T4 Again or with T3?

[GKeith]

Here are my results from a week ago:

TSH 0.010 -Low – ref. range-0.450 UIU/mL

Thyroxine (T4) 7.3 ug/dL - ref. range 4.5 ug/dL – 12.0 ug/dL

Triodothyronine (T3) 170 ng/dL – ref. range 71 ng/dl - 180 ng/dL

Immunoglobulin G, Qn, Serum – 1054 – 603 mg/dL – 1613 mg/dL

My "problem" is this: I'm taking 100 mcg of T4 & 25 mcg T3 and am having a "problem." As you can see my T3 is high but T4 is low to mid-range and I'm befuddled because I was never "treated right." I'm sure that's nothing new to anyone with hypo. For 27 years I "suffered" on .88 mcg of T4, never changed, never up or down, every GP went by the TSH only.

So, I was diagnosed in 1990 with hypo. I had gained 30 pounds almost overnight and couldn't understand it. I was a professional boxer for 10 years and still, at age 45 worked out a lot and so, when I went from a never over 175 to 200-210 in just a few weeks, I knew something was wrong. They gave me the 88 mcg's of T4, which shed the pounds quickly but after the first year, with no changes I began getting headaches and cold hands and feet. In the winters ice-cold hands & feet but, alas, even the endo's went by the TSH & my T4 never changed. i "crashed" in 2018 on a visit to Switzerland and had headaches so severe I quit taking the T4, which "worried" me but I did "feel" much better until I returned to Florida.

Now, I had been eating meals with almost no sugar as many of my Swiss relatives had a completely different diet. Make a long story short(er) I told my GP I was done with T4, causing him to send me to an endo, who put me on 50 mcg's of T4 and 10 of T3. I immediately felt "better," and asked for more T3, which he gave me and raised my T4 to 75. I felt "better" but still not right, so asked for more T4, thinking it was converting and got to 100 mcg of T4 & 20 mcg of T3. I'M taking 25 by supplementing 5 more on my own and feel better but with these latest results I am seriously wondering if I should (re) take T4 only and raise it to 125 or 150? The problem, which you've probaby figured out by now, is that with any T3 at all, I can't "check" my results, due to the T3, and I do feel better with more T3. Can anyone, like grey goose maybe, make any kind of estimation on my chances if I go back to T4 only. My "problem" is, of course, that the T3 is so "good," probably because it's 4 times stronger than T4 but doesn't last longer than 12 hours, for me, anyway. I am, of course, fearing the headaches I "connected" with T4. Of course, I would like to take one pill again but feel pretty good with the T3? A big? T4 only, just 1 pill when I've been taking 4 & 5 pills for almost 2 years, the T3 come in 5 mcg only so I take 2 5mcg pills with the 100 mcg T4 at night, then one and a half twice more in the daytime. Any ideas, guesses? Anyone have a similar experience?

[Hidden]

I´m sorry, but I am not familiar with those reference ranges? Are they FT3 and FT4, (free T3/T4), or total T3 and total T4?

If you are taking any form of T3, your TSH is likely to be low or even suppressed. That is nothing to worry about.

What was the original reason your doctor put you on T3 + T4?

Many people taking T3 or NDT will have very low FT4 levels. That is not a problem if you feel fine on a T3 + T4 combo or NDT. Once you are getting T3 directly from synthetic T3 or NDT, you need less T4 to convert to T3. That statement is based on my own experience taking NDT.

If you feel better taking some T3 along with T4, that could mean you have found what you need and you should not mess with it.

But I don´t feel I can tell more from your symptoms and labs without knowing more about your medical history, diagnosis, the reason you were put on T3 + T4, etc.

[GKeith in reply to Hidden]

They're FT3 & Ft4, sorry. I know about the suppression of the TSH, it's the doctors that don't seem to know (anything). My doctor basically gave in to me taking T3, as when he lowered my T4 from 88 mcg to 50 mcgs, he gave me 10 of T3 & everytime he raised the T4 he lowered the T3. Don't ask me how I got to 100 mcg T4 and 20 mcg of T3? I had to twist his arm a few times and supplement 5 mcgs at this time. I understand you need less T3 when you raise the T4, the problem is they, the doctors, never got my original prescription right and I have suffered for it. If they would have raised my T4 by 25 mcg of T4 every 3 months until I leveled off, God only knows how much T4 I would have landed on or if it would have "cured" me or not. I am still "looking" for that dose, I feel "alright" on the combo but have fleeting headaches and a stiff neck almost constantly. I believe T4 only or T3 only or NDT (in other words, 1 dose, 1 pill) is the best prescription. I am just, like 1000's of "sick" people are, looking for the "perfect perscription" which, of course, there is no such thing but the closer the better.

Peace be upon us all.

