T3/T4 ratio

[Buttercupsareyellow]

I had my thyroid removed in 2008. I have been on various doses of Levothyroxine since but in order to feel well my TSH is always suppressed and T4 tends to be top end or above range (even up to 150% conversion), whilst my T3 has fluctuated between 2.7% and 59% conversion (usually hovering between 30-50%). I have had a yearly battle with GP who states I need to reduce (usually a different panicked GP each time) and we have the same conversation again.

I had major surgery in January which did seem to really upset things. I had diarrhoea for 3 weeks and my levels in April were:

TSH: 0.04 (0.27-4.2)

T4: 26.8 (12-22) 148%

T3: 4.3 (3.1-6.8) 32.4%

At that time I was on 175 dose x 2 per week and 200 x 5per week

After much back and forth to GP I have reduced my dose gradually over several months. Now on 175 x 5 per week and 150 x 2 per week (so effectively reduced my dose by 25)

My last results were:

TSH: 0.04

T4: 22 (12-22) 100%

T3: 5.3 (3.1-6.8) 59%

I have put on some weight during this time and had some intermittent bouts of constipation, very low mood, body aches and been generally very tired

I have an upcoming appointment with NHS endo (fingers crossed re them being open minded) and was wondering:

Best approach for presenting my case for a trial on T3 as this has consistently been low over the years

If they agree what are the rates you drop Levothyroxine per dose of T3 I don’t want a huge unhelpful reduction in Levothyroxine that is unnecessary

Thank you for any advice

[tattybogle]

Hi, look at 'diogenes' reply on this post. it may be helpful to your argument.

healthunlocked.com/thyroidu...

I'm in the same boat , and have to have the same argument frequently. Recent FT4 was 242% of range (FT3 not done on that occasion but usually about 30-50%) but a reduction of only 12.5mcg levo left me chronically constipated ,so dose has been put back up(after another argument!)

[Buttercupsareyellow in reply to tattybogle]

It’s frustrating isn’t it. Thank you for directing me to the other post.

[SlowDragon Administrator]

After any surgery it’s likely B12 levels drop

Important to regularly retest vitamin D, folate, ferritin and B12

We need optimal vitamin levels for good conversion of Ft4 to Ft3

What vitamin supplements are you currently taking?

[Buttercupsareyellow in reply to SlowDragon]

I take vitamins C and D.

[SlowDragon Administrator in reply to Buttercupsareyellow]

Always stick to one brand of levothyroxine

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)

Is this how you do your tests?

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 vitamins including folate (private blood draw required)

medichecks.com/products/thy...

Thriva Thyroid plus antibodies and vitamins By DIY fingerpick test

thriva.co/tests/thyroid-test

Thriva also offer just vitamin testing

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins and antibodies then 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...

Come back with new post once you get full results