More or less T4 with T3?

[GKeith]

These are some bloods from a test a week ago. This is on 75 mcg of T4 & 30 mcg of T3. It looks to me like I'm converting the T4 into T3 pretty well. Feel good except for an occasional cold and a stiff neck that cracks like a knee popping sometimes. My endo doesn't want to prescribe any higher T4 without lowering the T3 to 20-25 mcg. I feel like I could take 100 mcg of T4 because the highest I ever had was 88 mcg, because, for 25 years I had no endo; just GP's who all simply left me on the 88 mcg and stared at the TSH adoringly, probably 4 mlU/L at the time.Of course I need T3 but if I can take more T4 and maybe a little less of it (T3) I suppose it would be an improvement. Anybody's input would be appreciated. BTW, I am in the States and T3 is free.

M FASTING: YES

KEITH Ordering Physician

Collected: 6/29/2019 9:27:00 AM -

A

Test Results Abnormal Results Units Reference Range Lab

ТР

T4 (THYROXINE), TOTAL

N T4 (THYROXINE), TOTAL 4.9 mcg/dL 4.9-10.5

A Test Results Abnormal Results Units Reference Range Lab

TP

T4 FREE

L T4, FREE 0.7 ng/dL 0.8-1.8

A Test Results Abnormal Results Units Reference Range Lab

TP

T3, FREE

N T3, FREE 3.6 pg/mL 2.3-4.2

A Test Results Abnormal Results Units Reference Range Lab

T3, TOTAL

N T3, TOTAL 140 ng/dL 76-181

A Test Results Abnormal Results Units Reference Range Lab

ТР

THYROGLOBULIN ANTIBODIES

N THYROGLOBULIN ANTIBODIES <1 IU/mL < or = 1

A Test Results Abnormal Results Units Reference Range Lab

THYROID PEROXIDASE ANTIBODIES TP N THYROID PEROXIDASE 3

ANTIBODIES IU/mL <9

A Test Results Abnormal Results Units Reference Range Lab

FERRITIN

N FERRITIN 39 ng/mL 24-380 TP

A Test Results Abnormal Results Units Reference Range Lab

VITAMIN B12 TP N VITAMIN B12 443 pg/mL P 200-1100

A Test Results Abnormal Results Units Reference Range Lab

FOLATE, SERUM

N FOLATE, SERUM 14.7 ng/mL TP

73

Final Reported: 7/2/2019 2:55:00 AM

Specimen: TM465910R Collected: 6/29/2019 9:27:00 AM A

Test Results Abnormal Results Units Reference Range Lab

GLUCOSE, PLASMA TP

N GLUCOSE, PLASMA 97 mg/dL 65-99

A Test Results Abnormal Results Units Reference Range Lab SODIUM

N SODIUM 136 nmol/L 135-146

A Test Results Abnormal Results Units Reference Range Lab

TP

VITAMIN D, 25-OH,TOTAL,IA

N VITAMIN D 25 37 ng/mL 30-100

OH, TOTALIA ng/mL

Vitamin D Status

25-OH Vitamin D:

Deficiency: <20 ng/mL

Insufficiency: 20-29 NG/Ml

Optimal: > or = 30 ng/mL

For 25-OH Vitamin D testing on patients on D2-supplementation and patients for whom quantitation of D2 and D3 fractions is required, the QuestAssureD (TM) 25-OH VIT D, (D2,D3), LC/MS/MS is recommended: order code 92888 (patients >2 yrs).

For more information on this test, go to: education.questdiagnostics....

(This link is being provided for informational/educational purposes only.)

COMMENT

We received a handwritten test order for Vitamin D and performed 17306, Vitamin D, 25-OH, Total, IA test. If this is.

A Test Results Abnormal Results Units Reference Range Lab

TSH TP

L TSH

0.06 mIU/L 0.40-4.50

[SeasideSusie Remembering]

GKeith

That looks a bit like a copy and paste job for your results. It's a lot of unnecessary information to plough through to try and find your actual results. Perhaps you can edit your post and just put in the necessary information, i.e. the test name, the result and the reference range, which will make it easier for members to respond.

