A little bit of background to me, I have had hypothyroidism since I was 18 years old, I'm male and now 31 years old. I have been on 125mg of Levothyroxine for many years, but have never been 100%, due to issues with tiredness. In late 2019 my doctor said that he will try me on a higher dose to see how I feel. So I went up to 150mg and did feel better but lost a lot of weight over the course of a year and a bit and had problems with urinating a lot and feeling thirsty. However as on the whole I was feeling good, it wasn't a major problem and due to COVID as everything I had completely forgotten about going up an extra dose. Anyway in October 2020 I did a vigorous cycle session and that night I became ill with bad diarrenha and was ill for a week. I thought it was just food poisoning, which it might have been, but I did get better but then about a month latter once I was feeling fine, I once again did a vigorous cycle ride and had the same response. Since then I have had stomach problems.
In Jan 2021 the doctors discovered my TSH levels where too low and requested I go down to 125mg as 150mg put me in the hyperthyriodism bracket, I think my TSH was 0.14. I have been on the 125mg again for over a year now and still have stomach problems and haven't gained any weight. I'm very skinny now. I also have sleeping problems and have to take sleeping pills and have issues with heat tolerance along with other problems that are harder to describe.
I have never done a full thyriod blood test as doctors have only ever done TSH tests. My results are below:
Well, it would help if you put the ranges for those results, but what it looks like is that you are a very poor converter of T4 to T3. So, your FT3 is too low and that is what is causing the symptoms.
You have a very ignorant doctor because dosing by the TSH is absolutely the wrong thing to do. The most important number is the FT3, because T3 is the active thyroid hormone. But, as it's in-range, he would say it's 'fine' anyway.
However, the only way round this is to procure some T3 to add to a reduced dose of levo. It's not easy to get from a GP, you would need to be referred to an endo. So, that should be your next step: ask for a referral.
You have hyperthyroid signs and symptoms which may suggest you are on too much hormone. I would try skipping your levothyroxine for a couple of days and then resuming on 100 mcg to see how you do.
Your body is working well in trying to maintain normal fT3 levels. The 'axis' works to try and keep fT3 levels steady, even if fT4 moves up or down. The is a complex explanation here ncbi.nlm.nih.gov/labs/pmc/a... if you want to read it.
Some tissues get their T3 from the blood and some by converting T4, so abnormal T4 levels can disrupt normal functioning.
So you're a classic "poor converter" and really need lio adding to the mix . It's endo-only, so the first step is to research suitable endos, as not all will prescribe it - because it's expensive (although getting cheaper all the time); because they don't like that it has a short half-life which they say makes it difficult to measure, and because an astonishing number of them don't think it works, and that people - like me - who have found it transformative are all sharing in some giant delusion
You can get a list of T3-friendly endos from DIonne at Thyroid UK - tukadmin@thyroiduk.org - and/or it's worth a new post asking for recommendations in your area. You don't need to see the nearest person, but must obv be reasonably convenient. And if you can't get it on the NHS, it's now only 50p per 20 mcg tablet on a private prescription
There's no evidence of poor conversion. People on levothyroxine monotherapy have lower fT3 than the general population and BlueRainArt has a higher fT3 than most patients on levothyroxine. As fT4 rises the rate of conversion is reduced, it also switches from type-2 deiodinase (D2) to type-1 (D1). This is important as D1 not only takes place away from the cell nucleus, it also converts T4 to rT3 which in turn inhibits D2. This is how the body protects itself from too much T4.
To arrive at a conclusion about conversion we would have to observe TSH and fT3 when fT4 is around mid-interval. Furthermore, the signs and symptoms are typical of hyperthyroidism or too much levothyroxine. Why would you want to increase metabolism? For more weight loss and diarrhoea?
Liothyronine might be needed but you can't make a judgement until the cause of these hyper signs and symptoms is identified. The most obvious cause is too much levothyroxine but it could be due to other non-thyroid causes.
The high fT4 is the most obvious thing to me .and weight loss/diarrhoea, and heat intolerance could all suggest overmedication.
So personally ,i think the first thing to try is to see if a lower dose improves how you feel. It might take at least 6-8 weeks on a consistently lower dose to know if it is an improvement or not. (you can get there a bit quicker by doing what jimh111 suggested .. have a day or two 'off' then resume at lower dose)
If getting your fT4 back into range doesn't improve things then at least you have ruled it out which makes it easier to decide what to try next.
