Trying to figure out ratio of T4 to T3?

[bmrj]

What is the ideal ratio of free T4 to free T3? Does anyone know that particular ratio? Or is it free T3 to free T4?

[greygoose]

There is no ideal ratio that suits all hypos. When you're hypo, you need what you need. And that might be - like me - 75 mcg T3 and zero T4. We're all different, with different needs. And, we have to find what we need by trial and error.

[bmrj in reply to greygoose]

Yes, true!!! Thank you.

[bmrj in reply to bmrj]

Yes, all true. I’m probably going to look for a new Endo. Sick and tired of his blowing off my symptoms as anxiety and my results as normal. TSH is 1.9 ( .465-4.68) Free T4 is 1.37 (.75-2.09) and Free T3 is 2.73 (2.77-5.27). Clearly the FT3 is below normal. And my TSH has been gradually creeping up and my FT4 dropping gradually. I’m just so tired of feeling sluggish, short of breath and like I’m ancient.

[greygoose in reply to bmrj]

Endos don't know anything about symptoms. But, he must be blind if he thinks your FT3 is normal! What are you taking?

[bmrj in reply to greygoose]

I totally agree. He obvi doesn’t care! I’m going to find an Endo who actually does!!! Yuck.

[bmrj in reply to bmrj]

I’m on Synthroid alternating, 112 with 100 5 doses of 112 and 2 doses of 100/week. I’m going to increase the dose carefully, maybe to 6-1/week as I don’t want to overshoot with straight 112 cuz my metabolic balance is pretty sensitive to small adjustments.

[greygoose in reply to bmrj]

Your FT4 is only 46.27% through the range. So, there's plenty of room to increase. But, even if you got it up to the top of the range, I doubt that would even bring your FT3 in at the bottom of the range. You really need T3 added to your levo.

[bmrj in reply to greygoose]

This is the lowest my T3 has been. It’s usually low normal. So might just try increasing my Synthroid a little. Thank you!!

[greygoose in reply to bmrj]

You're welcome.

[SeasideSusie Remembering]

bmrj

Presumably you mean as in test results?

No ideal ratio but when on Levo the aim, generally, is for TSH to be 1 or lower with FT4 and FT3 in the upper part of their ranges, reasonably well balanced if that is where you feel well.

So first of all we need good conversion of T4 to T3 and to help that we need optimal nutrient levels.

[bmrj in reply to SeasideSusie]

Yes, all true. I’m probably going to look for a new Endo. Sick and tired of his blowing off my symptoms as anxiety and my results as normal. TSH is 1.9 ( .465-4.68) Free T4 is 1.37 (.75-2.09) and Free T3 is 2.73 (2.77-5.27). Clearly the FT3 is below normal. And my TSH has been gradually creeping up and my FT4 dropping gradually. I’m just so tired of feeling sluggish, short of breath and like I’m ancient.

[NWA6 in reply to bmrj]

Are you on T3? Levo?

I use this calculator to understand where I am in range

chorobytarczycy.eu/kalkulator

Your FT4 is way too low 46% through range, you need more Levo to bounce that up to the 80’s or more

And your FT3 is -1.6% 😱 how are you functioning?

[bmrj in reply to NWA6]

Poorly. Functioning poorly. I’m going to speak to my internist tomorrow who’s been gone x 2 weeks. Hopefully, he, who is far more patient than the Endo dude will help me out. I’m on Synthroid 112 alternating with 100 about 5-2 doses/week. Never been on T3. I think I need to go up to 112/100 to 6-1 doses/week. Also my ferritin has been low at 10-13 and my B12 could use a boost as it is in the 400’s. Ugh. A metabolic disaster. Lol.

[NWA6 in reply to bmrj]

Can you tolerate Levo ok? If so you need to move up to 125mcg daily. And as Marz says optimise those Vits/Minerals too 🤗

[bmrj in reply to NWA6]

Yes. Definitely will do. Thank you!!

[bmrj in reply to NWA6]

Thank you for your input!!!!! I agree with you!