[GKeith in reply to SeasideSusie]

TSH 0.06 mIU/L 0.40-4.50

T4 (THYROXINE), TOTAL

N T4 (THYROXINE), TOTAL 4.9 mcg/dL 4.9-10.5

L T4, FREE 0.7 ng/dL 0.8-1.8

T3, FREE

N T3, FREE 3.6 pg/mL 2.3-4.2

T3, TOTAL

N T3, TOTAL 140 ng/dL 76-181

THYROGLOBULIN ANTIBODIES N THYROGLOBULIN ANTIBODIES <1 IU/mL < or = 1

THYROIDPEROXIDASE ANTIBODIES TP THYROID PEROXIDASE 3 ANTIBODIES IU/mL <9

N FERRITIN 39 ng/mL 24-380 TP

VITAMIN B12 TP N VITAMIN B12 443 pg/mL P 200-1100

N FOLATE, SERUM 14.7 ng/mL TP 73

GLUCOSE, PLASMA TP N GLUCOSE, PLASMA 97 mg/dL 65-99 SODIUM

N SODIUM 136 nmol/L 135-146

VITAMIN D, 25-OH,TOTAL,IA

N VITAMIN D 25 37 ng/mL 30-100

OH, TOTALIA ng/mL

Vitamin D Status

25-OH Vitamin D:

Deficiency: <20 ng/mL

Insufficiency: 20-29 NG/Ml

Optimal: > or = 30 ng/mL

For 25-OH Vitamin D testing on patients on D2-supplementation and patients for whom quantitation of D2 and D3 fractions is required, the QuestAssureD (TM) 25-OH VIT D, (D2,D3), LC/MS/MS is recommended: order code 92888 (patients >2 yrs).

[greygoose]

You cannot possibly tell how well you're converting when taking T3. You need labs on T4 only to tell how well you convert.

But, presumably, you thought you were a poor converter when on T4 only, and that's why you added the T3. Therefore, I really don't think it would be a good idea to reduce T3 in order to add in more levo. Your FT3 would go down, and it's only just over mid-range as it is. Why do you think you need more levo?

[GKeith in reply to greygoose]

Well, I could be wrong, no question about it, but I still remember how good I felt on T4 only for about 20 or 21 years. I say 20 or 21-years because it was actually 26 years but for about 5 or 6 of those years I had symptoms, including ice-cold hands and feet, which went, very quickly away, when I started the T3. So, I assumed (only recently) that if the GP's I saw would have upped my T4, from 88 mcg, which I had started on 26 years ago, to 100, 150 mcg, or whatever they should have, like 25 mcg every 6-months or so, I would have fared well(er) on T4 alone. I believe it was those GP's who made a (the) mistake by never looking at anything but my TSH and, thereby (had) never raised (or lowered) my T4 level. I have been taking 75 mcg of T4, now, for a month straight, with 25 mcg of T3 and it feels no different; my temperatures are actually slightly more stable and I don't have anymore hyper symptoms (diarrhea) as I did with 50 mcgT4 and 30 mcg T3 a month ago. Now, when I looked at my bloods on the 1st of April of this year, my TSH was 0.06 ng/dL and this one last week was 0.7 ng/dL: range is 0.40-4.50 miU/L so no real change there; my FT3 was 3.7 pg/mL in April, and 3.6 pg/mL, RANGE 2.3-4.2 pg/mL a week ago, so no change there my FT4, in April was 0.6 ng/dL and last week it was 0.7 ng/dL, with levels 0,8-1-8 ng/dL, so no change there either, so, if it's basically the same feelings, why would I not want to raise the T4? especially if it feels only (even) a smite better?

It's my understanding that “normal” T4 levels along with low T3 levels indicate a conversion problem. So, as my FT4 level was 0.7 ng/dL out of a 0.8-1.8 ng/dL and my FT3 level was 3.6 pg/mL out of a range of: 2.3-4.2 pg/mL, so the T4 level is (not normal, (but low) and the T3 is past the mid-level, so it''s not low.

I realize that the thyroid gland mainly produces T4 and only produces a small amount of T3 and only by converting the T4 the thyroid gland sends out does the T4 turn into T3 because it (T4) is an inactive hormone looking to become active by converting itself into T3 after it passes into the bloodstream and through the liver and I know many friends who feel fine on T4 alone. Now, I am just like everybody else, looking for my optimum dose, and the easier it is (one pill) the better I will (do) like it. I am also considering NDT but wonder what exactly T1-T5 & Calcitonin is and what it does that would (could) make it preferable to a T4/T3 combo?

[greygoose in reply to GKeith]

GKeith, you've absolutely lost me in all that. But I think you're saying that your bloods are the same whether you take T3 or not. Is that correct?

It doesn't matter how much of what your thyroid used to make, it doesn't make it any more. And, now you're hypo, your needs are different, and you need what you need. The trick is to find out what it is that you need, and you can only do that by trial and error. If you think you would feel better with more T4 and less T3, then try it. I was just explaining why it might not be so. But, I repeat, you cannot judge conversion when taking T3, you just can't have any idea.

I am also considering NDT but wonder what exactly T1-T5 & Calcitonin is and what it does that would (could) make it preferable to a T4/T3 combo?

