Should I switch to T3 only?

[lornyy83]

Hello dear people I need a help. I was diagnosed with hashimoto 3 years ago. I started first to treat the condition only with t4 but I didn't saw any improvement. I was fatigued, gained a lot of weight, hair loss so I find a doctor who is treating the condition with t3 also I was a little better my blood results were in the normal range. After a year on this combo my blood results got worse. My TSH is 0.19 ft4 -9.8 and ft3 - 3.2. My metabolism is slow, I can gain weight so easily my hair is falling. I was thinking to switch on t3 only. My current dose of t4 is 50mcg with t3 25mcg. Is it a good idea to switch to t3 only. 50mcg, 25mcg in the morning and 25mch afternoon? Any advice would be appreciated

[SeasideSusie Remembering]

lornyy83

My TSH is 0.19 ft4 -9.8 and ft3 - 3.2

Unfortunately, without the reference ranges for your tests - in particular FT4 and FT3, we can't interpret the results and offer any informed suggestions.

Please add the results, if you don't have them ask for a print out of your test results from the receptionist at your surgery, they will be on there. Don't accept verbal or hand written results, mistakes can be made, it should only be a print out.

[lornyy83 in reply to SeasideSusie]

Reference for t3 is from 3.2-5.9 and my ft3 result is 3.2. Reference for ft4 9.0-19.1 and my result is 9.8 and TSH reference 0.35-4.94 and my result is 0.19. Thanks for your help

[SlowDragon Administrator]

More likely you just need dose increase in levothyroxine

That’s very small dose of levothyroxine

Please add ranges on results

Typically many people find they need BOTH Ft4 and Ft3 at good levels

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also EXTREMELY important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially if you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies

Do you have Hashimoto’s?

Ask GP to test vitamin levels

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)

If/when also on T3, make sure to take last quarter of daily dose 8-12 hours prior to test, even if this means adjusting time or splitting of dose day before test

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...

Do you normally split your T3 into 2 or 3 smaller doses

If 2 doses at roughly 12 hour intervals

If 3 doses at roughly 8 hour intervals

Essential all four vitamins are at GOOD levels too

[lornyy83 in reply to SlowDragon]

Thank you for your reply. Yes I have a hashimoto. And I'm doing my lab tests as you described.. I don't take my pills the morning before I do my lab tests. I'm trying to attach my lab tests but I cannot see the button for attachments 😕

[SeasideSusie Remembering in reply to lornyy83]

lornyy 83

You can only attach pictures to the opening post of a thread. I have linked your other thread to this one so that all replies will be kept here to avoid confusion.

TSH: 0.19 (0.35-4.94)

FT4: 9.8 (9-19.1)

When taking T3, as you are, it is absolutely essential to test FT3, otherwise how do you know if you are taking enough or too much?

My current dose of t4 is 50mcg with t3 25mcg.

When on combination hormone replacement, some of us are fine with a low FT4, some of us need it much higher in range. I am on Levo plus T3 and I need both FT4 and FT3 in the upper part of the range, balanced at around 70% is good for me.

It's possible that you aren't taking enough T4 and you may be better with a higher FT4 level and my suggestion would be to increase your Levo first, either 12.5mcg or 25mcg, then retest in 6-8 weeks and reassess, and make sure that your test includes TSH, FT4 and FT3. Once you have done that come back with new test results/ranges for further comment.

Also, get those vitamins tested as SlowDragon has mentioned, vitally important to have optimal levels when on T3 and for any thyroid hormone to work properly.

[SeasideSusie Remembering in reply to SeasideSusie]

lornyy83

You have added your FT3 result since I replied above.

Your FT3 result is at the bottom of the range, as is your FT4 result. I would still suggest increasing Levo first, this will have the effect of raising your FT4 level and depending on how much natural conversion you have your FT3 level should rise as well.

FT3 should be tested at the same time, from the same blood draw, as TSH and FT4. Was this done or was FT3 tested separately as it's not on your print out.

[lornyy83 in reply to SeasideSusie]

The ft3 was tested couple of days after since the lab where I've done my tsh and ft4 done don't do ft3. I'm afraid that my body doesn't convert ft4 into ft3 but in reverse t3.. I've done some research and I have all the symptoms of reverse t3. Also I remember when I was only on t4 my ft4 levels were ok but my ft3 levels were way to below. Also I'm taking on daily basis d3- 5000iu, selenium-200mcg. I will do my vitamin test as you advice. Thank you once again

[SlowDragon Administrator in reply to lornyy83]

What is the highest dose of levothyroxine you have ever taken?

Typically we need somewhere around 1.6mcg levothyroxine per kilo of your weight. So unless very petite, that’s likely to be over 100mcg levothyroxine per day. Aiming to get Ft4 in top third of range

Often we still have low Ft3 on just levothyroxine.

First step is to get all four vitamins optimal as this improves conversion of Ft4 to Ft3

If, once all vitamins are at good levels, with Hashimoto’s then trial strictly gluten free diet, sometimes dairy free too

If Ft3 still remains low, then adding small doses of T3 alongside levothyroxine. Sometimes levothyroxine dose is reduced by 25mcg when adding T3.....but that depends where Ft4 result is within range, before T3 is added. Typically starting on 5mcg (1/4 tablet) T3, then adding 2nd 5mcg dose T3 2-3 weeks later.

[lornyy83 in reply to SeasideSusie]

Thank you. I will try to increase my T4 as you advice. I've done my ft3 also but I couldn't attach 2 photos. My ft3 is 3.2 and the reference for t3 is 3.2-5.9

[SlowDragon Administrator in reply to lornyy83]

Do you normally split your T3 ?

