Free T3 below the range :(

[Jalisi]

Firstly, thank you for all the help and support from such amazing and knowledgeable members of this forum.

My latest NHS bloods were taken 8:45AM, fasting, no levo 24 hrs prior. I have Hashimotos with positive TPO and TG antibodies. My TSH is 1.01 (0.55-4.78) free T4 13.3 (10-20) 33% through the range and free T3 3.4 (3.5-6.5) -3.33% through the range.

I'm currently on 75mcg levo, for which I had to really push my GP to prescribe, I increased the dose myself in the end. I'm also on Low Dose Naltrexone initiation - currently on 4.5 ml. Supplementing vit D + K2 MK7, iron, selenium, magnesium, omega 3. I'm gluten and dairy free.

I've just wasted time talking to the GP as according to her my free T4 is perfect and doesn't understand why I had free T3 tested. (The blood test had been requested by a different GP.) Apparently I'm on the correct dose and she won't increase it. I managed to get an Endo referral which means waiting for 6 weeks to see him.

What should I do? I'm thinking of increasing it myself. I'm tired of being tired.

Thank you so much for your reply.

[greygoose]

Can't you get another appointment with the GP that got the FT3 tested? Sounds like he's a bit more clued up.

[Jalisi in reply to greygoose]

Hi Greygoose, thank you for your reply. I had a borderline argument with the GP who ordered the blood test as she insisted that my then TSH of 1.9 was well within the range and refused to increase my levo from 50 to 75 mcg. I increased my dose myself and she had no choice but to give me the prescription. After that she insisted on blood test in 6 wks time, I told her if she's only monitoring my TSH without T4 and T3 there's no point. I think this is why she requested this blood test. Tbh I was shocked I had these tested. I will make an appointment with her but I think it will be the same answer as before. I'm walking around in circles. Am I correct to think I need an increase?

Again, thank you for your reply I really appreciate your help.

[greygoose in reply to Jalisi]

A TSH of 1.9 is, obviously, in-range - it doesn't take a genius to see that. However, it does take someone with a little knowledge of thyroid to know that it's not just a question of being in-range, it's a question of where in the range the result falls. A euthyroid person - someone with no sort of thyroid problem - would have a TSH of around one - 1.9 would even be a bit high for them - but, when you are hypo, it's not good enough to just get the TSH to a euthyroid level, because hypos don't react like euthyroid people. A hypo, on thyroid hormone replacement, needs a TSH much lower. So, 1 or under, or even suppressed. Which is why the TSH is not a good indicator of thyroid status. And, a doctor that only looks at the TSH is not a knowledgeable doctor.

Looking at your your results above, your FT4 is only 33% through the range. And, any doctor that thinks that could possibly be 'perfect' knows nothing about hypothyroidism. More importantly, the FT3 is under-range, and she didn't even understand why it was tested? She is very, very ignorant. Most hypos need their FT4 at about 18, in that range - about 80%, with the FT3 slightly lower at about 75%. But, it's a very individual thing. What you need are levels that make you feel well. So, if you don't feel well, yes, you do need an increase in dose.

[Jalisi in reply to greygoose]

Thank you for your reply, I am not feeling well, but so far my symptoms have been ignored by GPs. I'm fed up of begging them for levo. They talk to me like I'm a child.

I will up my levo to 100mcgs and wait to see my Endo. Although I'm not sure what to expect so not getting my hopes up.

Thank you so much your advice is greatly appreciated.

[greygoose in reply to Jalisi]

You're welcome.

[SlowDragon Administrator]

You clearly need a 25mcg dose increase in Levothyroxine

You're are poor converter, likely to eventually need addition of small dose of T3

Email Dionne at Thyroid Uk for list of recommended thyroid specialist endocrinologists who will prescribe T3

thyroiduk.org.uk/tuk/About_...

Official NHS guidelines saying TSH should be between 0.2 and 2.0 when on Levothyroxine and FT4 in top third of range

(Many of us need TSH nearer 0.2 than 2.0 to feel well)

See box

Thyroxine replacement in primary hypothyroidism

pathology.leedsth.nhs.uk/pa...

New NHS England Liothyronine guidelines July 2019 clearly state on page 13 that TSH should be between 0.4-1.5 when treated with just Levothyroxine

Note that it says test should be in morning BEFORE taking Levo thyroxine

Also to test vitamin D, folate, B12 and ferritin

sps.nhs.uk/wp-content/uploa...

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,

"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l.

Most patients will feel well in that circumstance. But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."

You can obtain a copy of the articles from Thyroid UK email print it and highlight question 6 to show your doctor

please email Dionne at

[e-mail]

[Jalisi in reply to SlowDragon]

Thank you for your reply SlowDragon. I thought as much. I have the copy of DR Toft's article ready to take to my Endocrinologist - thank you for this. I am going to up my dose myself and see whether he might help establish the correct levo dose. Not feeling too hopeful, but it's worth a try.

After this, I intend to go the private route.

Thank you again for all your help, I really appreciate it.