Conversion t4 to t3: So someone who is learned... - Thyroid UK

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Conversion t4 to t3

Pooka77 profile image
13 Replies

So someone who is learned please can you tell me is it possible to have medication induced hyperthyroidism from over treatment and still be a poor converter of t4 to t3?

I am prettycertain of the hyperthyroidism now as i have signs of TED. Which is quite distressing to say the least.

The crying isn't helping any.

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Pooka77
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Lalatoot profile image
Lalatoot

Depends what you mean by medication induced. If by medication you mean levothyroxine then you are just overmedicated not hyper. If you mean a non thyroid medication then yes some things can set the thyroid off and hyperthyroidism can result. My thyroid problems were triggered by iodine.

Thyroid eye disease is most often associated with Graves disease which is an autoimmune condition.

People who are hypothyroid can also have problems with their eyes being sore, dry, red and puffy. Mine are like this when I am undermedicated.

Pooka77 profile image
Pooka77

Over medicated with levo. I have always had issues with puffy eyes but this is defo different and looks graves looking.

I feel in every way over medicated. I felt like I was going to have a stroke a couple of weeks ago. Palpatations all the time. Felt very unwell.

Stoped levo for a week and felt much better. Now back on levo for a week and was feeling ok but starting to feel bit jittery again.

I am awaiting t3 result. I posted all other results in previous post.

I just wondered If it was possible to be hyper and still be a poor converter or is thatincompatible?

I see endo who was considering t3 in 10 days.

in reply to Pooka77

Hey Pooka, actually I had hyper-like symptoms when my ft4 was over 80% of range and t3 was under mid-range or low (due to several blood tests at different times I figured that my ft4 spikes over range by 20%ish in the afternoon). My eyes would bulge, my pulse would speed up and I would feel like something ran over me. And jittery. We should not go by blood tests only, that's what my Endo says. Bloods can be fine, but what you feel is more relevant. I know several people who have these overmed symptoms on high Levo, but low t3, some people don't tolerate high levo or even mid-range! I agree you ft3 should be tested along with tsh and ft4 for a full picture in case that's causing some issues.

Lalatoot profile image
Lalatoot in reply to Pooka77

You can have too much FT4 (that is overmedicated or a Hashis swing) and not be able to convert it to FT3. This would show in your results with FT4 being over range so higher than 21.1 and FT3 being low or under its range. However the only way to find out about conversion is to have TSH, FT4 and FT3 done on the same blood draw.

Is the endo going to look at doing FT3 bloods for you or prescribing T3? If it is to start on T3 please be aware that it is not necessarily a quick fix. You need to start on a low dose and build up over weeks and months. If you are taking a combo of levo and T3 then they need to be balanced to work in harmony to produce the FT4 and FT3 results that are optimal for you. That is what I am doing at the moment. I started on 5mcg T3 in November.

If you think you may have Graves could you ask the endo to do antibody testing for it? You really need to know if it is Graves as this will alter how you are treated. Graves eye disease works separately and is not connected to the thyroid. In Graves eye disease the autoimmune condition attacks the tissue around the eyes and it can continue to do so even though your thyroid is stable.

Please contact me if you think I can help in any way.

greygoose profile image
greygoose

Your last post turned into a bit of a punch-up/free-for-all, but I think you should re-read it.

As people said, the results you posted showed no signs of hyperthyroidism - whether it be from over-medication, Grave's or Hashi's. No antibodies were done so you cannot know if you have either; and no FT3 was done, so you cannot - absolutely cannot - know how well you convert. So, I don't understand why you're asking this question.

Serum free T4: 18.4 pmol/L (7.5-21.1)

*Serum TSH: 0.03 miu/L (0.34-5.6)

Your TSH is low there, but your FT4 was well in-range.

Pooka77 profile image
Pooka77

I know that's what people.said. I can only go how I felt. I felt very ill in a totally different way to undertreated.

I do not understand all of the tests very well I'm afraid. Still. Maybe I'm thick

I came on here for support. But sometimes it feels a lot less than supportive.

in reply to Pooka77

Pooka you're not thick and bloods are not everything, the most important is to listen to your body. Big hugs. We come here for help, we hear from doctors that our bloods are fine, but we don't feel fine. Here, we hear sometimes the same - bloods are fine, but we don't feel fine . So I think I know what you mean x

SlowDragon profile image
SlowDragonAdministrator

Sore, swollen, dry and gritty eyes can be hypothyroid symptom

Hypromellose eye drops may help

Pooka77 profile image
Pooka77

So if I was going to pay for a comprehensive blood test which would cover all bases, what would it be?

I don't have much money so want to make sure if i have to pay it is going to give me the answers i need.

LAHs profile image
LAHs in reply to Pooka77

Ask for TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies to start with. That will point you in the right direction.

It is a bit expensive at first (the private blood tests if your GP won't do it for you) but knowing everything that is going on and feeling in control of things will be worth it - you will probably soon make up the expenditure in petrol costs going to and from the doctors just to argue with him and feeling upset and frustrated afterwards.

Sadly, most of us are "on our own" with this problem, maybe one day the medics will catch up with their education. It's very scary when you find out your doctor is not the perfect being you imagine s/he should be.

Go get that blood test, do a bit of reading, ask some more questions here then you will feel a lot more confident. If it helps, when I got thyroid cancer and had to have a total thyroidectomy I knew something was wrong with my treatment and my doctor seemed to be evasive when I asked questions, and I felt VERY ill. I had never had a biology lesson in my life, that just wasn't my subject, but I soon realized that if I was going to survive (yes, survive) I had to start hitting the books. And I pulled through, you just have to keep digging and experimenting. Don't give up, the answers for you are out there.

LAHs profile image
LAHs

Oh, and P.S. knowing FT3 and FT4 will answer your question as to wether you are a good converter. You find the ratio, make sure you convert to the same units before you calculate the ratio. Or post here and someone will calculate it for you.

Merlio18 profile image
Merlio18

Hi from personal experience I would reduce levo how much are you taking ? And see if that reduces your symptoms on a lower dose if you haven't reduced it, start by 25 and see if your symptoms reduced I was very hyper with a very suppressed tsh of 0.03 so try to get the Tsh to around 0.5 and see how you feel. Every one feels different but I know I was getting heart issues and ended up in A n E and the doctor told me I had to reduce my meds but at the time I was on NDT but my TSH was very supressed like yours is and that's what caused it so I would try reducing dose by 25 see how you feel in a week or too you should tell within a few week if you feel gradually any different I did until your next appointment then ask the endo for full thyroid tests antibodies and T3 and reverse T3 if they will test it because it's very important you get a full picture and when the results come bk if the T3 is in the low range not optimal at 5-6 I would push for a T3 trial. Also if you haven't already address your diet and cut all gluten and dairy out to start and see if that helps before you next appointment.

And look into a high strength b complex around 30-50 of each b vit in it and vit c 1000 they will help too.

No, not really, not from thyroid meds. You can be over medicated but when you reduce meds you'll be hypo again. If you still have low FT3, you are definitely not hyper or even overmedicated, just wrongly medicated (probably). If you have autoimmune thyroid disease you can have a "hyper" swing regardless of meds. TED is not confined to those with an overactive thyroid although it's much more usual. It is possible to have Graves and Hashis together or Graves with blocking antibodies (which makes you hypo)

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