I recently started taking a small dose (7.5mcg daily) of liothronine, and despite having been taking levothyroxine for four months it’s the first time I’ve seen my bloods move in significantly in a positive direction. Latest results are:
TSH - 2.51 [0.27 - 4.2]
FT4 - 19.5 [12 - 22]
FT3 - 5.38 [3.1 - 6.8]
Since taking T3 in combination with T4 both FT4 and FT3 have increased, and my TSH has decreased. I am yet to experience any symptomatic relief however.
Now, I understand the basic physiology behind the thyroid and pituitary etc. and vaguely what these numbers mean, however in trying to work out where I need to be to be ‘in the zone’ and when, in theory, I should expect to feel better in myself.
My understanding is that FT3 wants to be somewhere in the upper region of 5.5 and 6.0, but if for instance I got to there but still had a TSH north of 1.0, could that signal that my body needs an FT3 level that’s higher still?
Or does the introduction of extraneous T3 effectively make TSH an irrelevant barometer?
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JonnyA
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Never thought I’d say this here but WTAF? I had to read through your previous posts to get a clue at what’s going on here. I’m flabbergasted that a man (I don’t know what your stature is) was started on 25mcg, now on 37.5 and then started on T3 so soon after diagnosis. I’d love to find a doc who was as open to T3 as this one is but honestly, sounds like you’re the human Guinea pig here. No way would I start someone on T3 until you’d at least been on a man optimal amount if Levo AND given time for your system to adjust. Only then would you know if you had conversion problems.
I’m not a fan of TSH prescribing. Not at all. But some sort of protocol should have been followed. Ie start on a decent dose, you’re 36, male, and no underlying conditions. Are all your Vits/minerals optimal?
50mcg starting dose and increase by 25mcg every 6wks till optimal.
I was so ill, on my knees with sub clinical symptoms and had to wait for the rise in TSH, so personally I think treating by TSH numbers is barbaric but I’m not sure this gun ho way is any better? Especially as you’ve yet to feel any improvements.
High FT4 with low FT3 indicates poor T4 to T3 conversion.Firstly ensure vit D, vit B12, folate and ferritin are optimal in order to support thyroid function and conversion.
Only once nutrients are optimal should the addition of T3 be advised
The important reading then becomes FT3 which you should aim to keep in range
There is no specific dose etc to put you "in the zone", what is important is how you feel and right now on that basis your levo dose is inadequate!
HOWEVER, if you are only taking 37.5mcg levo then your dosing protocol is wrong, not surprising that you notice no improvement.
Adding 7.5mcg T3 after 4 months is far too soon.
Before introducing T3 you should have aimed for an optimal dose of Levo first. As things stand there is no way of knowing your conversion status therefore no indication that you need T3!
To estimate your possible T4 dose multiply your weight in kilos by 1.6 and the result in mcgs will give you an idea of your required dose...it certainly won't be 37.5mcg!!
You should have started on 50mcg levo then been tested after 6/8 weeks before adding another 25mcg, this pattern should be repeated until you feel well. There is no quick fix for thyroid disease, increases must be low and slow.
Following diagnosis TSH offers little as a dosing guide despite what medics think. FT4 and FT3 being the thyroid hormones are the important labs.
With the extremely few exceptions, none of us here are a medical professional and even then they are not ‘advising’ in that capacity. We’re all just patients with shared experiences. I can well understand your urgency, as a young man, you want answers. But I do want to say, slow down. ‘FT4 was ok’, should have been changed to ‘FT4 is optimal’ it was only 65% through range.
You’re testing too soon after each change.
In all honesty, the advise you’ve been given may be more damaging. I’d stop T3 for now. Get on a starter dose of Levo (50mcg) wait at least 2mths for things to settle, retest and reevaluate.
How is all this affecting your life? How long have you felt unwell?
despite having been taking levothyroxine for four months it’s the first time I’ve seen my bloods move in significantly in a positive direction.
Well, that's not surprising, is it. Four months is but the blink of an eye in thyroid terms - especially not long enough to know if you're a poor converter.
My understanding is that FT3 wants to be somewhere in the upper region of 5.5 and 6.0,
Your FT3 wants to be where you need it to make you well. Could be higher than that. Could even be over the top of the range. We're all different and shouldn't allow ourselves to be pigeon-holed like that, but keep increasing until we find our own personal sweet-spot.
Or does the introduction of extraneous T3 effectively make TSH an irrelevant barometer?
Not when it's that high it doesn't. That TSH suggests under-medication. But, you should have taken enough levo to get the TSH down to 1 or under before deciding that you were a poor converter.
Its classic stuff really - crippling fatigue, brain fog, anxiety, depression, weight gain, cold intolerance - if this was a game of Pokemon I’d be doing pretty well I think.
Didn’t get anywhere with my GP in the UK, and even struggled with private endocrinologists as I was sub clinical (but absolutely experiencing a raft of symptoms). I eventually found one who was willing to prescribe treatment.
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