Should I take T3 for listlessness, fatigue, and slight depression?
My recent blood tests are shown below in hopes that those more experienced can give me their opinions.
If I want to take T3, my Endo has agreed to prescribed a very low dose of 5 mcg of T3 to take once a day with .88 Levo 6 days a week, which she says equals out to .75 Levo per week. I presently take .88, 7 days a week. Taken early morning, 2 hours before eating.
I have asked about my situation before on this forum and have had good advice, but have not taken it because there is always a fear of what the Endo said, that T3 can cause atrial fibrillation. I have not felt well in the last few years and now I am thinking to start on this very low dose of T3 because my regular doctor said that with 5 mcg, it is unlikely that I will get an overdose that would normally be the cause of a rapid heartbeat or fibrillation.
But I would like to get some feedback and suggestions from the knowledgable people here before I move forward with this plan. Thank you in advance for any suggestions and opinions.
Blood Test Results - 8/8/19
TSH, 1.25 (0.40 - 4.50)
T3, 2.5 (2.3 - 4.2)
T4, 1.2 (0.8 - 1.8)
Ferritin, 32 (16 - 288)
Folate, 23.8 (3.4 - 5.4)
Vit D, 35 (30 - 100)
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saritadelmar
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The .88 Levo would be 6 days a week if I take the T3 everyday, 7 days a week. Right now I am only taking .88 Levo, and that is 7 days a week, until I move forward on the T3.
Hi Saritadelmar, if you could please include the measures used in your test results (nmol/l etc.). Labs differ in the way they report but not seen these ranges used in tests before. Thanks
Thanks, I have tried to do a rough conversion from US to UK measures for my own curiosity but also for ease of reference for those in the UK. There are some outstanding questions/issues with some of the US measurements which hopefully those in the US can help with.
1. For T4/T3 (as there is only "FREE" between your results I wasn't able to tell which it belonged to so have assumed it applies to both T4 and T3.
2. For T4 you have both mIU/L ng/dL. For the conversion I used ng/dL.
3. Not sure what Vit B12 measurement unit is as not listed.
3. Iron saturation. We normally have this in % so would need some guidance from those in the US with how this is interpreted.
The below was drawn from a spreadsheet so headers are included for reference.
"Blood Test Results - 8/8/19 "
U.S.A.
What TestedMeasure (Original)Range (Original)Unit of Measure (Original)Measure (Converted)Range (in UK measures)Unit of Measure (in UK)
TSH1.25(0.40 - 4.50)mIU/LMilli-International Units Per Litre (mIU/L) >> 1.25(0.27 - 4.2)mIU/L
T3 (FREE?)2.5(2.3 - 4.2)pg/mLPicograms per millilitre (pg/mL) >> 3.84(3.1 - 6.8)pmol/L
T4 (FREE?)1.2(0.8 - 1.8)listed both mIU/L ng/dLUsed Nanograms per decilitre (ng/dL) >> 15.45(12-30)pmol/L
Ferritin32(16 - 288)ng/mLNanograms per millilitre (ng/mL) >> 32(30-400)ug/L
Folate23.8(3.4 - 5.4)ng/mLNanograms per millilitre (ng/mL) >> 23.8(3.89 - 19.45)ug/L
Vit D35(30 - 100)ng/mLNanograms per millilitre (ng/mL) >> 87.36(50 - 175)nmol/L
Vit B12 1649(200 - 1100) Not sure if serum or active?pmol/L
Iron total 62(45 - 160) mcg/dLMicrograms per decilitre (mcg/dL) >> 11.10(5.8 - 34.5)umol/L
Iron binding capacity328(250 - 450)mcg/dLMicrograms per decilitre (mcg/dL) >> 58.71(45 - 72)umol/L
Iron saturation32(16 - 288) ng/mLNanograms per millilitre (ng/mL)?%
I am not best placed to comment much as I am relatively new to the Hypothyroid forums but initial thoughts are:
1. Folate is elevated so would be good to know if you are taking folate supplements with your Vit B. It is worth noting that a high folate intake can mask vitamin B-12 deficiency. Although given your high Vit B12 test result it would appear unlikely. It is hard to say how much of an influence the folate intake (if you are supplementing) is having on Vit B.
2. Ferritin is on the lower end which is fine if you are feeling ok but for some it can be too low, especially when seen in context with the rest of your iron panel.
