I have lupus, anaemia, plus various gastrointestinal problems such as acid reflux, hiatus hernia, diverticulitis and now H pylori. Recently, I began to suspect that at least some of my symptoms may well be indicative of hypothyroidism and due to a lack of support from endo and a refusal to see me (although they are now unwillingly dealing with me) I commenced taking T3 and T4 off my own bat two months ago in January 2021. Initially, I had a good effect from the T3 and T4, but it quickly tailed off and I have now stopped taking it. I feel that my gut issues are preventing me from absorbing various nutrients properly, hence my anaemia and the negligible effect from T3 and T4. Over the past 5 years my GP and others have prescribed numerous course of oral iron, which only serve to lift my iron levels to within the normal range, but it never exactly goes through the roof and the moment the course finishes my iron always drifts down again. My gastroenterologist is now arranging for me to have intravenous iron. I have not had this treatment before and am hoping for a positive effect.
My question is about my T3 and T4 levels. Before I started taking the T3 and T4 my TSH was 2.5 and my T4 was 11.5. T3 had never been tested. I began to take T3 in January and T4. I was taking 25mcg T3 daily and 200 mcg of T4, yet when my bloods were taken by my gastroenterologist a few days ago my TSH was 0.03. My T4 was 14.6 and was T3 is 1.9.
Clearly my TSH is now suppressed but I find it surprising that neither my T3, nor my T4 are high, despite the high doses I was taking. I think this is evidence of my malabsorbtion issues. Essentially I think I was absorbing a small amount of the thyroid hormones, but not enough to raise my T3 and T4 to above normal levels.
Do others agree with this assessment.
Written by
Ophelia1
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I’m sorry to read your post and all the issues you’re having 🥺 I’m afraid I really don’t have anything constructive to add and are hoping that the others will as this issue confuses me. I will be interesting to read your replies.
I am of the opinion that as your tsh is suppressed then you are surely absorbing something. You do, however, need to put the reference ranges down for your t3 and t4 so that the clever bids will be able to see just how low they are.
Good luck with your iron infusion. I do so hope it helps you feel a bit better x.
were you still taking the T4 and T3 on the day of the blood test, and if so how long before test were last doses of T4 and T3 ?
Clearly you were absorbing some, as reflected in TSH becoming so low .
And also probably fT4 being higher than previous, but that 's no so clear cut , as fT4 result will be influenced by time of last dose . and is thus harder to compare to previous result without Levo.
the balancing effect of TSH dropping will have caused less of your own thyroidal T4 /T3 to be produced.
So maybe it's just that you added a lot of T4 orally which caused you to make less of your own T4 and the result is only looking like a small overall increase in fT4 ?
We don't know what it did to T3 without a starting point
It’s almost ALWAYS necessary to increase dose levothyroxine SLOWLY Upwards until on, or near full replacement dose
BEFORE considering adding T3
Standard starter dose of levothyroxine is 50mcg
Retest thyroid levels 6-8 weeks after each dose increase
Increase dose slowly upwards in 25mcg steps until Ft4 is in top third of range .....hopefully Ft3 is then roughly 60% through range
Extremely important to regularly retest vitamin D, folate, ferritin and and B12
We need optimal vitamin levels for good conversion of Ft4 to Ft3
IBS and gut issues are frequently linked to low stomach acid and often gluten intolerance
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
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 third or 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 did your tests?
Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins
If TPO or TG thyroid antibodies are high this is usually due to Hashimoto’s (commonly known in UK as autoimmune thyroid disease).
About 90% of all primary hypothyroidism in Uk is due to Hashimoto’s. Low vitamin levels are particularly common with Hashimoto’s. Gluten intolerance is often a hidden issue to.
Over the past 5 years my GP and others have prescribed numerous course of oral iron, which only serve to lift my iron levels to within the normal range, but it never exactly goes through the roof and the moment the course finishes my iron always drifts down again. My gastroenterologist is now arranging for me to have intravenous iron. I have not had this treatment before and am hoping for a positive effect.
The solution to your problem with iron should be obvious to any doctor. The fact that taking a course of oral iron raises your levels is good - it shows that you are absorbing it, even if you don't absorb it well.
You need to carry on taking iron until your levels are optimal, not just creeping into the range. And once your levels are as close to optimal as possible you need to find out how to maintain them.
To use myself as an example, I had catastrophically low iron and bottom of the range ferritin several years ago. I was given a prescription for two or three months worth of ferrous fumarate 210mg at maximum dose. I had a sneaky suspicion that I wouldn't get another prescription after the first one was finished.
I found out, purely by accident, that in the UK people can buy prescription-strength iron supplements in pharmacies without a prescription but with the pharmacist's permission.
It changed my life! I also found out how to pay for private testing with a finger-prick sample. So, I started looking after my own iron and ferritin treatment, and I've been doing it now for nearly 8 years. To get my ferritin up to optimal took 21 months of supplementing iron at maximum dose. I really do not absorb iron well at all, but I got there in the end. My serum iron was still low, but I had gone as far as I was prepared to go, and I started looking for my maintenance dose of iron to keep my ferritin as close to optimal as possible. It took a long time to find the right dose for me, and I still check it every few months. But it has been so worth it for me.
If you are losing iron faster than you are taking it in, you will become iron-deficient.
It is just a matter of time. Weeks? Months? Years?
If you change from having adequate iron - whether achieved by diet, supplements or infusions - to inadequate iron, you are obviously not taking in sufficient.
Provided you have no serious iron loss (e.g. internal bleeding), then you must increase the amount of iron you absorb - probably permanently.
A bit like a car which has an oil leak. If it is not catastrophic, you can usually manage by topping up every day. Maybe only a tiny bit. But leaving it until the warning light comes on is not a good idea.
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changing from t4 to t4/t3
T4 levels in relation to T3 dose
Increase Conversion of T4 to T3
Trying to balancing T3 and T4 
test results - on T3 and T4
