In November last year, I was prescribed T3/ T4 combination after 13 years of struggling on T4 only. I started off by taking 100mcg of Levothyroxine and 20mcg (split into two per day, so 10mcg in the morning and afternoon).
My results were as follows:
FT4: 16.8 (Range: 10.3 – 22.7) Increased from 15.1 without T3 supplementation
FT3: 5.5pmol/L (Range: 3.5 – 6.5) Increased from 3.9 without T3 supplementation
TSH: 0.03 (Range: 0.35 – 5.5) Decreased from 2.97 without T3 supplementation
Cortisol: 180nmol/l (Range: 133 – 537 nmol/l
My endocrinologist has said that my TSH is suppressed, so has amended my dosage of T4 to 75mcg and 100mcg on alternative days.
I am not feeling that great on it, and symptoms have not improved drastically. Could somebody just help me understand the results? I’m not actually sure what the results mean. Are there any supplements I can take to help. I’m just confused really.
In November, he did do a Synthen Cortisol test (between 8 and 10am). The results are follows:
Cortisol (Basal Sample): 279
Cortisol (30 mins): 648
Cortisol (60 mins): 760
The results showed (as mentioned in the letter), that I had:
normal response: A Cortisol >= 415nmol/L at any time
Again, I’m not sure what these numbers mean, so would be grateful for any guidance. Thank you for getting this far!
Written by
SharanLall
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They really should stop messing about with doses according to the TSH whilst ignoring if patient has improved or not. A link that one of TUK's deceased adviser wrote:-
It never ceases to amaze me that these endos who prescribe T3 have no clue as to what it does to test results. You don't read test results the same when on Levo/T3 combination as when on Levo alone.
Taking T3 lowers, even suppresses TSH. Which is what has happened with you, and is normal.
As long as FT3 stays in range then you aren't overmedicated.
Those results look pretty good, there was absolutely no need to change your doses at all. Your Levo should not have been reduced, your FT4 is 52% through range. Your FT3 is 66% through range. Many people on combination therapy would do well on those results. Some need a higher FT4/FT3, some are happy with a lower FT4, we are all individual and need levels where they are best for us.
Reducing your Levo dose will not raise your TSH back into range.
Thank you SeasideSusie! Your explanation is great. Are there any studies to that effect I can take to my endo? Since lowering my T4, I’ve gone backwards and some of my symptoms have re-appeared.
I'm afraid that I don't have any links saved about this. However, SlowDragon takes a combination of Levo and T3 and has a very enlightened endocrinologist, if she has any information that can help she may pop along now that I've tagger her.
Can you add Current vitamin D, folate, ferritin and B12 levels
Vitamins need to be tested regularly and frequently need supplementing to maintain at optimal levels
Do you have Hashimoto's? Diagnosed by high thyroid antibodies. If so Are you on strictly gluten free diet?
Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and fasting. Last Levothyroxine dose should be 24 hours prior to test, (taking delayed dose immediately after blood draw). This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)
If/when also on T3, make sure to take last dose 8-12 hours prior to test
Is this how you do your tests?
TSH is almost always suppressed on any dose of T3
Most important results are FT3 and FT4
With DIO2 gene variation you may need 3 x 5mcg doses of T3 per day at 8 hour intervals
Levothyroxine dose is likely too low, especially if vitamins are low
Just reading your thyroid results....thought that’s better, even your FT3 seems good now....but then read about your daft endo who thought the TSH needed raising, and thought oh dear...another doctor who doesn’t understand T3 use, or importance of FT3. Now you are taking the active hormone T3 your body may not need much FT4 , it is merely there for storage and conversion to FT3, similarly since you are adding T4 and T3 orally then you have ‘bypassed’ the need for TSH. Once on any T3 the usual recommended results of TSH of 1 or under, FT4 say 3/4 way thru range don’t apply , these ranges were for those on levothyroxin. Were you put on T3 due to poor conversion of T4, if so you might not notice a vast difference between new and old dose....but whether the TSH will rise by x10 plus is doubtful.
Never tested for gene ( does that mean you are not Hashimoto’s with autoimmune antibodies?) , but worked my way thru levothyroxin ( 13 years), levo/T3 combo for nearly a year with upto 100/50 combo, while a month ago became T3 only. So all I can advise is try it and see, be patient before you change; keep a ‘diary’ of bp, pulse, basal temp.too with doses and how you feel...so if necessary you can go back to when/ where you felt better to start again. I personally would stick on the 100:20 combo dose abit longer; test folate, ferritin, b12 and vitD as these need to be at optimal ( upper half of range) levels and can improve conversion/ thyroid health and also other ailments hypos tend to get like tiredness, hair falling out.... adding more T3 might send your TSH even lower! ( not that that will do you any harm)!
Got interrupted doing this reply, but now see you are not Hashi., and that you had tested mins / vits nearly 5 months ago now...so probably ok.
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