How important is the TSH level and/or the T4 level if the T3 level is optimal?

[Axleg]

Hi I've not posted for a while as I've been trying different variations of T4 & T3. What I don't understand is what is more optional for me and why are the results so close despite different amounts of medication? How important for example is the TSH level and/or the T4 level if my T3 level is optimal?

Currently I'm on 75mg Thyroxine (T4) & 10mg Lavothyronie (T3) apron waking then 15mg T3 before bed, todays blood results were,

Serum TSH 0.19 mu/L 0.27 - 4.20 mu/L

Serum free T4 11.16 pmol/L 12.00 - 22.00 pmol/L

Serum fee T3 4.9 pmol/L 3.10 - 6.80 pmol/L

Previous Blood results as of 01st February 2021 - Dose then was 75mg T4 & 10mg

T3 am then 10mg T3 pm.

TSH – 0.23 mu/L

Free T4 – 11.10 pmol/L

Free T3 – 4.4 pmol/L

Results as of the 04th September 2020 - dose them was 100mg T4 & 10mg T3 am then 10mg T3 pm

TSH – 0.03 mu/L

Free T4 – 15 pmol/L

Free T3 – 4.6 pmol/L

My T3 seems consistent regardless of the dose, is this the most important part or can I improve in other areas and if so how?

Any pointed as always would be greatly appreciated.

Thanks

Alex

[fuchsia-pink]

If you're a patient, the most important results are your actual thyroid hormones - free T3 and free T4 - and how you feel. If you're a GP the most important thing is TSH and if this is "in range" but the patient doesn't feel great - at best that's an inconvenience ...

If you take lio, your TSH is inevitably suppressed and so become even less relevant. Many of us like nice and high free T4 and free T3 - your free T4 is below range and free T3 is less than half-way though - but if you feel tiptop that's the right dose for you

Have you tested key nutrients recently?

[Axleg in reply to fuchsia-pink]

Thanks for the reply, I've not tested on vitamins for a while but they have not been an issue before. I'm still not 100% in terms of energy, mood and brain fog/concentration so improvements can be made for sure. If I upped my T4 assuming that would likely increase my levels? however maybe going back to 100mg T4 was better, it's hard to remember sometimes..

[fuchsia-pink in reply to Axleg]

I'd def increase levo if you can - it was only 30% through range on 100 mcg - so still quite low. And higher free t4 should increase free T3, if only a little. Remember you are ONLY over-medicated if free T3 goes over-range - not if TSH becomes suppressed.

Good luck x

[SlowDragon Administrator]

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)

When on T3, day before test, split dose into three smaller doses roughly equal 8 hour intervals. Taking last dose T3 at roughly 8-12 hours 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 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

[Twitchen]

I alternate 100mcg and 75mcg thyroxine on alternate days together with 10mcg liothyronine daily. I am below range on FT4 result but okay on the TSH and FT3. Can't say I feel particularly wonderful, but okay.

[Axleg]

Thanks for the advice, it's always good to hear other cases, I look the book up.