Hopefully those with more experience on this forum can chime in if they have not already elsewhere on this thread.
Although SeasideSusie is saying it is unnecessary to convert USA to UK, I will send you an image of the tests, so you can see more precisely what the details are. Both the T3 and T4 are Free.
I will be sending you the images in about 10 hours when I am home with the paperwork. Thanks.
Before you start adding T3 you need to know where your ferritin, folate, B12 and vitamin D are. All these essential vitamins and minerals needs to be at optimal levels within their ranges and just being in range is not conducive for thyroid hormone conversion.
Your ferritin needs to go up and at least over 70, your vitamin D needs to be at around 100, your folate is a little high ( is that range correct ? ) and I can't see a B12 reading.
These issues alone may be all you need to rectify for your conversion of T4 into T3 and thereby reduce your symptoms of listlessness, fatigue and slight depression.
Your T4 is currently 40% through the range and your T3 at just at 10% so there is room for an increase in Levothyroxine, and then a retest in 6 weeks time to check again and monitor your improvement. Your THS will come down with a dose increase but this isn't a problem for you as there is plenty of room in the range for the adjustment.
There is absolutely no point in adding T3 to your dose as this point in time.
First improve your vitamins and minerals and ask your doctor for a dose increase.
Thank you, this is so informative. In the back of my mind I was thinking that .88 was not enough for me. I was taking more in the past and one doctor along the way suggested a decrease. I think that started the downhill slide, but happened slowly and is taking a very long time to realize that it might be the problem or at least part of it. Your comments seem so right-on to me. Wondering now how to increase vitamins since I am taking B12 and it looks like too much of it. I will increase the D3, and also I will contact the Endo to ask for a dose increase. Thanks again and thnak heaven for this forum!
Regarding your doctor's fear of afib, unless you have pre-existing cardiac problems, IMO, she's ignorant about T3. Being too conservative is as reckless as overtreating.
Hi Saritadelmar, I have dealt with peoples hearts for over 20 years. A high percentage of the population will get af when older, it’s inevitable, wear & tear if you like. I have seen people with af symptoms who have improved once their thyroid problems have been treated, so I certainly would not be worried about a small dose of t3 causing af. Like the others have said, look at getting your Vit levels optimal & maybe ur thyroxine needs increasing or maybe ur not converting etc. But certainly 5mg dose shouldn’t cause any problems.
Thank you for your thoughts. Maybe I need to get some nutritional advice. And will definitely ask for a dose increase, as several have mentioned. The PVCs I have experienced in the last 10 years may be a result of age and wrong dosage of Levo. Thanks again.
Are these Free T3/T4 or Total T3/T4. It makes a big difference, Total T3/T4 aren't particularly useful tests, it's Free T3.T4 that are needed and tell us if we are optimally medicated or need to change our dose.
Vit D, 35 (30 - 100)
Presumably the unit of measurement is ng/ml, in which case the Vit D Council/Vit D Society recommend a level of 40-60ng/ml so you are a little low
The Vit D Council recommends, to increase your current level to the recommended level, supplementing with 2,500iu D3 when current level is 35ng/ml.
Retest after 3 months.
When you've reached the recommended level then you'll need a maintenance dose to keep it there, which may be 2000iu daily, maybe more or less, maybe less in summer than winter, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range.
There are important cofactors needed when taking D3 as recommended by the Vit D Council
D3 aids absorption of calcium from food and K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems such as hardening of the arteries, kidney stones, etc.
D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds if taking tablets/capsules/softgels, no necessity if using an oral spray
Magnesium helps D3 to work. We need Magnesium so that the body utilises D3, it's required to convert Vit D into it's active form. So it's important we ensure we take magnesium when supplementing with D3.
Magnesium comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds if taking tablets/capsules, no necessity if using topical forms of magnesium.
Check out the other cofactors too (some of which can be obtained from food).
Ferritin, 32 (16 - 288)
That's low. It's said that for thyroid hormone to work properly (that's our own as well as replacement hormone) ferritin needs to be at least 70, preferably half way through range.
I've seen it said that for females a good level is 100-130. Low ferritin can suggest iron deficiency anaemia, it would be a good idea to get a full blood count and iron panel.
