How important is T3 compared to T4...? - Thyroid UK

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How important is T3 compared to T4...?

lau99 profile image
24 Replies

...For regulating/maintaining healthy gut/bowel/digestive functioning? Sorry I keep coming back to this issue! I hate that this seems to be one of my biggest problems post-thyroidectomy (especially since it's so unpleasant and TMI to talk about), but I really haven't been the same since TT and it bothers me every day. After my initial panic re my latest bloods, I wonder if my Dr is reducing my Levo to see if there could be room to add T3? Which brings me to my main question - could adding T3 help at all with my constipation/general bathroom problems? Changes in diet /eating habits seem to have had no real effect for me, and medication prescribed to me by my Gastro doesn't work well enough for me to feel it's taken care of. I'm working on getting some bloodwork done to see what my vitamins are like.

On a sidenote, a sentiment that I've heard from a couple different Drs about my problems has been that having the TT put my body into a bit of 'shock', as I went from being severely hyperthyroid to suddenly having no thyroid at all. Could that still be affecting me more than a year later as well?

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lau99
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24 Replies
Nanaedake profile image
Nanaedake

What's happening to your vitamin levels and do you take magnesium citrate or similar?

lau99 profile image
lau99 in reply to Nanaedake

I only take Vit D at the moment, and haven't any idea about my levels. I'm currently working on getting a test for more info. I have seen the suggestion to add Magnesium citrate a few times here and am interested in trying it. :) Are there side effects like stomach upset or loose stools? What exactly does it do?

Batty1 profile image
Batty1 in reply to lau99

I had thyroidectomy in 2016 and have been taking magnesium citrate for 4 yrs a couple of hours before bed and had NO SIDE EFFECTS.... living without a thyroid is not easy and these Endos think that giving it a pill will make you better .... as your finding out its not that simple ... Im still struggling 4yrs later and I really hate the weight gain. I pretty much just given up and excepted that maybe this is as good as its going to get, I did develop psoriatic arthritis shortly after my surgery so a double whammy ... weight gain and joint pain side by side makes for happy times, not!

lau99 profile image
lau99 in reply to Batty1

Thank you for sharing your experience of Magnesium citrate :) I'll definitely have to give it a try. It just feels like my muscles have stopped working when I try to go? hopefully this will help. So sorry that you had to go through all of this, though. I really think that the NHS/Medical industry is far too eager to perform unnecessary thyroidectomies, in my experience anyway.

Batty1 profile image
Batty1 in reply to lau99

I have what I call jelly muscles in my upper thighs, hip and upper arms. I’ve been having this for some time now I personally believe Im under medicated. I really doubt the Magnesium will help you with this but will definitely help with constipation.

greygoose profile image
greygoose

This is a reply I gave to someone earlier today:

Constipation is something a lot of us get. The best things to help are magnesium citrate and large doses of vit C.

Three things to think about with constipation:

1. Are you getting enough fibre? You need fibre for your transit, BUT you don't want too much fibre because it could affect the absorption of your levo, making you more hypo, and therefore possibly more constipated. It's a matter of finding the right balance.

2. Are you drinking enough water - especially in this heat wave. Your body needs a constant supply of water, and if it's not getting enough, it will suck your poo dry (sorry for that image!) to get the water, leaving you more constipated and unable to 'go'.

3. Do you have low stomach acid? Low stomach acid can be caused by being hypo, but also by low-salt diets and B12 deficiency (also old age, but not much you can do about that). Low stomach acid will cause constipation. So, you need to check your nutrients, and your stomach acid level (bicarb test), and if either are low, you need to raise them. :)

I would add that getting your nutrients tested: vit D, vit B12, folate, ferritin - will give you a clue as to your stomach acid level. If they are low, they your stomach acid will also be low.

lau99 profile image
lau99 in reply to greygoose

Thank you, greygoose :) These are definitely points I'll bring up with my doctor when I next see him.

greygoose profile image
greygoose in reply to lau99

Be interesting to know how you get on. :)

jimh111 profile image
jimh111

I found that T4 has slightly more effect on the gut than T3 but you may need some T3 because you've had a thyroidectomy.

I would ask your doctor to check your calcium levels as high calcium can cause constipation. The thyroid secretes another hormone called calcitonin which regulates calcium. After thyroidectomy most patients don't seem to miss the calcitonin but it may not be so in your case. It's a long shot but calcium blood tests are very easy and reliable.

lau99 profile image
lau99 in reply to jimh111

That's probably a good shout, I was given a tub of calcium supplements immediately after my surgery but I, to this day, haven't needed to take a single one, as my bloods have apparently shown I don't need them. Perhaps I'll have to chase this up further.

