I recently added 7.5mcg of daily T3 to 37.5mcg of daily T4, around two weeks ago now. I know that T3 tends to act more quickly than T4, and both desperate for some relief and also intrigued to understand what's going on in my body, I took another blood test via Medichecks.
Here's the before and after results:
BEFORE:
TSH - 3.1 [0.27 - 4.2]
FT4 - 18.5 [12 - 22]
FT3 - 4.8 [3.1 - 6.8]
--
AFTER:
TSH - 2.51 [0.27 - 4.2]
FT4 - 19.5 [12 - 22]
FT3 - 5.38 [3.1 - 6.8]
--
Now, to my very untrained eye, everything there appears to have got slightly better. According to my endocrinologist, where we want to get to is an FT3 of between 5.5 and 6.0, and a TSH of 1 or below.
I'm not feeling any relief from symptoms at this time, but should I take this as a positive signal that things are moving in the right direction? Would you expect to see these numbers, and potentially an improvement in symptoms, without an increase in dosage?
Just feeling slightly desperate and want the anguish of the last three or four years to end.
Thanks
Jonny
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JonnyA
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2 weeks is too soon to tell. Yes t3 works more quickly as you say but its effects take longer to happen. For example taking t3 generally leads to a reduction in ft4 and in TSH. However these elements are slower in settling. So until you have been on a dose for at least 6 to 8 weeks you won't know how things will settle.Things have to be done slowly in the thyroid world.
I would keep going with your current regimen. It’s going in the right direction. T3 liothyronine does act far more quickly than Levothyroxine T4 but I’d give it at least 3 months to get a fuller picture of your blood tests but also how you will be feeling too. Have you checked your vitamins recently B12, D, folate and ferritin? These all need to be optimal not scraping in at the bottom of normal in the ranges. I’m a very poor converter I could only convert 8% of Levothyroxine to T3 when on Levothyroxine alone. I did the DIO2 gene test through Regenerus Laboratories also and that came back positive. I had an immediate positive response when I started T3 as I was in a bad way. Looking back though it did take a few months to feel well and normal again. I’ve been on T3 now for 2 years and oh boy it’s made a huge difference to my life. Keep it going it’s still early days.
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).
Day before test split dose of T3 into 2 taking half daily dose approx 8-12 hours before test
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
Is this how you do your tests?
Your Ft4 is high for such a low dose levothyroxine
When were vitamin D, folate, ferritin and B12 last tested
Yes, this is exactly how I take my tests (usually about 8am). I haven't however tested my vitamin D, folate etc. for a little while so maybe that's worth doing.
Re: FT4 being high, in fairness it's never been exceptionally low, which I think is why I haven't been put on a more serious dose of levo. My TSH was elevated about 6, with a sub-par FT3. Technically, I was sub-clinical but with a pretty debilitating level of symptoms that were gradually getting worse over time. Not sure why. Life's been pretty grim though, I know that much.
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
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.
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.
I find it all a little confusing to be honest. Most confusing is that despite my bloods looking better, I feel exactly the same - which is pretty dreadful.
I’m just impatient, I know that. I just want to feel (and look) better - I just have no idea how far I am away from that.
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