[bmrj in reply to NWA6]

Thank you for that calculator!!!

[Marz in reply to bmrj]

It's low T3 that causes symptoms as it is needed in every cell of your body.

The Synthroid is inactive and will only convert into Active T3 when Ferritin - B12 - Folate - VitD are OPTIMAL . You don't need an Endo for that 🌻

[bmrj in reply to Marz]

Yes. That makes sense.

[Hidden]

Unfortunately, it´s a myth that there is an ideal T3/T4 ratio for everyone.

I just read the following statement in another forum about Novothyral (a synthetic combo drug with the same T3/T4 ratio as in NDT); this is what the moderator says: "Novothyral contains too much T3 relative to T4" (the same statement has been made many times about NDT as well).

The question then is: too much T3 for whom exactly???? While it´s true that pigs produce T3 and T4 in a different ratio compared to humans, it´s logical to assume that a poor converter would need a higher T3 to T4 ratio than a good converter...the latter may not need T3 at all.

I personally abhor statements like the one above, as they prevent people from finding THEIR ideal treatment, be that T4 only, T3+T4, NDT, NDT+T4, NDT+T3, T3 only...you simply cannot say that ratio X is ideal for everyone. As others have said, you need to find out what works for YOU by trial and error.

[bmrj in reply to Hidden]

Thank you. I agree.

[Hidden]

PS. I find this to sum things up nicely:

thyroidpatients.ca/2019/09/...

[pennyannie]

Hello Bmrj :

I understand that T3 is said to be about 4 times more powerful than T4 :

I understand that most people feel better, when both T3 and T4 are balanced and in the upper quadrants of the ranges.

So, this presumed ratio, is just that, a guideline of where we may feel better when medicating with Levothyroxine - thyroid hormone replacement.

I read that most people seem to feel better when on Levothyroxine when their T3/T4 ratio comes in somewhere between 1/ 3.50-4.50 T3 to T4 :

Imagine a seesaw - with T3 and T4 sitting on the seats : to get the " bumps " and best fun from the seesaw you'll need the weights pretty even, as otherwise one is stuck in the air whilst the other is stuck in the mud :

Your thyroid needs a balance of both T3 and T4 thyroid hormones so it can react and bounce back from all that it goes through on a daily basis :

It is similar to how the seesaw mechanics work, with a TSH sitting in middle adjusting to the weights on either end.

No two people are the same, and conversion is variable due to the person's own medical health and history and lifestyle choices :

To improve your own ability to convert T4 into T3 it's advised to optimise your vitamins and minerals. If then, you still feel unwell the obvious next step is to review your T4 dose and possibly consider adding some T3 into the mix to see if this combo helps relieve you hypothyroid symptoms.

[bmrj in reply to pennyannie]

Nice analogy. I agree. Thank you!!

[pennyannie]

Hey there Scrumbler,

Well I haven't envisaged that yet, as I think my playground was only for monotherapy with Levothyroxine.

Once you qualify for it, you're with the " big boys " and I see you in a Fairground on a Helter Skelter with a support mat of T3 for your bum : and the more goes you want the further down the slide you go, and without a top up of T3 during all this excitement may risk slipping off the mat and going " bump " at the bottom.

Trusting all is well in your neck of the woods :

[pennyannie]

Touche -

[Popoff]

As others have rightly stated, there is no target ration for T3/T4. We all feel differently and thus, what is important, is to ensure that your dosage makes you feel well. As a guide, aim for TSH between 0.7 and 1.5; FT4 between 50% and 70% of the range that your lab is using and FT3 to be between 80% to 95.3% of the range used by your lab. Finally if you are also testing for rT3, it would be better if your rT3/T3 is close to 2. Of course normalising the thyroid hormone is only part of the story in feeling well when hypothyroid. Other vitamins also need to be in range. Always remember, rations and targets are a means to an end, with the end being having a few symptoms as possible, so this is ultimately the last target.

[bmrj in reply to Popoff]

Thank you for that info!!