I started seeing a consultant endo with the intent of adding T3 to my T4 (Synthroid) dosage. I’m not sure why but it has been several months now with FT3 on the low end of the range and she has yet to add it citing that although they’re not optimal they’re ok. I am tired of waiting and now she wants to go another 2mo before checking labs again with no changes to medications...I’ve read in other forums that optimally FT3 should be in the top 3/4 of the range and FT4 should be in the top 1/2 of the range.
Is it ok not to be “optimal” for trying to conceive purposes?
What medication/dosages have worked well for you in similar scenarios to try to raise both FT3/FT4?
TSH: 0.42, Range: 0.27 - 4.2 uU/mL
FT4: 16, Range: 11 - 26 pmol/L
FT3: 4, Range: 3.9 - 6.8 pmol/L
I’m on 88mcg Synthroid 6 days/wk, 75mcg 1 day/wk. Still fighting for RT3 and TgAb but TPOAb/Vit D/Mg/Zn/cortisol/Ferritin/iron are good.
In the past increasing Synthroid only dropped my TSH but barely had an impact on FT3/FT4
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she has yet to add it citing that although they’re not optimal they’re ok.
So, according to her, it's OK to be sub-optimal? I wonder if she would think the same if they were her results!
I’ve read in other forums that optimally FT3 should be in the top 3/4 of the range and FT4 should be in the top 1/2 of the range.
Normally, it would be the other way around. It's rare on T4 only to find the FT3 higher than the FT4, in their respective ranges.
Having said that, optimal is not a number, it's how you feel. If you don't feel optimal, then you aren't, no matter what your numbers.
FT4: 16, Range: 11 - 26 pmol/L 33.33%
FT3: 4, Range: 3.9 - 6.8 pmol/L 6.45%
You are very under-medicated!!! They should both be at least over 50%. I don't know how you're managing to survive with that low FT3.
Not surprising, of course. Your dose is rediculously small. Why the 75 one day week, for goodness sake? Even 75 every day wouldn't be enough. If I were you, I would be putting my foot down for an increase in Synthroid NOW. Your doctor has no idea what she's doing.
No point in testing rT3. It won't give you any useful information. It will tell you if your FT3 is high, but it won't tell you why, nor what to do about it. And, there are many, many reasons for over-range rT3, only one of which is due to thyroid. And, seeing your FT4 level, it's not likely to be affecting your rT3. Limit your battles to what is useful and forget about the rT3.
This is through a consultant endo. I am happy to consider any suggestions of doctors who will work remotely, is ok with a suppressed TSH, and most importantly cares about optimal.
I agree with grey goose you are very under medicated. Your doctor hasnt a clue to be honest. I would go to another one. Greygoose has given you some excellant advice.
There is no point adding in T3 until your T4 is high enough up the range to be fully utilised.
Your T4 needs to be in the top quadrant of the range and also your ferritin, folate, B12 and vitamin D all need to be optimal.
I don't know what constitutes " good " - what actual results do you have ?
If then, you are still with symptoms of hypothyroidism and your conversion of T4 into T3 compromised this is when you may benefit from T3 thyroid hormone replacement.
Your results are so low, I don't understand what this specialist is trying to do :
Your T4 is at around 33% - most people need this to be around double this result :
Your T3 is just 1 point above the bottom of a range of 29 points ;
As you slowly increase your T4 up the range it likely will convert into T3 and bring this very low number up it's own range and hopefully then, your symptoms will be relieved.
It is low T3 that causes the symptoms of hypothyroidism and the first step is to build up your T4 to an acceptable level and also optimise your vitamins and minerals to support your core strength and wellness.
Once you have achieved all these building blocks, if your T3 is still proportionately low and conversion compromised adding in a little may well be considered , but there is a way to go yet, in building up your T4 thyroid hormone replacement.
I very much doubt RT3 is anything of concern, as this is generally caused by excess T4 which I don't see as your issue - and even if it was, we all have some RT3 , it's a natural process and the body's own way of regulating surplus T4 and it is generally excreted out the body
For me, my t3 was always low when I took synthroid , I was always feeling out of control and the brain fogs were bad. I am now taking Armour Thyroid, but still have low energy. most of my side effect are gone.
In regards to your comment "There is no point adding in T3 until your T4 is high enough up the range to be fully utilised"; I'm assuming you meant FT4 to TT4. Where my FT4 is now is resulting in a low TSH and my endo doesn't want me to go below the low end on TSH; so I can't raise my FT4 any more than it already is.
Do you have any studies to share to help me convince her that it is ok to suppress the TSH? Or perhaps a suggestion of a doctor who will ignore TSH in favour of optimal FT4/FT3?
More recent labs:
TSH: 0.26, Range: 0.27 - 4.2 uU/mL
FT4: 17, Range: 11 - 26 pmol/L
FT3: 3.7, Range: 3.9 - 6.8 pmol/L
My ferritin, folate, B12 and vitamin D are all optimal.
No, I'm sorry I have no " official " studies on TSH suppression and yes I meant FT4 ;
As you said in your opening :- Increasing Synthroid only drops your TSH with very little impact on T3/T4 :
I just wonder if there is an absorption issue and maybe a liquid T4 medication maybe the answer.
What I so know is that the TSH was originally introduced as a diagnostic tool to help identify a person suffering with hypothyroidism and that it was never intended to be used as a measure of anything once the patient was on any form of thyroid hormone replacement, as then, it's the T3 and T4 that you need to be dosed and monitored on.
I wonder if another doctor might not be so TSH obsessed ?
I am self medicating as I have been refused both T3 and NDT through my surgery and hospital so now I buy my own full spectrum thyroid hormone replacement, organise my own yearly blood tests and look after myself and am much improved.
I'm with Graves Disease and post RAI thyroid ablation and now managing lingering Graves, thyroid eye disease caused by the RAI, and hypothyroidism and my TSH needs to be down at 0,01 for me to be well.
I have given up on a health care system that seemed intent on making me more ill than I ever was.
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