If you have too much T4, it actually reduces your efficiency of converting T4 to T3. So it's possible you may get improved conversion to T3 when your T4 is a bit lower than it is now.
(if your body thinks its getting too much T4 it deliberately gets rid of more of it into reverseT3.. and converts less of it to T3..so you can't really tell how well you can convert T4 to T3 while your T4 is so high)
When fT4 has been back in range for a while , if you don't feel better , then you can look into the suggestions that some added T3 is worth a try ... but there seems little point going in this direction until you've dealt with the very high Ft4 level first.
As for "how much lower ?" ..... it depends... if you took your last dose of levo within about 6 hours of doing this blood test , then i'd only reduce your daily dose to 112. 5 mcg .. but if your last dose of levo was more like 24hrs before this blood test, then i'd reduce to 100mcg/day .
(this is because you get a 'false' high in fT4 tests if last levo dose was taken shortly before the test , so depending on when you took it your fT4 is either 'very high' , or 'a bit high')
You can get 112.5mcg by taking 125mcg one day, and 100mcg the next...or by splitting a 25mcg tablet in half everyday .. either way works .. pick whichever way you prefer.
I seem to remember a figure of approx 14% .. but that's off the top of my head too .. which is dangerous place for me to pluck figures from... but whatever the correct % for Levo is .. it's not big enough to account for 27.2 [12-22] so i'm pretty certain BlueRainArt's fT4 is 'overrange ' to some degree.
On your previous post you were going to ask for your medical records :
Have you seen any blood tests detailing antibodies being over range and positive ?
When first diagnosed hypothyroid, several years ago were antibodies run as the reason for your health issue and can you see any details of positive and over range TPO or Tgab and / or a diagnosis of Hashimoto's auto immune disease ?
Once hypothyroid you can't flip to hyperthyroidism - but Hashimoto's causes erratic thyroid hormone production and swings of 'hyper ' type symptoms.
Your bloods do not look hyper, your T3 is in range and your T4 slightly over range.
What you are showing is a poor conversion of the T4 into T3 :
No thyroid hormone replacement works well until ferritin, folate, B12 and vitamin D are up and maintained at optimal.
Conversion on T4 into T3 can also be compromised by inflammation- shown on Medichecks as CRP - any physiological stress ( emotional or physical ), depression, dieting and ageing.
Bear in mind that if there is erratic secretion caused by autoimmune flare ups it is fT3 that jumps around not fT4. This is due to shorter half-life of T3. A high fT4 with normal fT3 indicates too much L-T4 being taken.
Thank you. yes - just read the links you kindly gave :
Have I understood that link correctly - that when on T4 monotherapy the T3 is generally lower - and that a higher T4, likely over range, is needed to acquire a T3 level similar to that achieved in healthy people ?
Considering all the exercise the O/P achieves I just thought he must have been used to a higher T3 level than that shown in this last blood test result ?
On levothyroxine monotherapy an fT4 around the upper quartile is needed to achieve an average fT3. This is not necessarily good as conversion to T3 is done by type-1 deiodinase (D1) when fT4 is high normal whereas most conversion is normally done by D2. D2 converts T4 to T3 close to the cell nucleus in tissues such as the brain and skeletal muscle whereas D1 converts T4 to T3 and T4 to rT3 close to the cell membrane in tissues such as the liver. Thus, D2 is able to achieve high T3 levels next to receptors ('local' T3), this is not so for D1.
So, whilst in both cases you might achieve the same serum T3 levels you don't get the same T3 levels in cruical tissues such as the brain and muscles. Two points: -
1. It would seem in this case there is too much hormone action, so until that is checked it doesn't make sense to try and achieve higher T3 levels.
2. I had a neutral attitude to higher fT4 levels but my recent research show it is a cancer risk healthunlocked.com/thyroidu... and I've also found studies that show that high normal fT4 is associated with reduced life expectancy (I will post on this in a week or so). I now feel we should avoid high normal fT4 levels.
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Low TSH High T3 Normal T4 Total Thyroidectomy
T3/T4 ratio is high - what does this mean?
Low TSH with normal T3, T4. 
T4 too high with normal TSH