Marymary7 profile image
Marymary7

I don't go unless I take two Magnesium Citrate at night which makes me wonder surely I can't be optimally treated. Definitely get all your vitamins up to scratch and get bloods done. I just regulate myself by taking one, two or none of the Magnesium Citrate. Agree with Greygoose and yes I drink lots of water.

lau99 profile image
lau99 in reply to Marymary7

It's so hard to tell if you're being optimally treated or not, isn't it :( Hopefully we get to a point where we don't need the magnesium citrate anymore, but for now that looks like it'll be my best bet!

NWA6 profile image
NWA6 in reply to lau99

Once you’re optimally treated you’ll know your optimally treated! Lol Then it is also easier to know when you’re going hypo and adjust. I think with most that are hypo we take a lot of symptoms for granted, it’s our ‘norm’ we don’t know how to feel anyway else.

Personally I think it’s absolutely shocking that those who have a thyroidectomy don’t automatically be placed on combo treatment. Your thyroid dies secret about/up to 20% of T3 and now that supply has gone.

Almost every single complaint I had while hypo and not on T3 has gone, vanished!

It’s a blanket statement but I suspect that most hypos who still have symptoms are not optimally treated and it just doesn’t have to be that way.

The one thing I have left is sore joints but I’m working on that, I doubt after so many years they’ll recover but at least I’m mentally well to deal with aches and pains.

SlowDragon profile image
SlowDragonAdministrator

You really need to test vitamin levels

Medichecks - JUST vitamin testing including folate - DIY finger prick test

medichecks.com/products/nut...

Medichecks often have special offers, if order on Thursdays

Calm vitality magnesium powder is cheap and easy to use...must be four hours away from levothyroxine.

cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off if go on thyroid uk for code

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

monitormyhealth.org.uk/thyr...

SlowDragon profile image
SlowDragonAdministrator

Vitamin D

GP will often only prescribe to bring levels to 50nmol.

Some areas will prescribe to bring levels to 75nmol

leedsformulary.nhs.uk/docs/...

GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)

mm.wirral.nhs.uk/document_u...

NHS Guidelines on dose vitamin D required

ouh.nhs.uk/osteoporosis/use...

But improving to around 80nmol or 100nmol by self supplementing may be better

ncbi.nlm.nih.gov/pubmed/218...

vitamindsociety.org/pdf/Vit...

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

Test twice yearly via vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function. There’s a version made that also contains vitamin K2 Mk7

It’s trial and error what dose we need,

Calculator for working out dose you may need to bring to

40ng/ml = 100nmol

grassrootshealth.net/projec...

Government recommends everyone supplement October to April

gov.uk/government/news/phe-...

Links on importance of magnesium and vitamin K2 Mk7 supplements when taking vitamin D

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

Magnesium best taken at bedtime or If you take levothyroxine at bedtime, take magnesium early evening

Best start on low dose and increase upwards until you get desired effect ....too much can cause diarrhoea

jimh111 profile image
jimh111

Magnesium citrate is a good form of magnesium and magnesium deficiency is common.

I agree with comments about taking Mg citrate and vitamin D. However, I would hold off for the moment and ask your doctor to check your calcium levels just in case they are abnormal. Magnesium and vitamin D affect calcium.

I've never heard of the 'shock' concept and a year is way too long, it would be better if they simply said they don't know.

pennyannie profile image
pennyannie

Hey there Lau

The body runs on T3 not T4 :

There are people on here who take T3 only and have no need for T4 :

T4- Levothyroxine is a storage hormone that needs to be converted by your body into T3 -the active hormone that the body runs on :

Your have lost your own natural thyroid production that would have been a combination of both T3 and T4 thyroid hormones :

I believe you now have a chemical imbalance and are missing that proportion of T3 that kicks off one's own metabolism and starts the whole process of metabolism.

T3 is currently a " hot potato " as, now, only endo's can prescribe and risk jeopardising their own jobs if this means going against the CCG rules and regulations within their area.

Alternatively there is Natural Desiccated Thyroid which was the successful treatment for hypothyroidism for over 100 years and this contains both T3 and T4 thyroid hormones and is pig's thyroid dried and ground down into tablets referred to as grains.

NDT can be prescribed by a doctor on a " named patient only " prescription. However, there are very few doctors who know or recognise the value of this treatment option and again, because of it's current price on the NHS is very expensive compared to Levothyroxine, so doctors need to apply to the local CCG and be actively supporting your needs as opposed to the financial implications.

There are a few endocrinologists prescribing both NDT and T3 on the NHS and these are generally distinguished specialists within this area of medicine.