Folate, 23.8 (3.4 - 5.4)
That's a very strange range for folate, can you double check it. In the UK if we have a range it can be something like (8.83-60.8)
Thank you for the detailed info on D3. I think I need to increase my dose. The T3 and T4 results are FREE, not total. I do take magnesium as well and will research the links you provided to get more information on which are the best suppliments and how much to take, etc.
Here are more results:
Vit B12 1649 (200 - 1100) taking suppliments
Iron total 62 (45 - 160) mcg/dL
Iron binding capacity 328 (250 - 450) mcg/dL
Iron saturation 32 (16 - 288) ng/mL
White Blood Cell Count 5.8 (3.8 - 10.8) Thousand/uL
Red Blood Cell Count 4.68 (3.80 - 5.10 Million/uL)
Should I take T3 for listlessness, fatigue, and slight depression?
Not just yet.
TSH, 1.25 (0.40 - 4.50)
FT3, 2.5 (2.3 - 4.2) = 10% through range
FT4, 1.2 (0.8 - 1.8) = 40% through range
The aim of a treated hypo patient generally is for TSH to be 1 or below or wherever it needs to be for FT4 and FT3 to be in the upper part of their reference ranges, if that is where you feel well. So at the moment you are undermedicated. You need to get your FT4 in the upper part of the range and then see where your FT3 lies.
If your conversion is still poor, then it could be due to low nutrient levels.
Your ferritin is definitely low and needs to be much higher for thyroid hormone to work properly.
Serum iron: 55 to 70% of the range, higher end for men - yours is 62 (45 - 160) = 15% through it's range
TIBC (total iron binding capacity): Low in range indicates lack of capacity for additional iron, high in range indicates body's need for supplemental iron - yours is 39% through range
Saturation: optimal is 35 to 45%, higher end for men - to calculate divide serum iron by TIBC - I'm afraid I can't work yours out
Ferritin: Low level virtually always indicates need for iron supplementation - yours is low in range
You need MCV, MCH, MCHC from full blood count and haemoglobin to see if you have anaemia.
You haven't clarified your folate range so I can't comment further on that.
Vit D needs a bit of work.
Vit B12 1649 (200 - 1100) taking suppliments
When taking B12 supplements we should also take a B Complex to balance all the B vitamins. Do you take a B Complex? You really don't need to take B12 any more, our B12 stores are good for at least 2 years, and if you take a B Complex they usually contain a decent amount of B12 anyway. If you don't take a B Complex then I'd suggest Thorne Basic B or Igennus Super B, but we really need clarification of your folate range first.
Once nutrient levels are optimal, if FT4 is high in range and FT3 low in range then consider the addition of T3.
Thank you for the brilliant response. I am going to call the doctor tomorrow to ask for an increase in Levo. I will at the same time ask to have the Folate clarified. It doesn't make sense to me either.
I do take a multi-vitamin as well as B-Complex. There is more info on the test results about the blood count and haemoglobin. I will send an image of the test later in the evening USA time, so you can see it right from the source.
You mention iron being low. Does that mean I should take iron supplements, or what would you suggest as far as foods are concerned? More leafy greens, and what about meat/beef? I don't eat much meat.
I appreciate all the information you have sent and will look at the link also. I feel so much better just getting this wonderful advice, and I will definitely follow it.
You mention iron being low. Does that mean I should take iron supplements, or what would you suggest as far as foods are concerned?
Iron is complicated. This is why you always need a full blood count and iron panel, not just ferritin, and why I wont suggest iron supplements. Low ferritin on it's own may respond to iron rich foods (the best one being liver, then liver pate or black pudding [although that may be a UK thing, not sure if black pudding is available in the US] ). Iron deficiency anaemia will require prescribed treatment.
Multivitamins tend to be a waste of time and money, they tend to contain too little of anything to help, often use the wrong form and least absorbable of ingredients and also often contain ingredients we shouldn't supplement unless tested for and found to be deficien, eg, iron, calcium, iodine. If it does contain iron then that affects the absorption of everything else as iron needs to be taken 2 hours away from other supplements.
If you take a B Complex and it contains Biotin (B7) or a Biotin supplement, then it needs to be left off for 7 days before any blood tests because if Biotin is used in the testing procedure then it gives false results (many labs use Biotin in the testing procedure so it's always safer to assume that the lab doing your tests does as well).
I've added a photo image of my entire blood test to my original message. Thank you in advance for any additional information you can share with me. I am so grateful for your help.
