T3 messing up results

[Joad467]

Hi,not sure how to move forward,am currently on 100 levo at my request,also take 12.5 T3,does taking the T3 mess up the T4 result, as feel I need more levo,buy doctor said I am overmedicated,could someone advise please. Thank you🙂

[SeasideSusie Remembering]

Joad467

Taking T3 tends to lower TSH and often suppresses it. It also tends to lower FT4 level to a certain extent.

What are your results that the GP is unhappy with? Can you post them along with their reference ranges.

Presumably, as you are taking 12.5mcg T3, this is self sourced? With your doctor's blessing or not?

[Joad467 in reply to SeasideSusie]

Thanks SeaSideSusie,will find result he not happy with he has referred me to see an endo,don't know when I will get appt,I bought the Tiromel myself.

[Joad467 in reply to Joad467]

On my online record it says aT4 serum level 12-22

[SeasideSusie Remembering in reply to Joad467]

12-22 is the reference range, there will be a result (possibly somewhere between those two numbers) as well.

Also, what is your TSH result/range?

When taking T3 it's important to test FT3 as well when testing TSH and FT4, you must know where your FT3 level is because this is what tells you if you are overmedicated.

If GP can't get FT3 tested then it really is important to have this so consider doing a private test. The cheapest test for TSH, FT4 and FT3 is with Monitor My Health, which is an NHS lab which offers this test to the general public as a fingerprick test and it costs £26.10 with code found here:

thyroiduk.org/help-and-supp...

[Joad467 in reply to SeasideSusie]

Thank you again this is snap shot of my results

None

[SeasideSusie Remembering in reply to Joad467]

Joad467

OK, so we have

TSH: 0.03 (0.27-4.2)

FT4: 10.9 (12-22)

FT3: 3.1 (3.1-6.8)

TSH is suppressed (below 0.1 is suppressed), FT4 is below range and FT3 is at the very bottom of the range.

There is something very, very unusual about these results. When TSH is low like yours one expects the see the hormone results (FT4 and FT3) high in range, when taking T3 FT4 will generally be lower in it's range than FT3 is in it's range.

So, the question is has something interfered with the test to give these strange results?

Do you take a biotin supplement or a B Complex or a hair/nail supplement or anything else containing biotin (B7)? Biotin can give false results.

When did you take your last dose of Levo and T3 before the test. Last dose of Levo should be 24 hours before the test, last dose of T3 should be 8-12 hours befor the test, and with 12.5mcg you would split this dose into two and take the last part of the dose 8-12 hours before blood draw. If you leave any longer than these times then you get false lows for your hormone results.

doctor said I am overmedicated

Your doctor is making the classic mistake of just looking at the TSH result. TSH is not a thyroid hormone, it's a pituitary hormone which is useful for diagnosis but once on thyroid hormone replacement it's the thyroid hormones (FT4 and FT3) that tell us our thyroid status and whether we are overmedicated. With a below range FT4 and bottom of range FT3 there is no way you can possibly be overmedicated, the FT3 would have to be over range for that. This is assuming that nothing has interfered with the test results.

[Joad467 in reply to SeasideSusie]

Thanks,no didn't take any supplements,and followed the rules re taking medication before blood draw,the doctor actually stopped levo without telling me,and when I did get them reinstated dropped it down to 75,I have since switched doctor

[SeasideSusie Remembering in reply to Joad467]

Why did the doctor stop the Levo?

How long had you been off Levo altogether, and how long had you been back on Levo before this test?

Do you have Hashimoto's (raised thyroid antibodies would confirm this if they've been tested).

Do you take any other medication?

[Joad467 in reply to SeasideSusie]

Hi he never said,found out from pharmacy when I went to pick them up,I phoned surgery and got them reinstated at lower dose ,my antibody tests have always been low, I take orlistat,when I remember ,thanks for reply

[SeasideSusie Remembering in reply to Joad467]

So you didn't go without Levo completely then?

[Joad467 in reply to SeasideSusie]

Maybe missed a couple of weeks,sorry memory not great

[SeasideSusie Remembering in reply to Joad467]

OK, so your FT4, FT3 and symptoms are screaming "undermedicated" but your TSH is completely out of sync wit your other results. Maybe there was some assay interference or other explanation for your TSH result, I think I remember something about a certain type of antibody interfering with TSH results - helvella have I imagined this?