2 or 3 doses per day

[lornyy83 in reply to SlowDragon]

Reference for t3 is from 3.2-5.9 and my ft3 result is 3.2. Reference for ft4 9.0-19.1 and my result is 9.8 and TSH reference 0.35-4.94 and my result is 0.19. What is your advice should I switch to T3 only?

[SlowDragon Administrator in reply to lornyy83]

No, very few people need to be on just T3

Essential to test TSH, Ft4 and Ft3 together in same test

As SeasideSusie suggested, I would increase levothyroxine by 25mcg and retest in 6-8 weeks. You should see both Ft4 and Ft3 rise

Meanwhile get vitamins tested too

What vitamin supplements are you currently taking?

Hashimoto's frequently affects the gut and leads to low stomach acid and then low vitamin levels

Low vitamin levels affect Thyroid hormone working

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common.

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps, sometimes significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

While still eating high gluten diet ask GP for coeliac blood test first or buy test online for under £20, just to rule it out first

healthcheckshop.co.uk/store...?

Assuming test is negative you can immediately go on strictly gluten free diet

(If test is positive you will need to remain on high gluten diet until endoscopy, maximum 6 weeks wait officially)

Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse

chriskresser.com/the-gluten...

amymyersmd.com/2018/04/3-re...

thyroidpharmacist.com/artic...

drknews.com/changing-your-d...

restartmed.com/hashimotos-g...

Non Coeliac Gluten sensitivity (NCGS) and autoimmune disease

ncbi.nlm.nih.gov/pubmed/296...

The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported

ncbi.nlm.nih.gov/pubmed/300...

The obtained results suggest that the gluten-free diet may bring clinical benefits to women with autoimmune thyroid disease

nuclmed.gr/wp/wp-content/up...

In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned

restartmed.com/hashimotos-g...

Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.

[Marz]

Having good levels of B12 - Folate - Ferritin - VitD - could help your conversion of T4 into T3 ... B12 around 500 - Folate and Ferritin mid-range - VitD 100 + are considered good results.

[DippyDame]

On 50mcg levo and FT4 sitting at the bottom of the range you are badly undermedicated

Your FT4 result 9.8 (9 -19.1) is only7.92% through the reference range

Your FT3 result 3.2(3.2 - 5.9) is 0%....

For good health both results should be approaching 75% through their respective ranges

You can see therefore, why you feel unwell and are undermedicated.

You refer to Reverse T3 andmay find this of use It is not a reading I would focus on....

thyroidpatients.ca/2018/07/...

Also from Verywell health -

"The take-home message is that the precise meaning and significance of rT3 are still being teased out. At the current time, there are no standardized guidelines with respect to interpretation or treatment planning based on rT3 alone. However, TSH, T4, free T4, T3, and free T3 levels are adequate indicators of your thyroid disease severity and management."

You say you do not convert well but with such a low FT4 there is only a limited amount of T4 that might be converted so it may not be poor conversion... just low T4.

On what basis did you conclude that your conversion is poor.....this is evidenced by high in range FT4 with low in range FT3 - and your results do not suggest this.

Have you had the Dio2 genetic test which can reveal a polymorphism which impairs conversion? Impaired to a small degree if inherited from one parent but more so if from both parents. My positive result was homozygous/both parents.

You need to increase your levothyroxine otherwise your condition will not improve....your symptoms are typical of undermedication. 50mcg is just a starter dose, I suggest that you need to add another 50mcg....and so on as follows.

Test again 6 weeks after the increase, depending on the result I suspect you will need a further increase (even more)

At this stage I don't think you need to add any T3....and I speak as someone who needs a large dose of T3- only! But if you feel you must add T3 then continue with 25mcg added to 75mcg levo. It will take about 8 weeks for the body to adapt.

We are all different with different needs.

Hopefully as your FT4 rises your FT3 will start to rise too.....time will tell! You can adjust your dose if/as required after each test

Your suggestion that you might move from 50mcg T4 + 25mcg T3 to 50mcg T3-only would be far to big a change. T3 is the more powerful hormone.

Unless you are absolutely confident that your body can cope with T3 only then stick with a single or combo dose....T3 only has been described as "the last resort" and you don't appear to be a anywhere close to needing that.

I'm not a medic just another member who has had a long, bumpy, journey of discovery to recovery on T3- only!

Best...

DD

[lornyy83 in reply to DippyDame]

Dear thank you for putting an effort to explain everything. Make sense everything what you have mentioned above. I will take your advice, I got the the same advice from others on this post to increase my t4 for 25mcg. I will continue with 25mcg t3 since I feel much better since I started taking it. I was always tired on t4 only even when I increased my dose. So 75mcg of t4 with 25mcg of t3. I will check my lab tests after. Thank you very much you helped a lot ❤

[DippyDame in reply to lornyy83]

Good luck....keep us posted and come back with any questions you might have.

[lornyy83 in reply to DippyDame]

Update.. it's been past 2 weeks since I added 25mcg of levothyroxine and my hair is shedding like crazy. Any advice? Thank you

[DippyDame in reply to lornyy83]

Unfortunately it takes much longer than two weeks to raise hormone levels to optimal and about 6/8 weeks for the body to adapt to a new dose/increaseYou should be retested in 6/8 weeks after an increase then your dose should be adjusted as required.

Sadly there is no quick fix......patience is the way forward and I understand how frustrating that can be. Been there!

[lornyy83]

Thank you, yes I will keep you posted. Good luck ❤