[greygoose]

of course, that the T3 is so "good," probably because it's 4 times stronger than T4

Well, no, not necessarily. It depends how well you convert. And, the only way we can know how well you convert is to see FT4 and FT3 tested at the same time when on T4 only. Do you have the relevant labs?

but doesn't last longer than 12 hours

Well, that's just not true. The half-life of T3 in the blood is 23 hours, but what gets into the cells stays there for about three days. T3 is a hormone, and hormones don't run out or get used up like aspirin.

Do you split your dose?

Triodothyronine (T3) 170 ng/dL – ref. range 71 ng/dl - 180 ng/dL

Sorry, but that is not a Free T3, that is a total T3 which gives you no useful information. Once can tell by the range. An FT3 range would never look like that. So, we don't know how much available T3 you have in your blood. And, until we know that, there's not much anyone can say.

Thyroxine (T4) 7.3 ug/dL - ref. range 4.5 ug/dL – 12.0 ug/dL

I have my doubts about that being a Free T4 range, too.

The problem, which you've probaby figured out by now, is that with any T3 at all, I can't "check" my results, due to the T3, and I do feel better with more T3.

No, I can honestly say I haven't figured it out. In fact, I cannot make head nor tail of that sentence. Why can't you 'checke' your results?

[GKeith in reply to greygoose]

Okay, this is a blood test from a new supplier so it could be TT3 but I believe it's FT3. My endo usually only checks the Frees & the TSH, I gotta harass him to get what I want. The "good" thing is he doesn't keep track of anything & when I tell him I'm taking 25 T3 and not 20, he usually falls for it, it's only too bad that I have to get it like that. The T3 hits me quick, the T4 takes awhile. As far as the ranges go, the last test I got there, was measured in different measurements the T4 was 0.83 ng/dL in the other test measured in 0.82 -1.77 ng/dL & the T3 was 3.5pg/mL and measured in 2.0 -4.4 pg/mL. The reason I said I couldn't check any results is because as you said the t3 suppresses the TSH and makes the levels no good to see if the T4 is converting to T3.

[greygoose in reply to GKeith]

Well, you certainly can't see how well you convert when taking T3, that's for sure. But, that's got nothing to do with the TSH. If you really want to see how well you convert, you'd have to go back to T4 only, but I really wouldn't recommend it.

It doesn't matter what the measurements are, you interpret the results according to the percentage through the range. All blood tests have ranges.

I'm 99.9% sure that is not a Free T3. If it were, it would say so.

[GKeith in reply to greygoose]

You're right there, so they are totals, the GP's have no idea what's what in anything, this was my GP, not my endo, at least he distinguishes between frees & totals. My last test before this one was on May 4 and the FT4 was 0.83 ng/dL - O.82 -1,77 ng/dL range and the T3 was 3.5 ref. range 2.0 - 4.4 ng/mL.

[greygoose in reply to GKeith]

So, the FT3 there was 62.5% though the range. Probably not high enough for you. In any case, plenty of room for an increase in T3.

So, given that you were taking 100 mcg T4 and 20 mcg T3 - is that correct? - and your FT3 was only 62.5%, I would guess that you really don't convert very well. But, it's only a guess, mind you!

If you stop the T3, the FT4, on 100 mcg levo, would rise - who knows how far - but the odds are that if you then increase the dose, it would go too high, and your conversion would become even worse. So, it really doesn't seem a good idea to me, to go back to T4 only. But, you can only know for certain if you try.

[GKeith in reply to greygoose]

I know, thanks for your time, I really don't want to go back to T4 alone, so probably won't but will continue titrating. I have been taking 25 mcg T3 for the past 2 months but may now lower it to 20 to see if that helps because when I first decided to take T3 I could see I wasn't converting well enough. It's been hell getting the right dose too because the doctors are all so stubborn with their (lack) of knowledge. Thanks again. Your time & knowledge is fantastic. Peace be with you, & us all, in these, the troublingest times I've ever experienced.

[greygoose in reply to GKeith]

I'm not sure lowering your T3 is going to help, when it's not very high in the first place. But, you must do what your instinct tells you.

[GKeith in reply to greygoose]

You were right about the T3, I left it the same and it works fine. I have been deluding myself because it's so much easier to take T4 alone so you can "grade" yourself but how you feel it is, in the end what you have to live with & no amount of anyone (esp. doctors) telling me with my TSH I should be feeling great; that went on for the first 28 years of taking T4 only.

[greygoose in reply to GKeith]

They don't seem to understand that the TSH doesn't make you feel anything. It's just a chemical messenger from the pituitary to the thyroid to tell it to make more hormone. They just have no idea!

[GKeith in reply to greygoose]

touche' I say to all physicians who ahould listen to their patients with a human heart, instead of a reptilien one.

[uchi in reply to GKeith]

Hi, you should check your selenium and zinc levels. Or just take supplements. They are essential for the conversion T4 to T3. That was my case and dr advice.

