T3 or not to t3

[Sleepyachy]

Hi , how come the doctors dont give t3? Confused ?

I dont even no if I need t3 ?

[SeasideSusie Remembering]

Sleepyachy

how come the doctors dont give t3?

Because their training in thyroid disease is so poor that they have no understanding of the importance of T3. Also T3 is very expensive and they don't want to pay for it.

I dont even no if I need t3

This is because FT3 is not routinely tested. If FT3 is tested alongside FT4 and TSH we can see how well we convert T4 to T3. If our conversion is poor then we may benefit from the addition of T3. But lack of testing and lack of understanding about T3 by doctors means that unless we take things into our own hands we don't know if we need T3.

[tattybogle]

How come doctors don't giveT3 ?That's a big question with a long answer , but ....Simple answer ...., in UK they are not allowed to start someone on it .

They are only allowed to continue a prescription that has been started by an NHS Endocrinologist who has decided that there is a need for it in that patient . And even then they will do their best to get out of doing so because the NHS currently pays a fortune for it.

I don't even know if i need T3

Until you have been on a high enough dose of Levothyroxine to get your TSH lower than it is , and your fT4 higher than it is, you can't tell if you need it or not.

It might be that with a higher dose of T4 (Levo ) you would be getting enough T3 from it to make you feel better, and if that's the case , there is no need to go to the trouble and expense of adding T3.

The way to tell if you have a problem converting T4 into T3 is to take the highest dose of Levo allowed by the ranges in the blood tests and then test both fT4 and fT3 on that dose, and you can then see how much T3 you've got. If fT3 is still low , then you can try and get an endocrinologist to agree to try adding some T3.

But you cant tell how much T3 you can get from T4 while you are still not taking enough T4.

"16th dec, bloodtest

fT4 16.1 [11.0 26.0]

Tsh level 1.80 [0.27 _4.2]"

"Well got my results . In range .

18.5 t4

1.6 tsh .

Thyroid antibodies mildly elevated.

So i am stopping on 100 Levo for now."

Your old posts and most recent TSH/fT4 tests give a picture of someone who might benefit from trying a slightly higher dose of Levo to improve how you feel.

You fT4 is only around a third of the way into the range , many people need it nearer the top to feel better . And there is plenty of room to lower your TSH before it gets anywhere near the bottom of the [0.27-4.2 ] range.

According to your last TSH of 1.6 there's room to increase dose by 25mcg (or at least 12.5mcg if GP is super cautious) and see what happens to how you feel and to your TSH/fT4.

Given your current level of problems i think it would be perfectly reasonable for your GP to allow a trial of a slightly higher dose for a while. There are no increased health risks associated with Low TSH until it goes down to less than 0.04 , the 'risks' for TSH 0.04 to 0.4 are the same as the 'risks' of TSH that is still within range.

I can find you a paper with evidence for this if it will help you talk to your Doctor.

[SlowDragon Administrator]

How long since your last dose increase in levothyroxine

Do you always get same brand of levothyroxine

What vitamin supplements are you currently taking

As you have Hashimoto’s low vitamin levels are extremely likely unless supplement regularly

If been on current dose levothyroxine at least 8 weeks it’s time to get bloods retested

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)

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 antibodies and vitamins

medichecks.com/products/adv...

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 down to £26.10 if go on thyroid uk for code

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

monitormyhealth.org.uk/

NHS easy postal kit vitamin D test £29 via

vitamindtest.org.uk

The aim of levothyroxine is to increase dose upwards in 25mcg steps until TSH is ALWAYS under 2

When adequately treated, TSH will often be well BELOW one.

Most important results are ALWAYS Ft3 followed by Ft4. When adequately treated Ft4 is usually in top third of range and Ft3 at least 60% through range (regardless of how low TSH is)

Extremely important to have optimal vitamin levels too as this helps reduce symptoms and improve how levothyroxine works

If GP only tests TSH and Ft4.....if Ft4 is under 60% through range and/or TSH over 2 you are ready for next 25mcg dose increase in levothyroxine

Come back with new post once you get results

[SlowDragon Administrator]

If you are not on strictly gluten free diet.....likely to benefit from trialing it

But get coeliac blood test done BEFORE cutting gluten out