Hello,
Can anybody help. I had private thyroid tests two weeks ago and didn’t realise this at first. Before I started Levothyroxine treatment my t3 was 4.6 and now it’s at 3.6. (Range starts at 3.1). Also, my TSH has gone from 5.2 to 1. ( top of the range 4.2)My T4 started at 11 and has been at 16 range (11-22)for the last three test results.
Does this mean I’m not converting T4 to t3?
Can anybody advise me on what is happening and what I should do next please
Many thanks
How much levothyroxine are you currently taking
How long on that dose
Are you male or female
Results from previous post
Active b12 59 pmol/l. (118-701)
Ferritin 40 ug/l (30-370)
Folate 45 nmol/l (6.8-29.5 or 4.5-45.3)
TSH 1.06 (0.27-4.2)
Ft4 16.5 pmol/l (12-22)
Ft3 3.6 pmol/l (3.1-6.8)
Tpoab 6 KIU/l (0-34)
T4 98 nmol/l (57-148)
TgAB 13.3 KU/l (0-115)
Vit D 125 nmol/l (50-200)
What vitamin supplements are you currently taking
Was test done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test
Do you always get same brand levothyroxine at each prescription
Ft4 is only 45% through range
Ft3 only 14% through range
Helpful calculator for working out percentage through range
I’m on 50. Split dose 25 am 25 pm. I’ve been on Levothyroxine three years and was started at 25 but put up when TSH went over 5.I’m female. Always tested at 8.30 am.
I was tested for vit d about 12 years ago and I was diagnosed with osteomalacia and my bone scan showed osteopenia/ osteoporosis. I was given 2 vit d tablets a day. My rheumatologist was testing in 2016 and was worried about my opposite shaped ( concave or convex!) red blood cells that were immature- either being produced like that or being killed off early. He prescribed daily 5 mg folate tablet. . I take my Levothyroxine at 9 am and at 9 pm with lots of water.
I don’t understand why I’m being consistent with everything but my thyroid levels are all over the place. Can you help??
Day before test you need to change how you take Levo so that last full 50mcg is 24 hours before test
50mcg is only a starter dose so it’s hardly surprising you’re under medicated
guidelines on dose levothyroxine by weight
How much do you weigh in kilo approx
Even if we frequently don’t start on full replacement dose, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near full replacement dose
NICE guidelines on full replacement dose
nice.org.uk/guidance/ng145/...
1.3.6
Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.
Also here
cks.nice.org.uk/topics/hypo...
gp-update.co.uk/Latest-Upda...
Traditionally we have tended to start patients on a low dose of levothyroxine and titrate it up over a period of months. RCT evidence suggests that for the majority of patients this is not necessary and may waste resources.
For patients aged >60y or with ischaemic heart disease, start levothyroxine at 25–50μg daily and titrate up every 3 to 6 weeks as tolerated.
For ALL other patients start at full replacement dose. For most this will equate to 1.6 μg/kg/day (approximately 100μg for a 60kg woman and 125μg for a 75kg man).
If you are starting treatment for subclinical hypothyroidism, this article advises starting at a dose close to the full treatment dose on the basis that it is difficult to assess symptom response unless a therapeutic dose has been trialled.
BMJ also clear on dose required
bestpractice.bmj.com/topics...
Guidelines are just that ....guidelines.
Some people need more …..some less
healthunlocked.com/thyroidu...
LOW FT3 can be cause of osteoporosis
Aiming for Ft3 roughly 60% through range
Osteoporosis
thyroidpatients.ca/2018/07/...
I was 42 kilos when I started Levothyroxine so I was about right on 50. But last year I’ve been putting on lots of weight( cellulite really) which I am annoyed about and don’t understand. I always take 50 ( double dose) in the morning before and don’t take again until after blood test as per instructions on this site. As I say I don’t mess about with the time I take my tablets as I really need them and my body will become hyper and I’ll rapidly feel ill if I don’t take them by 9 pm.
Why is my TSH responding by coming down but my t3 is low? I thought it worked that If thyroid hormones were low TSH would increase.
It’s interesting that low t3 is associated with osteoporosis. Im going to read that article now. Ps im 60 this year! Thanks 😊
Vast numbers of patients on just levothyroxine end up with low Ft3.
It’s not how the body works naturally
In a fully functioning thyroid we would make 80% Ft4 and 20% Ft3
In order to get thigh enough ft3 it’s frequently necessary to have Ft4 right at top or above top of range
Conversion of Ft4 to Ft3 gets worse as we age and after menopause
All four vitamins need to be optimal
42 kilo = 67mcg levothyroxine per day according to guidelines
Thanks for your advice. The article was informative too. I think I need to pass on these latest test results to my endocrinologist. One last thing… I sent my hair samples to ‘ check my health’ for analysis group because I feel so awful. It came back that I’m allergic to gluten and some gluten free, all dairy, herbs and spices, nuts etc it also revealed I don’t have any good gut bacteria and I have low amylase, peptin and lipase. Could my digestive problems and lack of absorption and / or conversion be causing problems too???
Low stomach when hypothyroid acid leads to low nutrient absorption and low vitamin levels as direct result
About 86% of autoimmune thyroid patients are gluten intolerant
Personally I think it’s ALWAYS Worth trying strictly gluten free diet
Ideally get coeliac blood test done first
I had zero gut symptoms….endoscopy revealed extremely gluten intolerant
Hair analysis…..rather alternative….
Suggest you trial strictly gluten free
Then some months later might consider trialing lactose or dairy free (much harder in my opinion)
Yes I think coeliac test is needed. Do I get that done privately? Also, I meant to ask ‘ do doctors accept private blood test results’?? It’s a real shame that they don’t completely check all enzymes, hormones and vitamins altogether when a patient says they are not functioning correctly. Instead they test in an illogical way over years and years! My endocrinologist is going to test for oestradoil , FH and LH this week. I’ve no idea why??? Do you??
No…especially as you have such low Ft3 and on such small dose levothyroxine
But vast majority of endocrinologists are completely uneducated into importance of GOOD Ft3
Ft4 is too low, showing you have room for dose increase in levothyroxine first
You might eventually need addition of small doses T3 prescribed alongside levothyroxine
Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,
"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.
In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l.
Most patients will feel well in that circumstance.
But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.
This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."
(That’s Ft3 at 58% minimum through range)
You can obtain a copy of the articles from Thyroid UK email print it and highlight question 6 to show your doctor
please email Dionne at
tukadmin@thyroiduk.org
I only made progress after joining this forum ….more on my profile
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