[GKeith in reply to uchi]

The problems with supplements are immense; they can help but they can also be quite dangerous. You get selenium & zince from other foods, seafoods, etc, you may not get enough but you can also get too much.

[Lalatoot]

GKeith I don't think you have the correct results to compare. I think you have total T4 and Total T3 results. What you need are FT4 and FT3 results. F stands for free and this is the T4 and T4 circulating in the blood which is free for the body to use. I wouldn't want to suggest anything until we know the free results.

[GKeith]

You mean because of the ranges I just posted to Grey Goose?

[crmavb]

I take 6mcg t3 with 112.5mcg T4

[GKeith in reply to crmavb]

And how do you react? That seems to be too high T4 for so low a T3 but, believe me, it makes no difference, I should know, we're all different & will fare on totally different doses; ask greygooses, she would know if anyone would.

[crmavb in reply to GKeith]

I’m doing well. As I lose weight I lower the T4 and the T3 is just right

[GKeith in reply to crmavb]

Funny you should say that because I've always had a strange relationship with T4. When I think about T4 I think of one thing---headaches. When I think about T3 I think of one thing---energy. I quit taking T4 totally 2 years ago this October but was talked into taking 50mcg of it with 20mcg's of T3, which I talked the endo into 30 mcg, after wanting to try T3 for the last few years of the 28 years I was on T4 alone. I then felt satisfied until a few months later he wanted to up the T4 to 75 and lower the T3 from 30 back to 20 which I did. Six months later I raised the T4 again to 100 mcg and told him I was taking 20 with it and somehow he agreed to it. But now, I began just this week experiencing headaches I remember from the last few years of my taking 88mcg's of T4 for 28 years. And, the two months straight of horrendous headaches still on .88 mcgT4 alone.

What really bothers me though, is that the T3, by itself, was much better than the T4 alone or the T4, T3 combo, even though I had been "brainwashed" into thinking that T4 is part of every thyroid "cure," when in fact, if truth is to be heard than T4's only job is getting into the bloodstream, going through the liver and turning into T3. Well, if true, why do we (any of us) even need any T4, when we can get T3, already converted in a pill? But, NDT has T4, our healthy thyroid's have T4 so ..... see the pressure these doctors put on patients? It's, alas, my opinion that money rules their worlds and T4 is CHEAP ... dirt cheap compared to T3. So, now, after all these years and trials & tribulations I have (finally) decided to either try NDT or stick to T3 alone or with 50 mcg (or less) of T4. My point to you crmavb, is that if you lose weight and lower the T4 you will probably feel better if you raise the T3. T4 is less than useless (headaches) unless it converts to T3 and I have that problem, so with 30 years of knowledge I would tell you that T3 is gold and painless whereas T4 is tin and is fast becoming rusted due to the knowledge of too many hypothyroid patients who have felt the differences and are now "revoluting" as I am to allow patients to know the truth that T4 alone is (eventually) crap for everyone and that money and profit is an inhumane bargain that these doctors have made with the devil and all for their greed, selfishness and "purposeful" ignorance that they display everytime they lie to themselves and point to a TSH too low and say: "See, I told you you need more T4."

[crmavb in reply to GKeith]

I hate the headaches too. And I don’t want to split the dose to avoid them. Headaches for me , have been a sign of too much or too much too soon.

Too much T3 makes me jittery and slightly anxious.

How much sleep are you getting?

I used to think bad things about T4 and I used to take NDS and T3. But I feel better for being on T4 mostly with a little T3. It’s also better for my budget. The T4 is available on free prescription and I make one bottle of 100x 25mcg last over a year!

[GKeith in reply to crmavb]

You mean you take 25 mcg of T4 and have 100 pills that you "make" last a year? Or, do you mean you take 100 mcg T4 and 25 mcg T3 last for a year? Or......? How much T3 do you take?

[crmavb in reply to GKeith]

Sorry I was referring to the T3 that I buy in the last sentence!

[GKeith in reply to crmavb]

Got it.

[Liyaelize]

I'm familiar with the reference ranges as I am in the USA. Ideally they like T4 to be around 1.1 with the reference ranges you gave. If you are feeling well with the lower T4 just be stay with your current dose If not increase your T4 by 12.5 mcg. and later by another 12.5 if needed. As some may convert to T3 and that could be to cause higher T3.

[GKeith in reply to Liyaelize]

You mean an equal amount of T4 to T3 strength wise? Which would be 100 mcg T4 to 25 mcg of T3 with a strength of 4 to 1, t3 being 4 times the strength of T4?

[Liyaelize]

Your T3 looks good. I. Would add just T4 alone. Like you I avoid all supplements as they fix one thing and trigger a host of other things due to all the bad ingredients in them

[GKeith in reply to Liyaelize]

Right on the money, for sure.