Confused by latest results (again! ), is it now time for T3?

[LisaG28]

Hi, Following my last post in August, I reduced levo very slightly given slightly elevated over range FT4 and a drop in FT3. Not surprised by result below given weight gain, tiredness, and drop in temperature

Nov result: 125mcg x5 / 100mcg x2

TSH - 1.73 (0.27 - 4.2)

FT3 - 3.99 (3.1 - 6.8)

FT4 18.3 (12-22)

Reverted back to original dosage ( same reference ranges)

Jan result: 125mcg x7

TSH - 1.08

FT3 - 5.06

FT4 - 22.10

I am now confused as TSH would suggest a slight increase in levo ( has never previously been over 1 whilst on 125mcg) but again the FT4 is slightly over.

All vitamins are optimal and I continue to take selenium.

Is it now time to stop tweaking and look at introducing T3, would others agree that I am not a great converter or should I persevere. T3 and T4 are always out of kilter with each other, regardless of the result.

I fully acknowledge that I am fairly well compared to others on this forum, though certainly not my pre diagnoses self, however I still cannot loose weight, has gone up since the reduction in August, muscle fatigue, struggle to stay awake after 9 and swings between tears and anger.

Any thoughts, guidance would be appreciated as always.

Many thanks

[SlowDragon Administrator]

Reading your previous posts.....do you have Hashimoto's?

Ever had thyroid antibodies tested?

Ever had high antibodies test results?

You need to get FULL Thyroid and vitamin testing

Can see you supplement B12 and vitamin D

Do you supplement vitamin B complex?

When was vitamin D last tested

Are you on strictly gluten free diet (can help with mood swings)

Do you always get same brand of Levothyroxine?

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also EXTREMELY important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially if you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies

Ask GP to test vitamin levels

You may need to get full Thyroid testing privately as NHS refuses to test TG antibodies if TPO antibodies are negative

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .

Last dose of Levothyroxine 24 hours prior to blood 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)

Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies

thyroiduk.org.uk/tuk/testin...

For thyroid including antibodies and vitamins

Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have special offers, Medichecks usually have offers on Thursdays, Blue Horizon its more random

[LisaG28 in reply to SlowDragon]

Hi slowDragon, yes I have hashimoto's confirmed by high antibodies. Following advice on here all vitamins at maximum. Last Vitamin D result was 92.

I take a b complex, igennus, but stopped 7 days prior given biotin.

I follow the same testing protocol as recommended here, first thing in the morning, no levo beforehand.

Have the same brand of levo mercury pharma, pharmacist really good at accomodating. Am gluten free.

Not sure there is much more I can do, apart from looking at T3

Thanks

[SlowDragon Administrator in reply to LisaG28]

Suggest you see what happens at a further test in say 2-3 months

If FT3 starts to drop, like many of us with Hashimoto's, you may need addition of small doses of T3 prescribed alongside Levothyroxine

[SlowDragon Administrator in reply to LisaG28]

Have you done DIO2 gene test?

This can help get NHS recognition of need for T3 ...assuming you test positive

thyroiduk.org.uk/tuk/testin...

[LisaG28 in reply to SlowDragon]

Hi SlowDragon , I haven't as I genuinely believe that I will never be prescribed T3 on the NHS, given my CCG is Croydon. If I was to ever to go down the this route, it will need to be self sourced, which is why I've been keen to tweak to see if I can improve on levo only.

[SlowDragon Administrator in reply to LisaG28]

DIO2 gene test still might validate your decision to self medicate....if you do eventually go down that route

[diogenes Remembering]

From your results, first TSH is well within range though that isn't necessarily the prime target. The important result is the ratio of FT4/FT3 which is a guide to conversion of T4 into the active T3 that keeps you alive and kicking. This is around 4.5/1 which indicates you are on the edge if not over the insufficient response that indicates you don't convert T4 very well. It might be in this situation that to try to increase T4 greatly would not raise your FT3 sufficiently. However in your case perhaps you can achieve balance and better health without going into other therapies. I wouldn't be frightened of raising FT4 even more to see how it goes after a month or so. Getting an FT4 above normal range is no problem. But you have quite a cushion for TSH being lower eg down to 0.5 under increased T4 therapy which may raise your essential FT3 and restore health.

[LisaG28 in reply to diogenes]

Many thanks diogenes, I really appreciate you taking the time to respond. I will certainly follow your advice and increase slightly and retest.