Looking for advise on my conversion T4-T3. I have been on T3 few tears now but was advised (wrongly) to stop in October it as i has said felt racy. My TSH was suppresed. I was on T4 125 and T3 10. I felt so unwell and had symptoms appear. I went saw private Endo who after reviewing blood results taken ptior to taking meds in January (TSH 5.79, FT4 17.9 FT3 3.5) put me back on it with review more bloods to be retaken in March. March blood results before meds were TSH <0.05, FT4 15.9, FT3 3.9. She reduced me to 5mcg in March as felt racy and using loo list weightp. She asked me to retake in May two jours after meds. Results were TSH 0.28, FT4 18.5, FT3 3.8. She agreed to increase T3 7.5mcg (2,5 3xper day as had increased hypo symptoms feeling cold,fatigue. However after month taking i had several sleepless nights so i tookmedicheck test. Blood taken at 2.30pm TSH 0.17, FT4 20, FT3 3.96. By that point i had taken 100Levo 5Liothyronine. When I spoke to Endo with these new results she asked me to take 5mcg T3 in morning and 2.5 in afternoon. Few nights last werk ws unable to sleep so last night I didnt take afternoon dose and i slept. So confused whats going on. Ive read about conversion but dont understand it. Also, if TSH is affected by T3 then why does it not stay suppressed irrespective of level of T3 taken. Mines is increase/decreasing when T3 is adjusted. Grateful for help as im in muddle. Spending most of my days lying as so tired and eating is vegetable/fruit meat/fish as seem to be reacting
Conversion: Looking for advise on my conversion T... - Thyroid UK
Conversion
SuD7
Ive read about conversion but dont understand it.
T4 is a pro-hormone and it converts to T3, the active hormone which every cell in our bodies need.
To find out how well you convert you can only do this if you take Levo only because once you start adding T3 then it's impossible to see how you convert because you'd be measuring the T3 you are taking, not how much T3 is being made by your body from the T4 you take.
Also, if TSH is affected by T3 then why does it not stay suppressed irrespective of level of T3 taken. Mines is increase/decreasing when T3 is adjusted.
I can't really answer that but if you have Hashi's then levels fluctuate and sometimes results are difficult to explain.
Are your nutrient levels optimal? They need to be before adding T3.
Not quite sure what you're asking, here. But, you were obviously not converting very well, which is why you were put on T3. Once you are on T3, conversion is not only irrelevant, but impossible to determine.
Conversion is what we call the action of T4 becoming T3. If you want to get a little bit techical, T4 contains four atoms of iodine. During conversion, one atom of iodine is removed, so that it becomes T3.
This is necessary because T3 is the active hormone, needed by all the many, many cells in your body. And, it's low T3 that causes symptoms. T4 is basically a storage hormone, waiting to be converted.
I really don't understand why it's all or nothing with some doctors. If you felt 'racey' on the dose of T3 you were taking, it seems to me the solution would be to reduce the dose, not take you off it completely. But, it seems some doctors are just looking for any old excuse to take you off it because a) it's expensive or b) they don't feel comfortable dealing with it.
It's difficult to comment on your results because you haven't put the ranges. It's essentail to put ranges because they vary from lab to lab, and we need those that went with your results.
Also, if TSH is affected by T3 then why does it not stay suppressed irrespective of level of T3 taken.
The simple answer is because it is affected by the amount of T3 you take, not just the fact of taking it. But, when you're taking T3, the TSH is pretty much irrelevant, so I would forget about it, if I were you. 
Thank you. Reference range as follows
TSH (0.30-4.20)
FT4 (12-22)
FT3 (3.1-6.8)
January
TSH 5.79 (0.3-4.2)
FT4 17.9 (12-22)
FT3 3.5 (3.1-6.8)
Not sure I understand. Your private endo put you on T3 because of these results? These results just show that you are under-medicated. Your TSH would have to come down to around one before you could judge your conversion level.
TSH <0.05 (0.3-4.2)
FT4 15.9 (12-22)
FT3 3.9 (3.1-6.8)
Presumably your endo reduced your T3 due to your low TSH. But, your FT3 was really far too low to be causing symptoms of over-medication.
TSH 0.17, FT4 20, FT3 3.96. By that point i had taken 100Levo 5Liothyronine.
Are you saying that you took your levo and T3 before the blood draw? Because your FT3 is still much too low.
Your TSH is low there because you had your blood draw at 2.30 pm. TSH is highest early morning, and drops throughout the day.
So, you are still under-medicated, despite the TSH, because your FT3 is much too low for good health. Do you always take your T3 on an empty stomach, well away from food and other medication/supplements?
Just reread your respone. Yes blood draw was taken at 2:30pm after i had taken meds (100 levo & 5 liothy). My next blood draw is this week coming and enfo asked gor after meds but so tempted to do before taking them. Not sure what to do.
Well, if you take your 'meds' anywhere near the blood draw - best to leave 24 hours for levo and 8-12 hours for T3 - all you will be measuring is the dose you just took. You will get false highs for FT4 and FT3. And you will have no idea what your normal circulating level is.
