Whether to raise T3 or Levo

[DoDoc]

I take 75mcg Levo with 12.5 mcg T3 and recent blood results were:

Free T4 13.4 (12 - 22)

FT3 3.6 (3.1 – 6.8)

TSH 0.5 (0.27 – 4.20)

I took both Levo and T3 twenty four hours before the test and realize that I should have taken the T3 eight to twelve hours before the blood draw, so presumably it should be a bit higher.

Up until four years ago I was on 100 mcg Levo alone and my last blood then were:

Free T4 18.03 (12 - 22)

Free T3 3.85 (3.1 - 6.8)

TSH 2.02 (0.27 - 4.20)

As you can see, there isn’t much difference to the T3 result and the T4 has dropped considerably. ( I was going to discuss this with my endo at my last appointment, but was assigned to another doctor who seemed to want me to go back to Levo only.)

I assume the T3 should be higher and I’d be very grateful for advice as to whether to increase the T3 or to raise the Levo back to 100mcg in the hope that some will convert to T3 ( though I suspect I don’t convert very well.)

Recent results on vitamin levels were:

Vitamin B12 and Folate

Serum vitamin B12 849ng/L (197 – 771) High

Serum folate 17.4 ug/L (3.9 – 26.8)

Actions completed: satisfactory for this patient

Iron Profile

Serum ferritin 56 ug/L (13 – 300)

Serum iron level 19.3 umol/L (10 – 30)

Serum transferrin 2.6 g/L (2 – 3.6)

Percentage iron saturation 29.4% (30 – 40)

Low

Actions completed: satisfactory for this patient

As the serum ferritin is low, I’m wondering if that impacts on the T4 to T3 conversion. Any advice would be greatly appreciated.

[fuchsia-pink]

How do you feel?

Personally I like both free T4 and free T3 to be high in range, so I'd be inclined to increase levo first, re-test and then add more lio if needed later.

[DoDoc in reply to fuchsia-pink]

Many thanks for replying fuchsia -pink. I will try increasing the Levo first and retest. That makes sense.

Thanks agin and keep safe.

[SeasideSusie Remembering]

DoDoc

You can't really compare those two tests.

1) On 100mcg Levo:

Free T4 18.03 (12 - 22)

Free T3 3.85 (3.1 - 6.8)

TSH 2.02 (0.27 - 4.20)

Shows a good level of FT4 but poor conversion of T4 to T3. It would have been a good idea to increase your Levo at that stage to get your TSH down to 1 or below and see what your conversion was like then.

2) On 75mcg Levo and 12.5mcg T3

Free T4 13.4 (12 - 22)

FT3 3.6 (3.1 – 6.8)

TSH 0.5 (0.27 – 4.20)

You know you left too long a gap between last dose of T3 and blood draw, so your normal FT3 level will be higher.

As you can see, there isn’t much difference to the T3 result and the T4 has dropped considerably.

As mentioned, you currently have a false low FT3 result so you can't compare them, and if you'd left the correct time gap your FT3 may be in the region of 4.3 (guesstimate only).

If your T3 was added after the results shown in (1) above, then as your FT4 was only 60.3% through range, there was really no need to reduce your Levo. Taking T3 will lower FT4 anyway, so your FT4 would have reduced without lowering your Levo.

I am combination hormone replacement and I would be very unwell if my FT4 went that low. I need both FT4 and FT3 around 60-70% through range, some people do fine with a lower FT4.

Personally, based on my own experience, if those were my results I'd be increasing Levo back up to 100mcg, retest in 8 weeks to see what my levels are then. You probably have some natural conversion still (as I do) so I would expect to see both FT4 and FT3 improved. You could then reassess and see whether you need a further increase and decide if it should be Levo or T3 (my guess would be if a further increase is needed it would be a bit more T3).

As the serum ferritin is low, I’m wondering if that impacts on the T4 to T3 conversion.

Yes. I've seen it said that ferritin should be 70 for thyroid hormone to work properly. Recommended is half way through range and yours 14.98% through range, but that is a very wide range for a female, mine with private labs is 13-150 but with my GP is up to 300. I would aim to increase your ferritin and you should be able to do this by eating liver regularly, maximum 200g per week due to it's high Vit A content, also liver pate, black pudding, and including lots of iron rich foods in your diet

apjcn.nhri.org.tw/server/in...

Was Vit D tested?

[DoDoc in reply to SeasideSusie]

Many thanks, Seaside Susie. That makes perfect sense. I will increase the Levo and retest in 8 weeks, as well as raising ferritin levels.

Will it matter if the Levo is a different brand, as I'm prescribed Mercury Pharma , but will have to get the added 25mcg privately?

Incidentally, my last Vit D levels were approx. three quarters through the range.

Thanks again and keep safe.

[SeasideSusie Remembering in reply to DoDoc]

DoDoc

Some people are able to use different brands with no problem, others find they need to stick to the same brand. You'll have to try it and see if you're OK.

Vit D is recommended to b e 100-150nmol/L (40-60ng/ml) according to the Vit D Council/Vit D Society.

[DoDoc in reply to SeasideSusie]

Thanks again SeasideSusie.