Can your FT3 be "good" but your cells be unable to use it...?

[Zazbag]

I just had an appt with a private endocrinologist, unfortunately the wrong type of appt was booked so it was cut short, but when I pointed out my T3 (around 60% through range) and asked whether that's still low enough to cause my ongoing symptoms, she said that it looks quite good and shouldn't be, but it might be that my cells are not taking up the FT3 that's in my blood. I've never heard about this before... can anyone please explain? Thank you.

[Lalatoot]

Look up thyroid hormone resistance.

[DippyDame]

The endo is confused she appears to only have part of the story. about RTH....but bits may be missing here!

She has got the drift of T3 not being able to reach the tissues/cellular level but the rest is very vague and frankly not instilling much confidence!

Your FT3 should ideally be close to 75% through the ref range. She "thinks it looks quite good".....sorry "thinking" isn't good enough as the foundation of a diagnosis. Why does she say "it shouldn't be?

60% means you have room to add more levo and if your conversion is good that will eventually raise your FT3

Is your conversion good?

Poor conversion is indicated by high FT4 and low FT3.

That may be part of your problem.

Vit D, vit B12, folate and ferritin all need to be optimal (not just in range) for good thyroid health

Should your conversion be poor then adding a little T3 to a levo dose usually helps.

For a more accurate evaluation we need at least FT 4 and FT3 labs

She is referring to Thyroid Hormone Resistence (RTH) but (probably)with a lack of understanding of the condition

I have the condition and require a massive dose of T3 to remain in reasonable health....long story in my profile

It is a very complicated condition which on the basis of what you say is unlikely to be your problem.

It sounds as if you are undermedicated.

Are you taking any thyroid replacement hormones?

Medics tend to have a poor knowledge and grasp of thyroid disease.

Most endos are diabetic, not thyroid, specialists

Most private endos also work in the NHS......so "private" doesn't necessarily mean they are thyroid experts. They are few and far between.

That lack of knowledge is why over 100,000 people have arrived here in desperate need of help!

I would say your telephone appointment was neither helpful nor productive....sorry!

If you can add any labs you have (including ranges - important) then we can have a look and try to help.

Best...

DD

PS...

If you wish to read about RTH then Hugh Hamilton offers a straightforward explanation in his ebook which you can find on Amazon for £3.56 or free if you have Amazon Prime. It is called "Impaired Sensitivity to Thyroid Hormone (Thyroid Hormone Resistance)" by Hugh A Hamilton

This may help eliminate any doubts you have....and may educate your endo!

PPS...

Just looked at your previous posts and this jumped out

"I have had a low red blood cell count which has continually decreased since I was diagnosed but the GP assured me it's not important."

Your red blood count does matter....

"I had a folate deficiency last year that was undiagnosed for months, but my folate is now within range"

As I said above your results need to be optimal not just in range!

Medics do not understand nutrients and their significance

You need to get " all your ducks in a row" in order to treat your thyroid.....it is unwise to jump in the deep end with T3 which is a powerful hormone which must be treated with respect.

There are no quick fixes for thyroid disease so you must be patient it takes 6 weeks plus for the body to adapt to each new dose

I suggest you re-read SlowDragon responses to your first post....you are veering off track too fast and too soon!

[Zazbag in reply to DippyDame]

Many thanks for taking the time to reply.

My vitamin D, B12 and folate were all optimal on 1st June this year and I continue to supplement them all:

Vitamin D: 96

Vitamin B12: 548.2 (180 – 900)

Folate: 18.4 (2.5 – 19.5)

My ferritin is not really where it should be but it's higher than it was (have been taking 420 mg ferrous fumarate since February):

Ferritin: 53.1 (22 – 275)

My latest thyroid results are (after having an increase to 150 mcg levo):

(NHS blood test results differ from Medichecks despite both tests being from the same blood sample)

NHS test:

TSH: 0.03

FT4: 19.4 (74% through range)

FT3: 5.2 (56.8% through range)

Medichecks:

TSH: 0.023

FT4: 22.6 (106% through range)

FT3: 5.6 (67.6% through range)

I'm not sure why you think I've jumped the gun, I am clearly at the top of the range for FT4 but still having symptoms and my T3 isn't great. I've felt awful all year, and most of last year, so I have grown impatient with the NHS, hence why I sourced a private endo who is actually from the Thyroid UK list and calls herself a thyroid expert (Georgina Conway). I know that a lot of people come onto this forum without much prior knowledge but I wouldn't say I am one of those people.