I'm always very suspicious of endos that want you to take your meds before the blood draw, because the results don't tell you anything useful. Because you cannot be certain how much of the dose you actually absorbed, so it can't tell you if you're on the right dose.
Are they really that thick that they can't work it out? Or do they do it deliberately so that they can keep your dose down to a minimum on the pretext that your blood levels are high? I just don't know.
But, of course, taking meds before the test won't have any effect on the TSH, because that doesn't move very fast. That is affected by the time of day the blood is taken. But taking levo will affect the FT4 and taking T3 will affect the FT3.
My TSH taken mostly in morning with my tests.. think couple were in afternoon few years back but TSH was higher then not lower.. it was <0.05 last Jan and August
If i take T3 level 12-8!hrs prior that would mean taking it at 8pm at night..i wouldnt sleep. Can i not tske it in mornjng and test following?
No, you can't. That would give you a false low FT3. So, that wouldn't be much good, either. Have you already tried taking it at 8 pm? Or are you just guessing that it would affect your sleep?
Ive been taking at lunchtime and could sleep hence why just took morningg 5mcg past two says so could sleep...so think taking at 8pm most likely be disaster for sleep. So upset with this thyroud
When i look back old results my TSH was also suppressed on T4..and think was over the ref range for T4.. so doesnt make sense to me..if its just T3 suppress TSH
It isn't just T3 that suppresses TSH. It's a combination of T4 and T3.
TSH - Thyroid Stimulating Hormone is produced by the pituitary in response to low levels of thyroid hormone in the blood. I don't even know if the pituitary differentiates between T4 and T3, and what's more, once you are on thyroid hormone replacement, the TSH is not a very reliable indicator of thyroid status. But, now that you're on T3, the TSH really is not important, because it doesn't have a job to do anymore. It cannot stimulate your thyroid because your thyroid doesn't respond. And, it cannot stimulate conversion because you don't need to convert anymore. So, it's really not worth bothering with.
Thank you. I didnt understand as thought T3 suppresses TSH but when i was on T4 only it was sldo suppressed so thats why confused. Could i have been converting snd have high T3 but they didnt test T3 then. Also read that conversion happens in peripheral tissues so csn that happen even though low levels in blood. So worried about bones/heart as Endo has said higher risk osteop/heart issues.
Could i have been converting snd have high T3 but they didnt test T3 then.
That's a possiblity. But, you can't know how well you convert unless you test FT4 and FT3 at the same time, whilst on T4 only.
Also read that conversion happens in peripheral tissues so csn that happen even though low levels in blood.
It can happen in most tissues. A lot happens in the liver. Some in the brain, etc. etc. etc.
So worried about bones/heart as Endo has said higher risk osteop/heart issues.
Oh these damned endos! Why do they so love scaring their patients? Higher T3 I imagine you mean? Yes, but it would have to be very, very high for long periods to affect your bones and heart. And, you're not likely to get levels like that just from conversion. You'd have to take an awful lot of T4!
Hello SuD7
As I understand things you have Hashimoto's AI thyroid disease.
I do not have this disease but read that your medication may need to be changed / reviewed more often as with each AI attack your thyroid is left a bit more worse for wear and possibly with a further reduced function.
I think it's advised to try and reduce your antibodies and apart from excellent advice you'll find on here Izabelle Wentz has written extensively on how she has helped herself with this disease.
Ultimately your thyroid become less productive and your dose of thyroid hormones will need to be increased. No thyroid hormone works well if you do not maintain ferritin, folate, B12 and vitamin D at optimal levels, so this maybe an area that needs to be looked at.
Conversion can also be compromised by diets, ageing, chronic long term pain, depression and physiological stress - emotionally or physical - also play their part, in lowering metabolism.
Once on anything other than levothyroxine the conversion ratio doesn't apply and it is very much up to the skill of the specialist to adjust both T3 and T4 to find levels acceptable to you as the patient. Generally this seems to be when both T3 and T4 are balanced and with them both being in the upper quadrant of the ranges, but it is a fine balance and just adding T3 to T4 is not necessarily the quick fix as sometimes expressed on forums, especially since you have Hashimoto's and your thyroid levels not necessarily stable to work to and from.
Thank you.
I know its AI but not sure its Hashis as I heard highly regarded Endo say most UK is AI as Hashis you have goiter which I didnt have. I am retesting B12 (active) Folate vitamins this week.. B12/Folate have asked at docs but that jyst be serum B12 which isnt useless adked for Ferritin too mot sure they will allow...it was 50 in March when last tested. VitD was 70 also. I take 1000iu most days.
Reference range
TSH (0.30-4.20)
FT4 (12-22)
FT3 (3.1-6.8)
Well I'm sorry, I had a quick look back and thought I read you have Hashimoto's.
A goitre can also cause interrupted levels of thyroid hormones but think you're now saying you haven't a goitre.
Either way it sounds as though your thyroid hormone output isn't stable and this obviously puts a further spanner in the works.
I need both my ferritin and vitamin D to be maintained at around 100 and with my folate around 20 and active B12 at around 130 all just to support and build my core strength.