I think you should ask your GP to retest, preferably using a different lab, based on these unusual results.

[Joad467 in reply to SeasideSusie]

Maybe the new doctor will be more helpfull,as other doc just said we will wait until you have seen endo

[helvella Administrator Thyroid UK in reply to SeasideSusie]

Human anti-murine (anti-mouse) antibodies (HAMA).

TSH antibodies.

But I think both of those would tend to give an artificially raised TSH.

[Joad467 in reply to helvella]

Thank you helvella will look into that

[SeasideSusie Remembering in reply to helvella]

OK, thanks helvella

[Shelleyblue in reply to Joad467]

Hi - do you know that ORLISTAT prevents absorption of levothyroxine and liothyronine and some vitamins and minerals ! There is a lot of research that says people on thyroid medication should not be given ORLISTAT. Has your doctor prescribed ORLISTAT for you ? If GP has then they need to increase both of your levothyroxine and liothyronine to compensate and you should not take the ORLISTAT within 8 hours before or after that medication ! Sorry to be bearer of bad news but I think ORLISTAT is giving you the low fT4 and fT3 readings, weight gain and fatigue. Please consider stopping the ORLISTAT before increasing thyroid medicine though - you may start to feel better a few months after stopping the ORLISTAT. :/

[Joad467 in reply to Shelleyblue]

Thanks Shelley blue,all doctor said was take them 4 hrs apart,will have to speak to them about that👍

[Picketywitch in reply to SeasideSusie]

Hi Seaside Susie, my TSH is 0.001. The endocrinologist I saw said taking T3 permanently suppress the TSH. Mine been like it for years. I take T3 & T4 I’ve had total thyroidectomy. If I could have coped without having it done I would have. I’ve never been well since. All the best to all of you experiencing problems.

[SeasideSusie Remembering in reply to Picketywitch]

Yes, I know taking T3 suppresses TSH (I wish all doctors did), as I said in my first reply

Taking T3 tends to lower TSH and often suppresses it.

but it's the fact that what she's taking - Levo and T3 - is producing such dire hormone levels so I went on to ask

So, the question is has something interfered with the test to give these strange results?

but maybe it just is undermedication.

[radd in reply to Joad467]

Joad467,

I see what SeasideSusie is getting at but if you have symptoms I would say you are actually still under medicated and TSH just isn't responding as usual (which is quite usual on this forum 😁). How do you feel?

[Joad467 in reply to radd]

Thanks Radd,have put on 3 stone,and get really exhausted, and cold if I am still,all the usual delights 😊

[radd in reply to Joad467]

Joad467,

TSH: 0.03 (0.27-4.2)

FT4: 10.9 (12-22)

FT3: 3.1 (3.1-6.8)

So GP is prescribing 100mcg Levo which leaves FT4 well under-range, and you are self-medicating 12.5mcg T3 which still leaves woefully inadequate FT3 levels, and TSH is behaving as if you are over-medicated!

When we introduce T3 meds they change the way our blood test look and will not be understood by most GP’s. Presuming T3 is fairly new?, I have looked at your previous posts and one year ago whilst medicating only 100mcg Levothyroxine your labs said FT4 was still bottom of range and FT3 middle, and TSH again really low (under range) which is not usual.

These older labs make it difficult to tell if you were just under-medicated in Levo or needed additional T3 meds (poor converter) because sometimes when we are low in thyroid hormone the body will automatically convert more T3 in an effort to retain well being, even though this obviously isn’t sustainable long term by the body.

And now even medicating a little T3 I would still say you need an increase in Levothyroxine. Will your doctor go with that given TSH is so low? It may very well be if you had a Levo increase you wouldn't need T3 meds (which makes life a lot easier). You could mention Central Hypothyroidism because the low FT4 and low TSH evidenced a year again (which was complicated further by you self sourcing T3) is really not usual.

Whilst you wait for the endo appointment I would concentrate on getting meds working better by optimising essential cofactors; iron (absolutely essential), Vit B12, folate and Vit D. Also, if you have elevated thyroid antibodies to try controlling inflammation with gluten free diet and supplementing selenium (known to reduce thyroid antibodies).