There's no such thing as T5. Did you mean T2? I don't think we're quite sure what T2 does, if anything. There are theories, something to do with weight control, but I don't think anyone is sure. T1, as far as we know, doesn't do anything. It's just part of the deiodination process so that the iodine can be recycled.

Calcitonin it to do with calcium control, it counter-balances parathyroid hormone. But, it's doubtful that these are the reasons some people do better on NDT, because the thyroid only makes tiny quantities of each and there's no guarantee that they would survive the pill-making process. But, it isn't preferable to T4/T3 for everyone. Not everybody gets on with NDT. Again, you have to try it to know.

[GKeith in reply to greygoose]

Not exactly. I'm saying that I was never diagnosed anything but T4 for 26 years and the last five were full of symptoms, like ice-cold hands and feet, itchy skin and hair and periods of brain fog and I know my body changes as I get older, I'm 73, and I am not trying to turn back the clock 26 years but I took one pill 88 mcg T4 for 21 years, app., and had no problems. I am trying to imagine what I would be feeling like now if I had had an endo who had increased my dose(s) by 25 mcg of T4 until I became hyper enough to back down to the last dose where I would (then) be optimal. I removed all sugar from my diet for an entire month when the T4 gave me the worst headaches imaginable and I stopped taking the T4. I believe it was coming off the sugar now that caused the headaches. I was in Switzerland and upon returning to the States, I went to see my GP and demanded an endo, which I got, I had read innumerable books and been on many sites, like this one, to "educate myself." I demanded T3 and he started me off on 5 mcg T3 and lowered my 88 mcg Levo to 75 and then 50, until I reached 20, then 30 mcg's of T3, where I (feel) felt good and still do but began having hyper symptoms and decided to supplement myself (back) to 75 mcg T4, which I did. I lowered the T3 to 25 because of the hyper symptoms and they leveled off with 25 mcg T3 and 75 mcg T4. Why, I don't know. So, I am just trying to figure out the best dose now. I can control my temperatures with the T4/T3 combo, mostly the T3 but I have done it for weeks in a row. My basel temp's (1st thing in the morning) are 97.5-98.1 whenever I take the T3 and also after a workout when (if) I fall asleep and then upon waking take the temp's they are always between 97.5-98.1. Peace go with you g.g. and thanks for giving out your knowledge so freely.

[greygoose in reply to GKeith]

You're welcome.

[NWA6 in reply to GKeith]

Hey GKeith 👋 If I’m understanding you correctly you were mostly happy on T4 for most of the time you’ve been Hypo but at some point some idiot didn’t let you have enough T4 and so your symptoms worsened and somehow you began combo treatment and yet you aren’t happy with it and you feel you’d like to go back to T4 only in order to stop fannying about with all these ‘optimal dosing’ ?

So yes absolutely try it. Your T4 is below range atm? Atm your on about 195 total Thyriod replacement. Do you feel good or not? If you need to equal or increase that replacement in the form of T4 only I’d do it something like this

Wk1 100mcg t4 plus 30mcg T3

Wk2 120mcg T4 plus 25mcg T3

Wk3 140mcg T4 plus 20mcg T3

Wk 4 160mcg T4 plus 15mcg T3

Wk 5 150mcg T4 plus 10mcg t3

Wk 6 160mcg T4 plus 5mcg T3

Wk7 170mcg T4

Work out your own numbers, I am not medical but just sharing my thinking’s

Hold at any point, maybe you do still like/need T3 maybe it’s unrealistic to get rid of all of it. Many of us have more T4 and a top up of T3 ie I was on 175mcg T4 and never felt well. Now I’m on 132 T4 and 20mcg T3 which is much more total Thyriod replacement than I’ve ever had but it’s perfect for me as I don’t convert well enough.

Good luck figuring it all out 🤗

[GKeith in reply to NWA6]

Well, I was "happy" because for 21 years, the T4-alone worked and I only (had to take) took one pill. Now if I find out that I am converting T4 as easy as I did 26 years ago, of course, I would prefer that, but, because of what I've learned (since then) and because I've taken T3, that's not gonna happen. I know that T3 is app. 4 times as potent as T4, so that at 25 mcg T3 and 75 mcg T4 I'm actually on about 175 mcg of thyroid (medication). I really can't see (don't want to) myself quitting very much T3, as I took it (T3) alone for the first month and then took 50, now 75 (again) and I realize it's converting but the T3 is what's giving me an energy-flow that I don't want to give up. It's also what's keeping my thermostat working (temperature ) and my blood pressure in good shape. I am just about optimal on 75 T4 and 25 T3 and will probably stay here & maybe even up the T3 2.5 mcg's or so. Thanks for your answers Paula and may peace be with you.