[DippyDame in reply to Zazbag]

As I suggested above your conversion may be inadequate and your Medichecks labs seem to point to that. Your FT4 is over range but there is no evidence that your FT3 has risen correspondingly.

If you re read my reply carefully you will see that I did not say you had "jumped the gun". But, semantics aside....

Your post referred to your endo's comment that, " it might be that my cells are not taking up the FT3 that's in my blood. I've never heard about this before... can anyone please explain? "

I briefly pointed out that I do not think you have RTH and directed you to further information, but that I thought you should (first) investigate your conversion.

Did this endo address conversion?

Did she refer to the Dio2 genetic test?

Did she suggest that you have a conversion problem?

Did she suggest the addition of a little T3?

Many of us have had little success with the NHS......it took me nearly 50 years to find out why my health had declined to the point where I could barely function! I only began to find the answers when I arrived here.

Like the people to whom you refer I too arrived here with little prior thyroid knowledge (most people do) time, experience, much reading plus valuable support and direction from the experienced members here helped me find the answers that had eluded me for decades.....and importantly, to understand the reasons behind those answers.

Do you now have a plan going forward? I know nothing of this endo, my faith lies with the experienced members here. Without them I would now be seriously ill.....or worse .

I'm very sorry that you feel so unwell, most of us here can empathise. I hope your endo helps you to feel better

Best

DD

[Zazbag in reply to DippyDame]

Again, I appreciate the effort you have put into replying. I don't think it's necessary to debate anything, but "you are veering off track too fast and too soon!" to me reads as "jumping the gun".

Unfortunately I was booked in for the wrong kind of appt so it was only 15 minutes long which didn't allow us to go into any kind of detail.

She mentioned conversion, she said mine wasn't bad but could be better.

She didn't mention anything about the Dio2 gene.

She suggested I would be a good candidate for Armour Thyroid.

She suggested that I have a SIBO test as I mentioned that my erythrocyte sedimentation rate is abnormally high.

I have another appt booked with her for Tuesday next week. I have sent her a very detailed document I spent hours writing yesterday which covers all my symptoms and all relevant blood test results. Personally I want to try T3 in combination with levothyroxine as even though my T4 looks "good" and my T3 is better than it was, I really do not feel good. I'm very angry/irritable/prone to low mood and exhausted and my hair is still falling out and I still can't recover from exercise. I think I need less T4 and more T3. Her suggestion that I try NDT was a surprise but I think we will discuss it more next week. In the meantime I am just trying to get through the day without seriously messing up at work or ripping anyone's head off. It is proving to be very difficult. I spent all weekend on my sofa.

[marsaday in reply to Zazbag]

Your bloods look good. T3 is in a good area above 5.

Ft4 is 19 or 22 depending, so towards the top of the range.

So you have plenty of T4 in the tank and you are converting well, but you still feel rubbish. So the uptake the endo was referring to is correct. You are not sucking up the T3 into the cells well enough. This is super common and relates to the adrenal area.

For me i found low dose progesterone made a big difference. You are female and i am male so the quantity you need might be different, might not. Whether it is worth using a low dose of progesterone oil called ProgestE that is for you to consider. It is £35 approx and is sold by a company in Sheffield. If you google the product in sheffield it will come up.

IF you experiment with some T3 try use a tiny amount first. something like 1/8th of a tablet. So 2.5/3mcg in strength. Have a read of Dr Blanchards book functional thyroid. Its a good read and talks about how low dose T3 is more effective than the bigger doses.

Another thing to try is taking the T4 at bedtime. This may have a more positive effect on cortisol generation as the thyroid and cortisol hormones interact with each other at night while they are being made. I really notice a difference if i switch from bedtime to morning dosing. You have to try it for a bit and then switch back to really notice it was doing something.