Although the results are small and feint, nothing seems to be out of range and there doesn't seem to be any sign of iron deficiency anaemia, so you can try to help raise your level by eating liver regularly, maximum 200g per week due to it's high Vit A content, also liver pate, black pudding, and including lots of iron rich foods in your diet
Thank you for your assessment on the test readout and particularly the folate. I will add liver to my diet and other iron rich foods. Thanks for the link!
I will be calling my Endo in a few hours. I am taking .88 Levo each day. What would the reasonable increase be? I am thinking she is going to suggest to stay on the .88 and increase it by adding more only for a few days during the week. I would be very grateful for your opinion. Thanks in advance.
I don't know what dose strengths you have in the US, here in the UK we tend to have multiples of 25mcg, and when fine tuning maybe adding 12.5mcg.
At the very least I would say that you should increase to 100mcg per day and retest in 6-8 weeks, possibly with a further increase then.
You need to get your FT4 into the upper part of the range, I'd say at least 75% through range, which should bring your TSH to below 1, then see where your FT3 lies. If your FT3 is still low in range then consider adding T3.
I actually noticed a change right away which is contrary to what people say, that you will feel results in a few weeks. I notice that my heart is beating a bit stronger than usual and I am experiencing some PVCs but was feeling a few before the increase. I am now on 100mcg per day. I am a bit anxious hearing my heartbeat, especially at night when it is quiet. And if it isn't a placibo effect, I definitely have a lot more energy. Can it really be that I can feel the results so quickly?
Thank you for your quick response. But there is an immediate harder heartbeat. Should that be a concern? It is very much like I felt 30 years ago when an endo started me off with 100mcg from nothing.
Though saritadelmar's TSH is decent, we all agree that none of us should be treated according to TSH. She says she's fatigued and depressed. Perhaps more T4 and the addition of T3. As I have said; a doctor being too conservative or just plain clueless about managing hypothyroid can do more harm than good.
These thyroid results are very low. Overall you are very undermedicated. In terms of blood tests the goal of thyroid treatment is to get good levels of freeT3, when taking T4 tablets this means having a good level of freeT4 first. By good levels I mean in the top quarter of the range.
Your freeT3 is absolutely on the bottom, and freeT4 is well below halfway. If either of these is total instead of free I am not as confident, but I believe with low results like this the interpretation is quite similar. It's only once you get closer to your optimal dose that it matters too much.
As others have said, you don't necessarily need to try T3 yet, you could do just as well by raising your T4 dose until the freeT4 is high in range and see how you feel then. It may take several raises of 25mcg to get you there. Only if you get freeT4 high and still don't feel well do you need to think about T3. I think often when people don't feel well they hear about T3 and think it's what they need to get better, but the most common reason we see on the forum that T4 treatment isn't working is that it's not dosed correctly. People are often left on the wrong dose for years
This Endo sounds like she believes a lot of fairy stories, which unfortunately is quite common It's really preposterous to suggest you're in danger of overmedication symptoms when at the moment you're criminally undermedicated.
If it's possible you should be looking to sack this doctor and find a new one.
And if your endo declines or refuses, don't be surprised and it would absolutely be time to find another doctor, not as if it's that easy to find someone who understands the complexity of hypothyroid disease and doesn't operate by medical dogma. Wishing you success. Don't let your doctor intimidate you.
Thank you for the advice and good wishes. I will not take no for an answer, as I do have doctor choices and my Endo is quite experimentative. I just needed some feedback, support and direction, besides hers, and I think the increase in dose that everyone has suggested will be the immediate next step - then work on the proper nutrition. Thanks again.
I have been in levothyroxine for over three years now. Started it on 50mg then if course increased to 100mg.i feel more tired now than ever before mostly because recently I was put in lisnopril for high blood pressure. I can only say that my cloresterol levels are up. I like you know that you want relief from underlying issues that can form from taking certain medications even in low doses. All I can say is stay on top of your numbers when having blood work done.. Good luck
I hear there are several natural methods of lowering high blood pressure. Have you tried any alternatives? Side effects from pharmaceuticals are sometimes worse than the illness.
I will take your advice and keep an eye on my blood results. I will have tests in 4 and a half weeks. If it doesn't show an improvement I think it will be time to start on some T3.
Thanks for your comment, and good luck with your medical journey as well.
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