Trying to get my T4 and TSH levels in better range

[CraigP100]

Trying to get my T4 levels down as am always on the upper level - 22.8 for T4 and 3.28 for TSH. I had a total thyroidectomy 5 years ago and the results are always similar. Do I cut down my intake very slightly? I'm on 125mg per day. Any advice would be appreciated.

[Lalatoot]

With those results it might be that levo alone is not providing you with the correct mix of hormones.

Perhaps you should get vitamins and FT3 tested to give a fuller picture of what is going on.

Vitamins need to be optimal for the hormones to be fully effective. FT3 levels also need to be considered.

[CraigP100 in reply to Lalatoot]

Thanks, I've only had my T3 measured once and it was bang on in the middle so fine. Haven't tested for vitamins so I'll do that. Thank you

[Lalatoot in reply to CraigP100]

In a normal person Ft3 lags only slightly behind ft4. If your ft4 is at the top end of range and Ft3 in middle then your Ft3 result is lagging behind too much.

This is why we suggest getting Ft3 measured.

In other words maybe your tsh and ft4 are higher because that is the only way your body can get a half decent supply of t3.

[SlowDragon Administrator]

For full Thyroid evaluation you need TSH, FT4 and FT3 tested. Also EXTREMELY important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially if you are under medicated...as suggested by high TSH

Ask GP to test vitamin levels

Recommended on here that 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)

Is this how you do your tests?

If you took levothyroxine before blood test the high Ft4 is false result

Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins

List of private testing options

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus ultra vitamin (doesn’t include folate)

medichecks.com/products/thy...

Thyroid plus vitamins including folate (private blood draw required)

medichecks.com/products/thy...

Medichecks often have special offers, if order on Thursdays

Thriva Thyroid plus vitamins

thriva.co/tests/thyroid-test

Blue Horizon Thyroid Premium Gold includes vitamins

bluehorizonbloodtests.co.uk...

How do you feel?

[CraigP100 in reply to SlowDragon]

Thanks, I've only had my T3 measured once and it was bang on in the middle so fine. Haven't tested for vitamins so I'll do that. Thank you

[CraigP100 in reply to CraigP100]

And I generally feel ok but have been ill for the last 4 months with low level symtoms as I had reduced my levothyroxine and my weight increased slightly but over the month it mush of had an effect. I'm just trying to get T4 in better range - always seems high. Will try to go private - thanks

[SlowDragon Administrator in reply to CraigP100]

it’s extremely common to need high Ft4 in order to get high enough Ft3

Ft3 frequently needs to be at least 60% through range

Do you get your blood test as early as possible in morning before eating or drinking and last dose levothyroxine 24 hours before test

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,

"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l.

Most patients will feel well in that circumstance.

But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."

You can obtain a copy of the articles from Thyroid UK email print it and highlight question 6 to show your doctor

 please email Dionne at

[e-mail]

Professor Toft recent article saying, T3 may be necessary for many especially after thyroidectomy or RAI

rcpe.ac.uk/sites/default/fi...

british-thyroid-association...

Come back with new post once you get vitamin results and ranges

Frequently patients need to test privately....especially to get essential T3 test

[CraigP100 in reply to SlowDragon]

Thanks very much

[pennyannie]

Hello Craig and welcome to the forum ;

A fully functioning working thyroid would be supporting you on a daily basis with approximately 100 T4 + 10 T3. Levothyroxine is T4 and a pro hormone and your body needs to convert the T4 into T3 which is the active hormone that the body runs on and I read T3 is about 4 x more powerful than T4 and most people use about 50 T3 daily, just to function.

Personally I just think if there has been a medical intervention and the thyroid surgically removed or ablated with RAI that both T3 and T4 should be on the patient's prescription, for if, and probably when both these vital hormones will need to be prescribed.

Some people can simply get by on T4 alone, some people at some point in time simply stop converting the T4 into T3 and some people simply need both these vital hormones dosed and monitored independently to bring them into balance and to offer the patient a level of wellness that they find acceptable.

Your conversion of the T4 into T3 can be compromised if your ferritin, folate, vitamin D and B12 are not maintained at optimal levels. We can't know f you have a conversion as we haven't a T3 blood test result and would suggest in the first instance you ask your doctor for a full thyroid panel to include TSH,T3,T4, antibodies and the afore mentioned vitamins and minerals.