When you have all the test results including TSH, T3, T4, antibodies, and ferritin, folate, B12 and vitamin D why not start a new post with all these results and ranges and brief outline of your thyroid journey and current health issues, and you will receive back considered answers.
No need to apologise..hope i didnt offend you it was not my intention. I thought at first too hashi until i watched talk with this Endo and he said Hashis is goiter and most folk UK is AI so I may have been mistaken.
No worries - I'm not offended, just a little confused.
Sorry should read..hashimotos has a goiter..which i didnt have. Sorry for confusion. Thanks
Good morning {
Asda sell little tubs of frozen chicken livers - they are very clean and mild - flash fry in a little olive oil and then whizz down into a pate maybe with a dollop of mayo and keep in the fridge- take a spoonful of this each morning and your ferritin will go up over the next few months - and that's one mineral sorted - 1 tub a week should get you nicely up the range without any of the nasty side effects that some iron supplements can give you.
I still supplement my ferritin this way though not so strictly - and at my peril !!!
Looking at previous posts
You have Hashimoto’s
Low vitamin levels are EXTREMELY common with Hashimoto’s
What vitamin supplements are you currently taking
When were vitamin D, folate, ferritin and B12 last tested
Are you on strictly gluten free diet?
Thank you for response. Yes I thought hashi too as i had TGab antibodies TPOab but following a review of Youtube presentation by an emminent UK Endo he said most folk in UK just have AI thyroid not Hashi as apparently Hashis has a goiter which i didnt have. I thought i had hashi based on just having AB.
My vitamins were last checked in March. B12 Active (110) serum 550/600, Folate 4.7, Ferritin 51 & VitD 70.
Yes sttictly GF.
Uk medics are pedantic
Here in UK ...Hashimoto’s is ONLY autoimmune if it is with goitre
And Ord’s thyroiditis is autoimmune without goitre
en.wikipedia.org/wiki/Ord%2...
Rest of the world calls both forms of autoimmune Hashimoto’s
Folate, ferritin and Vitamin D look too low
Please add ranges on vitamins and antibodies
Sorry im confused so is it Hashis then or Ord inhave? Never heard of Ord. thank you
If you don’t have a goitre, and you live in UK it’s Ord’s thyroiditis
If you live else where ....it’s Hashimoto’s
Ord’s is more common
When i was diagnosed i didnt have goiter.. do not recall a lump at my thyroid it was blood levels GP went by (his wife was Endo and he called her during my appointment
Yes im in Scotland. First ive heard of Ords
patient.info/doctor/hashimo...
However, there is also an atrophic form of autoimmune thyroiditis (Ord's thyroiditis) which is more common in Europe.
stopthethyroidmadness.com/t...
Ord’s thyroiditis / Atrophic thyroiditis
This form of thyroiditis refers to a reduced thyroid size, and is basically very similar to Hashimotos, i.e. one or both antibodies will be attacking the thyroid. It’s more common in European countries. Ord’s/Atrophic Thyroiditis patients tend to see their thyroid atrophy rather than form an enlarged goiter.
ada.com/conditions/thyroidi...
Also known as Ord’s disease, this autoimmune condition is characterized by atrophy of the thyroid gland and hypothyroidism. It is very similar to Hashimoto’s disease, apart from the shrinking of the thyroid gland instead of the development of a goiter. Ord’s disease and Hashimoto’s disease have historically been classified as separate disorders, but research suggests that they may instead be different manifestations of autoimmune thyroiditis, with some medical practitioners calling for the combined term Ord-Hashimoto’s disease to be used.
With Hashimoto’s TSH is frequently highly unreliable
Mix of levels changing constantly due autoimmune attacks and low vitamins
The most important results are ALWAYS Ft3 followed by Ft4
With Hashimoto’s we frequently need high enough dose to shut your own thyroid right down
But essential to maintain optimal vitamin levels too...frequently that means continuously supplementing and very regularly retesting
Exactly what vitamin supplements are you currently taking?
Essential to always test thyroid as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test and last half or third of daily T3 dose 8-12 hours before test
B12, folate, vitD. Though temp stopped vit b12/ folate as im testing on Thursday
Ok
Come back with new post once you get results
Aiming for vitamin D at least around 80nmol and around 100nmol maybe better
Folate and ferritin roughly half way through range
Serum B12 at least over 500
Active B12 over 70
Are you supplementing magnesium or vitamin K2 mk7
Yes vitD has K2 in it. Was taking a little mg but stopped it.
Got blood draw on Tuesday but said take T3 8-12 hrs away but cant take in evening as wouldnt sleep. My lmFT3 level was 3.5 in jan on T4only and was 3.96 in July after taking 5mcg. If i get tested early and taken dose previous afternoon will that be ok?
Many, many people (myself included) find taking last 5mcg dose at bedtime improves sleep
First time I found that out ....was when took last dose later than normal because of blood test the next morning
Initially under endo recommendation was taking 20mcg T3 - 10mcg at 6am, 5mcg noon and 5mcg at 6pm
After discovering T3 improves sleep .....same doses ...times 7am, 3pm and 11pm
Levothyroxine at bedtime often works better too.
Certainly more convenient ......and perhaps more effective taken at bedtime
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