Should I add T3 or wait and see?

[Sophie01]

Hi there,

Bloods after 4 weeks on 100 Levo only are as follows

TSH 2.29 (0.50-4.00)

FT4 17.5 (10.0-19.0)

FT3 3.7 (3.6-6.5)

After 2 weeks on 100 Levo only, bloods were as follows

TSH 4.42 (0.5-5.5)

FT4 12.6 (9.0-19.0)

FT3 2.9 (2.6-6.0)

Prior to this, after 1 month ‘clearing out’ 2 year trial with NDT and tertroxin that was overall unsuccessful

TSH 9.5 (0.5-5.5)

FT4 8.5 (9.0-19.0)

FT3 2.8 (2.6-6.0)

SO, I seem to be moving in the right direction, but FT3 sure is taking its time to increase, and feeling still rather lacklustre! Doctor said to stay on current 100 Levo for one month more before changing anything. This is by far the highest my FT4 has ever been, and FT4 was always around mid range (I was on 75 levo and 10 T3 before trialling NDT) Is this high FT4 a problem, given I’ve only been on current dose 1 month? Should I wait and see if more conversion to T3 happens over next month, or should I drop back Levo dose & add in 5 T3? Any thoughts will be hugely appreciated!

thanks x

[Judithdalston]

Taking your bloods every 2 weeks is unnecessary, and it would be better to see what the results were like after at least 6 weeks as FT3 might still improve. Have you had your ferritin, folate, B12 and vit D tested as need to be optimal for good thyroid health and conversion of T4 to T3?

[Sophie01 in reply to Judithdalston]

Thanks Judith, much appreciated. Yes I know I’ve taken bloods prematurely, but leaving on OS holiday on Tuesday, and won’t see doc for 2 months, so was hoping for some indication I’m on the right track!! Blooming hormone business is a life lesson in patience that’s sure! I’ve been working with great dr for 5 years, addressing all the vitamin levels, they’re ok-ish , I’ll wait & see, test again after another month if I can 😊

[SlowDragon Administrator]

As you have Hashimoto's low vitamin levels are especially likely

Important to test levels regularly

[Sophie01 in reply to SlowDragon]

Thanks SlowDragon. Yes I see a fab functional doc (5 years now) who has me on all the right supps / diet etc, most of the relevant vitamin levels are ok-ish!! I guess I’ll wait & see if more T4-T3 conversion happens over next month (not overly hopeful, in the past I’ve had to add T3 to Levo as poor converter!) Just feeling a little down as have a 2 month overseas trip starting Tuesday, had hoped to feel a bit better!

[Eyes-wide-shut in reply to Sophie01]

Hi would it be possible to pm the name of your functional DR. Many thanks.

[Hashihouseman]

Taking bloods frequently isn’t a bad thing if you can afford it. Some research indicates that tsh stabilises between 2-3 weeks not the 6-8 bandied about! Also it seems to me to be very useful to see the direction of travel before we go too far the wrong way and levels then spend all year oscillating widely because we test too infrequently. Moreover levothyroxine/fT4 stabilises 1-2 weeks so we can see how a dose is settling in. The only caveat I would add is that it may be that it is worth tolerating a higher than ideal tsh in response to levothyroxine only because it may take longer to show more ft3 in blood tests. so waiting even 2-3 months after finding a tolerable dose of levothyroxine could be the best evidence of what your t4-t3 conversion capacity is...... oh and there is also the potential negative feedback on ft3 if we take too much t4, either in each dose or cumulatively, to consider!

[AnneEvo in reply to Hashihouseman]

What does "potential negative feedback on ft3 if we take too much t4," mean?

[Hashihouseman in reply to AnneEvo]

Most of our T3 comes from conversion of t4. Most of that catalysed by the enzyme DIO2. As ft4 rises the activity of this enzyme slows to a point where more t4 gives less and less T3 so there is probably an optimum level of t4 which is directly affected by replacement therapy strategy because it is not in the automatic control loop that exists with a healthy thyroid gland.

[AnneEvo in reply to Hashihouseman]

Thank you.

[Sophie01 in reply to Hashihouseman]

Thanks Hashihouseman for your input on my query, you’ve really inspired some food for thought! More (Levo or T3 supplementation) is not always better it seems! In any case, I have stayed the course & haven’t altered my dose from the 100 Levo, and had bloods taken a few days ago (having then been on that 100 Levo for 2 days under 8 weeks) I wonder if you’d mind having a quick look at the results, & offer any insight please? I’ll also make a separate post asking for thoughts on these results, but thought you may miss that! I’ve had the tests done in Italy, so unfortunately the units of measurement and ranges are quite different from those at home (Australia) But, though my maths isn’t fantastic, I reckon that my TSH is just below mid range, FT4 just below mid range (is this ‘normal’ to have dropped so much in a month on the same dose of Levo?!) and FT3 is just above mid range (moving in right direction!) I’m feeling ok-ish, not fab, but do crash every afternoon after lunch......I’d really appreciate any thoughts you might have about where to go from here?!

Thanks Hashihouseman!

Cheers

Sophie

[LAHs]

Hi Sophie, good advice above but I would also recommend you measure your Selenium (Se) level and, if found to be low, then take a supplement or eat two Brazil nuts per day. Se is the catalyst for the T4 to T3 conversion and it must be present in addition to the vitamins listed above in order for T4 to T3 to take place. I personally eat Brazil nuts because it gives you magnesium also.