P.S. For optimal efficacy of any thyroid hormone replacement, whether it be T3,T4, or NDT you do need your vitamins and minerals maintained at optimal levels and not just anywhere within the range. I think you also need to look at the interactions of any other medications.

Ultimately, you have lost your own thyroid hormone production and the thyroid produces T1, T2. T3. T4 and calcitonin.

shaws profile image
shawsAdministrator

I am not medically qualified but have recovered thanks to Thyroiduk before this forum began.

The thyroid gland produces certain hormones that permit our body to function as normal. It is T3 andT4.

Their advice/support helped me to recover as, like many newly diagnosed people, taking levothyroxine and felt far worse than before I diagnosed myself due to GP stating I had nothing wrong. He didn't seem to notice a TSH of 99. (I also have my thyroid gland).

I had never heard of hypo previously and the word meant nothing to me at all. Neither did any doctors/consultants I consulted who knew no clinical symptoms or thought of hypothyroidism. It was a non-medical person I knew who suggested it.

As you have had a TT, I think the very basic those people should be prescribed is T4/T3. The authoirties have withdrawn NDT (natural dessicated thyroid hormones) and the very first replacement which saved lives from 1892 onwards.

Through False Statements made by those who'd you imagine were fully knowledgeable about its history have now been successful in withdrawing T3 due to the tremendous cost to the NHS - leaving patients panic stricken - do they care? NO.

Doctors have been instructed to not prescribe T3 as the cost has risen astronomically. Endocrinologist can but many are reluctant due to its cost.

Quite a number of Researchers have found time and time again that many improve with a T4/T3 combination which can restore health especially those who've had a thyroidectomy.

Our body cannot function without T3 (liothyronine) which is needed in our millions of T3 (liothyronine) receptor cells and is the Active thyroid hormone.

T4 (levothyroxine) is inactive and it is assumed it converts to T3 but some of us cannot do so effectively and I'm one of many thousands.

The heart and brain contain the most T3 receptor cells.

vocalEK profile image
vocalEK

Speaking of TMI, I had never heard of "pebble poop" until I started trying to figure out what had gone wrong after I began taking a medication that has constipation listed as one of its side effects. Here is probably more than you will ever want to know about poop:

unitypoint.org/livewell/art...

Even though I stopped taking the offending medication, I found that constipation was ongoing. Fiber intake seems to be the key to breakthrough (so-to-speak) for me. I now have an afternoon snack of a bowl of raisin bran with almond milk. While they are in season, I am adding half a peach to the bowl. Other "p" foods are supposed to be good, too, such as prunes and pears. Don't like either one, though, but love peaches.

In addition, some of my low-carb desserts have added fiber. Check the nutrition label. I aim for at least 6 grams of fiber per serving.

lau99 profile image
lau99 in reply to vocalEK

Thanks so much for this info! That's a great resource that you pointed me towards :) Sadly regarding my fibre intake, it would seem that every time i've tried to increase my fibre intake through foods or medicines/psyllium husk, my stools become even more difficult to pass and I ultimately end up feeling worse :(

vocalEK profile image
vocalEK in reply to lau99

I've been doing well lately with single-serve mini guacamole (3 grams fiber) with 9 tortilla chips (3.6 grams fiber) and then a bowl of raisin bran cereal (8 grams fiber) with almond milk (1 gram). Finally, after dinner my desert consists of a low-carb, high fiber treat such as these healthline.com/nutrition/at.... It's important to read the nutrition labels of all of these foods.

Gerispice profile image
Gerispice

Before I was optimally treated I had terrible constipation. I wouldn’t go for 3 weeks at a time and would end up in A&E begging for an enema to relieve the pain. The reason was I didn’t have enough energy to move my gut because I’m a very poor converter of T4 to T3. We all convert at different levels of efficiency. Adding T3 to my existing regime of T4 only, cured every symptom of hypothyroidism for me and I’ve lived a normal life ever since - apart from the constant battle with the GPs who are constantly trying to reduce my T4 and take away my T3 altogether. My advice would be to get your T3 level checked. It may be that you are also a poor converter. This can be overcome by either adding T3 or increasing your T4 to give your body a chance to convert a bit more. Good luck x

lau99 profile image
lau99 in reply to Gerispice

Thank you for sharing this. I suspect that I might feel better with the addition of T3 as well, but I think my new endo wants to get a clearer picture of my conversion status before moving forward with anything at the moment. I really hope that I can come to some kind of breakthrough with this x

Gerispice profile image
Gerispice in reply to lau99

I do hope you succeed. We are all different in our experiences and management of this illness. You have to find what works for you alone, and stick with it. I’m very sad that it’s such a long and difficult journey for us on the whole. I don’t lose hope that one day we will all receive the correct management that we all deserve without the battle for survival x

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