I just would like to ask how is it possible that being on T4 only ( 88 mcg per day), I have a suppressed TSH and a lowish FT3.
I don’t understand the mechanics. Why a suppressed TSH gives me a lowish FT3?
My latest result are:
TSH 0.07 ( 0.27-4.2)
FT4 20.8 (12-22)
FT3 4.42 (3.1-6.8)
Because TSH stimulates conversion of T4 to T3. So, if your TSH is suppressed, conversion will be poor and therefore your FT3 will be low.
As always thank you for your prompt reply greygoose.
I wonder why it is so suppressed... ??? I only take a relatively small amount of T4.
Is there anything one can do to enhance conversion?
It's suppressed because of the level of your FT4 - although could also be that your pituitary is a bit sluggish.
There are many things that affect conversion. Do you have Hashi's? Just having Hashi's can mean that you're a poor converter.
Have you had your vit D, vit B12, folate, ferritin and zinc tested? Optimal levels of those nutrients are necessary for optimal conversion.
Are you getting enough calories? Do you have an infection of some sort? Are you taking Beta Blockers? Have you tried taking selenium?
But, sometimes there's just nothing you can do about it, and absolutely need to add T3 to your levo to be well.
''But, sometimes there's just nothing you can do about it, and absolutely need to add T3 to your levo to be well. '' I guess it's the only thing I can do.
I know I have a bit of resistance with taking t3, years of ''brainwashing'' by my endos...and as result I am still a bit scared. I know it's just conditioning..
I have a lowish ferritin, all the rest is in good level and I don't take beta blokers.
Do you know what is the t4/t3 ratio when supplementing?
Clara62
I have a lowish ferritin,
How low? Are you doing anything about it?
Ferritin is recommended to be half way through range and it's important to have a good level of ferritin (as well as other nutrients) for conversion of T4 to T3.
Recommended levels for nutrients are:
Vit D - 100-150nmol/L or 40-60ng/ml
B12 - top of range for Total B12 test, minimum 70 (better over 100) for Active B12 test.
Folate - at least half way through range.
Ferritin - half way through range.
Is this where your "good levels" lie (apart from ferritin)?
Thank you SeasideSusie 🙏
These were my last results.
iron never been so low.... it used to be 20.00 just last October and now only 8.8...
Also the transferritin saturation was always high like 39% and now it's 19% ...
I am supplementing vit D now
B12 pml/L 181 (25-165)
Folate nml/L 533 (285-1474)
Vitamin D 78. ( 50-200), a few month before the result was 102
Iron 8.8. ( 6.6-26)
TIBC 46 ( 41-77)
Transferritin saturation 19% ( 20-55)
Ferritin 55 (13-150)
Clara62
B12 pml/L 181 (25-165)
Is that an Active B12 test? The alternative would say either Serum B12 or Total B12 and there would be a wider range, perhaps going up to 900-ish.
Do you supplement?
**
Folate nml/L 533 (285-1474)
That's not a range I am familiar with but you are actually low in range, it's only 21% through range.
**
Vitamin D 78. ( 50-200)
How much D3 are you taking? With that level, to reach the recommended level, the Vit D Council would suggest about 3,000iu daily.
Do you take D3's important cofactors - magnesium and Vit K2-MK7?
D3 aids absorption of calcium from food and Vit 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 D3 as 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 magnesium as tablets/capsules, no necessity if using topical forms of magnesium.
naturalnews.com/046401_magn...
drjockers.com/best-magnesiu...
**
Iron 8.8. ( 6.6-26)
TIBC 46 ( 41-77)
Transferritin saturation 19% ( 20-55)
Ferritin 55 (13-150)
Optimal levels for an iron panel, according to web.archive.org/web/2018083... :
Serum iron: 55 to 70% of the range, higher end for men - yours is 11.34% through range
Saturation: optimal is 35 to 45%, higher end for men - yours is 19%
TIBC: Low in range indicates lack of capacity for additional iron, High in range indicates body's need for supplemental iron - yours is low in range at 13.89%
Ferritin: Low level virtually always indicates need for iron supplementation - yours is 30.66% through range
You have conflicting results because your low serum iron and low saturation suggest you need to supplement iron, yet your low TIBC suggests that you don't. Iron is complicated, your doctor should be looking at this.