Are you split dosing your T3 meds?

[Joad467 in reply to radd]

Thank you for detailed reply ,I am just scared doc will request blood test and say I am overmedicated then lower dose again have been going gluten free,I will make sure I take supplements suggested,thanks Radd

[radd in reply to Joad467]

Joad467,

This is the problem many members have and why some of us end up self medicating. You are in need of a dose increase, most likely thyroxine. As you are already self sourcing T3 why don't you just self source Levo? It's a lot cheaper and easier to obtain than T3.

[Joad467 in reply to radd]

Thankyou I want to but don't know where to look

[radd in reply to Joad467]

Joad467,

Just write a post asking for Levo and members will DM you their source.

[Joad467 in reply to radd]

Great thanks Radd👍

[Joad467 in reply to Joad467]

Please don't get into trouble by naming where I can source levo

[radd in reply to Joad467]

Joad467,

Anyone who advises you of their Levothyroxine source will do it by DM as per forum rules.

[Joad467 in reply to radd]

Thanks have just made a post

[radd in reply to Joad467]

Joad467,

If you self source Levo, I would suggest only increasing by 25mcg and then waiting six weeks to do private labs. post results including ranges (numbers in brackets) for members to comment.

.

private labs

thyroiduk.org/help-and-supp...

[Joad467 in reply to radd]

Thanks so much Radd,have registered on that site,and will get some 🙂

[SlowDragon Administrator]

How much levothyroxine are you currently taking

all thyroid blood tests early morning, ideally before 9am last dose levothyroxine 24 hours before test

On T3 day before test split daily dose into 2 smaller doses, spread through the day at approx 8 hour intervals, taking last 1/4 tablet 8-12 hours before test

Is this how you did your test ?

Taking almost any of T3 will suppress TSH…..as shown by your results

GP doesn’t understand and will always reduce levothyroxine to try to bring TSH up …..which won’t happen as you’re taking T3

[Joad467 in reply to SlowDragon]

Hi SlowDragon and thanks 100 levo ,yes I did all that ,don't know what to do from now on 🤔

[SlowDragon Administrator in reply to Joad467]

How much levothyroxine were you on before adding T3

What were results on just levothyroxine

How long have you been taking 2 x 6.25mcg T3

What time was last dose before test?

Ft3 result is very low

Ft4 obviously too low ….you need 25mcg dose increase in levothyroxine retest in 6-8 weeks

Email Thyroid U.K. for list of recommended thyroid specialist endocrinologist and doctors who will prescribe T3

[e-mail]

Essential to regularly retest vitamin D twice year when supplementing and test folate, ferritin and B12 once year minimum

What vitamin supplements are you currently taking

[Joad467 in reply to SlowDragon]

Thanks,was on 125 at one point, not sure ,would have to find past results,have been on T3 after not being able to afford thyroid S,so probably couple of years on T3,I take B12 and Vit D

[SlowDragon Administrator in reply to Joad467]

You need to retest vitamin D, folate, ferritin and B12

Likely being under medicated lowering vitamin levels

Orlistat can significantly lower vitamin D

Are you taking vitamin D tablets/gels or vitamin D mouth spray

drugs.com/disease-interacti...

Many U.K. patients forced to test privately to make progress

NHS easy postal kit vitamin D test £29 via

vitamindtest.org.uk

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

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/

[Joad467 in reply to SlowDragon]

Thanks,I take gel capsules,and thank you for telling me about the testing sites and thier offers 🙂

[SlowDragon Administrator in reply to Joad467]

Likely to need to use vitamin D mouth spray to avoid poor gut absorption

See what results are before changing

Aiming for vitamin D at least around 80nmol and around 100nmol maybe better

[SlowDragon Administrator]

Orlistat and levothyroxine

Are you taking Orlistat at least 4 hours away from levothyroxine

gov.uk/drug-safety-update/o...

webmd.com/drugs/2/drug-1433...

Let your healthcare professionals (e.g. doctor or pharmacist) know that you are taking these medicines together. Separate the times you take your thyroid medicine and your orlistat by at least four hours. Let your doctor know if you have any symptoms of hypothyroidism.

[Joad467 in reply to SlowDragon]

Hi yes it was stated on prescription 👍