If your doctor can't do this for you, there are companies listed on the Thyroid uk website who can, and once with the results start a new post with the results and ranges and you will receive considered opinion.

You don't talk of any symptoms you maybe struggling with, but with your trying to change your TSH and T4 numbers. You can't control either of these numbers, but your doctor can and the logical option is to prescribe you a little T3- Liothyronine and drop down your T4 a little if it's over range. You can run with an over range T4 if it's giving you a good level of T3 but we don't know this number so I'm guessing your T3 is low because of the high TSH suggesting you need more thyroid hormone replacement, and then your TSH will go down and most people feel well when the TSH is around 1 or under.

Currently in the UK you need to be referred to an endocrinologist and accepted for a trial of T3 - Liothyronine and it's not a done deal as CCGs throughout the country are actively restricting the prescribing of this vital hormone due to costs. It has risen in price, just in uk, by some 6000% though still just a few euros in mainland Europe.

If you look at - open prescribing - analyse - you can see by CCG area and surgery how your area compares with the postcode lottery we seem to find ourselves in. My area was leading in prescribing T3 back in 2018 but I think this was the very reason I failed in obtaining a new prescription for T3 and given the excuse that my TSH was too low to qualify. !!!

Many people on here are self medicating and buying their thyroid hormone replacements but in the first instance it's better to try the correct medical route open to us, the NHS.

If you simply look at what you have lost through having your thyroid removed you will see that that small proportion of T3 your thyroid gave you equates to about 20% of your overall daily requirement and no matter how hard you try, over time, this alone can pull you down and compromise your health further.

[CraigP100]

Thanks, I've only had my T3 measured once and it was bang on in the middle so fine. I'll probably go private and test the lot and vitamins as suggested here. I suppose levels are different at various times of the day. I'll try an earlier test if possible. Haven't tested for vitamins so I'll do that. Thank you

[pennyannie in reply to CraigP100]

Hey there,

Bang in the middle is not optimal - we are all different and would strongly suggest you need both T3 and T4 much higher than 50% through the ranges to be well :

Please follow the instructions from SlowDragon on how and when to take the blood draw and if taking any supplements with biotin these need to be stopped 7 days beforehand. In fact, I stop all supplements a week before a blood test, just so, I'm not measuring what I might have taken as opposed to what my body is actually holding onto.

[silverfox7]

Would be best to look into vitamins etc. As thyroid patients we lose them easily so often need topping up. I tested Vit D, B12, Folate and Ferritin but thankfully was only low in VIT D and folate. VIT D I caught up on easily but it took a year to address folate but I feel so much better but just needed to share it’s not always a quick fix but you do gradually improve as you go along.

[CraigP100 in reply to silverfox7]

Thank you. I do take a very good multivitamin every day and extra vitamin D but will definitely check

[SlowDragon Administrator in reply to CraigP100]

Multivitamins not recommended on here

Better to test and supplement only what you need

healthunlocked.com/thyroidu...

Definitely essential to stop any supplements that contain biotin a week before ALL blood tests

[silverfox7 in reply to CraigP100]

Just seen SlowDragon has told you multivits are very week and often poor quantity to help us.

[tattybogle]

Forgive me if i;m misunderstanding. But i dont understand why you reduced your Levo , or why you want to reduce it more.?

Was the 22.8 much over the top of the Lab Ref Range ?

[CraigP100]

A little over the top range - I've just always struggled to get in lower than 20

[jrbarnes]

I only have half my thyroid. I was in the same boat. My FT4 levels were 18.8-19.0 to get my FT3 levels to 3.5-3.8 but after about 6 years my FT3 levels dropped down to 2.6 without changing my dose. Adding more Levo made me feel terrible. I"d say with your FT4 levels where they are your FT3 levels should be higher. I'm currently trying out a combo of natural desiccated and Levo. If your FT3 levels were 3.8-4.4 with a slightly elevated FT4 I wouldn't worry about it but your FT3 is in the low 3s. The last thing you want to do is lower your medication because then your FT3 will drop even lower. However, I have read that men can tolerate lower levels of thyroid hormone than women. If your FT4 levels are slightly elevated and you feel fine then it's not something I'd worry about but if you're tired and having all the symptoms of hypo then you need to get those important vitamins tested and possibly think about doing a T4/T3 combo.