Thank you for your detailed reply SeasideSusie.
''You have conflicting results because your low serum iron and low saturation suggest you need to supplement iron, yet your low TIBC suggests that you don't. Iron is complicated, your doctor should be looking at this.''
I know these are conflicting results. Although I have a variant detected for hemochromatosis ( according to 23 and me), they say that I am not likely at risk of developing iron overload related to hereditary hemochromatosis based on your genetic result. ( My grandmother died for hemochromatosis ).
Unfortunately, never a doctor had anything to say about my results, even an hematologist I just saw last year for some other related issues. I guess I should be lucky enough to find a doctor with an open mind and knowledge about thyroid problems. Almost impossible.
B12 pml/L 181 (25-165)
''Is that an Active B12 test? The alternative would say either Serum B12 or Total B12 and there would be a wider range, perhaps going up to 900-ish.''
Yes, it's ACTIVE B12 test. I don't supplement.
Vitamin D 78. ( 50-200)
''How much D3 are you taking? With that level, to reach the recommended level, the Vit D Council would suggest about 3,000iu daily.''
I supplement 2,000 daily plus sunbathing when the sun is out...I take D3+K2.
Do you also think I should add T3 ?
Do you eat meat, liver or other iron rich foods ?
If you do that already iron may be due to low Ft3
Obviously TSH will drop even lower
Starting T3 very cautiously...5mcg max. If goes ok add second 5mcg in mid/late afternoon.
Hold at that dose and retest in 6-8 weeks
Possibly reduce levothyroxine to 75mcg at same time
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)
If/when also on T3, make sure to take last third or half of daily dose 8-12 hours prior to test, even if this means adjusting time or splitting of dose day before test
List of private testing options
thyroiduk.org.uk/tuk/testin...
Medichecks Thyroid plus ultra vitamin
medichecks.com/products/thy...
Medichecks often have special offers, if order on Thursdays
Thriva Thyroid plus vitamins
Blue Horizon Thyroid Premium Gold includes vitamins
bluehorizonbloodtests.co.uk...
Blue Horizon Full thyroid test but not including vitamins
bluehorizonbloodtests.co.uk...
If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3
£29 (via NHS private service )
monitormyhealth.org.uk/thyr...
I started again eating a bit of meat a month ago, I have been pescatarian for several years. Maybe it wasn't a great idea...
If the TSH will drop even lower they will not be able to detect it any longer!
In an ideal world I would like to have a not suppressed TSH and high in range FT4 and FT3...it's not going to happen 
I don't know how to solve this puzzle ...
Thank you for all the links and advice 🙏
Well the blood test is only a snapshot
In an ideal world you could have a blood test in middle of, or immediately, after exercise. Then you might see TSH higher
Wearing a Fitbit or equivalent to record resting heart rate and daily exercise levels can be helpful
Many people have suppressed TSH on levothyroxine and almost always have suppressed TSH on any dose of T3
Thank you 🙏🙏🌺
What are you doing to help improve low ferritin
Vitamin D needs to be at least around 80nmol and around 100nmol maybe better
Folate at least over ten
Serum B12 over 500
Thank you SlowDragon 🙏
These were my last results.
iron never been so low.... it used to be 20.00 just last October and now only 8.8...
Also the transferritin saturation was always high like 39% and now it's 19% ...
I am supplementing vit D now
B12 pml/L 181 (25-165)
Folate nml/L 533 (285-1474)
Vitamin D 78. ( 50-200), a few month before the result was 102
Iron 8.8. ( 6.6-26)
TIBC 46 ( 41-77)
Transferritin saturation 19% ( 20-55)
Ferritin 55 (13-150)
So you need to sort this before considering adding T3
GP should be doing full iron panel test for anaemia
Likely need iron supplements
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
Links about iron and ferritin
irondisorders.org/Websites/...
healthunlocked.com/thyroidu...
healthunlocked.com/thyroidu...
drhedberg.com/ferritin-hypo...
restartmed.com/hypothyroidi...
Post about iron supplements
healthunlocked.com/thyroidu...
Thank you very much SlowDragon 🌺
Query about suppressed TSH
Suppressed TSH- what does it mean?
Suppressed TSH - Reasons
Suppressed TSH - thoughts? 
