Got t3 tested. What are your thoughts?

[Assiya]

Finally my first t3 result.

[Assiya]

Tsh 0.38-5.33 mine is 15.24 tpp high but a bit less than 2 months ago. It was 17 and i ve been taking 50 levothyrax.

T3 1.34-2.37 mine is 1,13 too low.

Can you tell now what may be the cause of low thyroid hashimoto (2 months ago anti bodies were 116 too high, not tested this time.My liver ?

[SlowDragon Administrator in reply to Assiya]

50mcg levothyroxine is only a starter dose

The aim of Levothyroxine is to increase the dose slowly in 25mcg steps upwards until TSH is under 2 (many People need TSH significantly under one) and most important is that FT4 is in top third of range and FT3 at least half way through range

You need 25mcg dose increase in levothyroxine....bloods retested 6-8 weeks later

Most people eventually need somewhere around 1.6mcg levothyroxine per kilo of your weight

But we frequently need to increase dose slowly

NICE guidelines

nice.org.uk/guidance/ng145/...

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

Your high antibodies confirms autoimmune thyroid disease (Hashimoto’s)

Low vitamin levels are extremely common with Hashimoto’s, especially if not on high enough dose ....as your results suggests you are

You need vitamin D, folate, B12 and ferritin tested too

What is the range on Ferritin result above?

Also MCV and haemoglobin ranges?

[greygoose in reply to SlowDragon]

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

So, if someone weighs 100 kilos, they should start on 150 mcg levo? Isn't that rather setting them up to fail?

[SlowDragon Administrator in reply to Assiya]

It’s not necessary to repeat the antibodies test. Once cause is established, antibodies will fluctuate

[Assiya in reply to SlowDragon]

Iron 17 range between 10 and 30 Ferritine is 25 ranges between 20 and 250

Mcv 93 ranges between 82 and 98 hemoglobine 8.8 good ranges are between 7 and 9.2

[SlowDragon Administrator in reply to Assiya]

So only ferritin is very low

Common when under treated and still hypothyroid

Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption

dailyiron.net

Links about iron and ferritin

irondisorders.org/Websites/...

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

drhedberg.com/ferritin-hypo...

restartmed.com/hypothyroidi...

[Assiya in reply to SlowDragon]

Ill read that

May get me some info about iron deficiency but hemoglobine is normal.

[SlowDragon Administrator in reply to Assiya]

Which is why you don’t need iron supplements...but just increase iron rich foods ...and get levothyroxine dose increased up slowly

75mcg levothyroxine and retest in 6-8 weeks

[Assiya in reply to SlowDragon]

Thank you SlowDragon for your help. Stay safe.

[DippyDame]

Hello...Am I missing something or are there no ranges for your lab results? Oooops see below!

TSH is far too high....you are undermedicated.

Without ranges (different labs use different ranges) it is impossible to evaluate FT4 and FT3 results....both should be at least 75% through the range

For example...a high FT4 combined with a low FT3 suggests poor conversion.

This may be the result of low nutrient levels i.e. vit D, vit B12, folate, ferritin which support good thyroid health or the thyroid genetic variant Dio2..... more later if required.

Ah, sorry, just noticed you've later added FT3 range to the result 1.13 (1.34 -2.37)

Yes, your FT3 is far too low but this could be the result of your low thyroxine dose of only 50mcg. This is only a starter dose!

Personally I wouldn't dose by body weight.

Initially I would be looking for an increase in thyroxine (e.g 25mcg) followed in 6 to 8 weeks by another test. Depending on those results you will most probably need further increases and testing until, hopefully, your TSH drops to close to 1 and your FT4 and FT3 are close to 75% through their respective ranges.

If further adjustments to dose or the addition of some T3 is required that should then be considered.

Good luck

Stay safe

DD

[Assiya in reply to DippyDame]

Thank you be well and safe

[greygoose]

And, yet, that's where dosing by weight started. The whole thing is so twisted and upside down! The further we advance, the less they know.

[greygoose]

So true.