A final thing to suggest is experimentation with doses, but going lower rather than higher. Sometimes you can over shoot on meds so testing out what it is like on a lower dose can produce good results. Usually you will feel worse and this is good because it confirms you were heading towards the correct dose or were on it. If you feel better then this is a new discovery and shows you have been on a bit too much. Being irritable and moody might be a sign you are over medicated. It's tough to understand exactly where we are with the meds, so lowering can often give you some good answers. A reduction could be 12.5 to 25mcg per day for a few days and see how you respond.

[Zazbag in reply to marsaday]

Thanks for your post. You are the only person so far who has looked at my results and said that they think I am converting well... I've been told that my FT3 percentage through the range should be a bit below that of my FT4 when according to Medichecks I am overrange for FT4 and only two thirds through the range for FT3. I feel terrible.

I have always taken my T4 at night.

I was on 100 mcg until July, then put on 125 mcg but was still having symptoms and my FT3 was only 17% through range, so I asked for my dose to be increased to 150mcg, which I've been on for 6 or 7 weeks now. I think I have given levothyroxine my best shot but it doesn't seem to be working for me.

[Zazbag in reply to marsaday]

I'm not sure I want to play around with reproductive hormones, this is the first time I'm hearing anything about using progesterone to help with hypothyroidism. I understand that Cerazette is a progestogen-only pill, not sure if that means its effect is analogous to progesterone but when I took that for a few weeks last year I became suicidal in a matter of weeks. Horrible stuff.

[Zazbag in reply to marsaday]

I also tried evening primrose oil, which I believe increases progesterone as it contains GLA which is a precursor to it, and that also made me feel suicidal.

[DippyDame in reply to Zazbag]

In your position, and with your compromised conversion, I would be aiming to titrate T4/T3 combinations by, initially, slowly introducing T3 at a quarter tablet, you may not feel any difference to begin with but as you slowly raise T3 and reduce T4 you will eventualy find your optimal dose. You have already worked that out!

Each grain of Armour contains liothyronine (T3) 9mcg and levothyroxine (T4) 38mcg.

"Equivalence charts show that 1 grain of NDT (Armour) has the approximate equivalence of taking 100mcg of levothyroxine. Ensure that you discuss dosages with your clinician" (source TUK).

Do you think that fulfills your requirement?

I'm clearly not a medic but I feel there is more flexibility in titrating T4/T3....others may disagree.

Dosing is not an exact science because we are all different with differing needs and trial and error is often the way forward.....I was advised of this and it certainly proved to be so my case.

You need to test 6 weeks after each change to ensure you are not overmedicating......currently you are overmedicated on T4 ....above you quote FT4: 22.6 (106% through range) Ideally FT3 should sit around 75% through range for good thyroid health. Not 106%!

Basically you are suffering the consequences of low T3.....that, most likely the result of poor conversion. High FT4 with relatively low FT3.

It would be unwise at this stage to work on the assumption that "my cells are not taking up the FT3 that's in my blood". I would contend that there just isn't enough T3 in your serum and that, consequently, the T3 receptors are struggling to transfer an adequate supply into the tissues. Different issue.

The only way to overcome a type of RTH is with a supraphysiological dose of T3....for example I need 200mcg! It is a very complex condition.

The cells/tissues need a constant and optimal supply of T3 to ensure good health....there are trillions of them in the body so they are "hungry"!

Important to have optimal nutrients!

Currently you need to examine the consequences of poor conversion and subsequent low FT3....and to resolve that.. I've been there and eventually discovered RTH.......I don't wish to contradict your endo but I'm afraid time and experience does not support her suggestion of a form of RTH? Just low T3!

Your FT4 is not looking "good" you are overmedicated and that will generate rT3 which ( briefly) will be metabolised and excreted

thyroidpatients.ca/2019/11/...

Info re the Dio2 genetic test, a positive result sometimes persuades medics to prescribe T3. I tested Dio2/ homozygous causing increasingly poor conversion

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

I sense your frustration and anger in your writing, typical symptoms of hypothyroidism. Symptoms will improve once you are properly medicated......many of us have experienced this so you are not alone here. I found that this forum gave me the encouragement and confidence to tackle my own serious situation....worth any number of clueless medics!.

We are all here to help and share our thyroid journeys.....

Keep us posted please

Rant over...

DD