the T3 and T4 looked ok but the TSH rose over time. Taking a look under the bonnet where he never bothered to gaze, I saw my rT3 was well above the reference range. No wonder I felt so awful.
Taking both high dose levothyroxine and a low dose of liothyronine, I found myself experiencing thyrotoxicosis alternating with severe hypothyroid symptoms if any adjustments were made in the T3. Not good.
I'm far more tolerant of dose adjustments in the T3 now that there's minimal LT4 in the picture. My endocrinologist has zero experience with this, so I am his science experiment as I tinker with the hormone mixes at home and try not to blow myself up.
At 75 mcg LT4 my levels of FT3 and FT4 were at the low end of the range.
The body can be an inscrutable system.
And the ranges include unknown numbers of undiagnosed people with thyroid disease so they aren’t very meaningful. The ratio between FT3 and rT3 I found to correlate very well with how poorly and how well I feel.
Too much T4? 
Free T4
T4+T3 combo
T4 - T3 relations 🤝
Blood test results. Endo wants to reduce t4
