FREE T3 remains the same ON/OFF medication

[Andrew1978]

Can someone help me understand why whether on T4 or off T4 meds, no matter where the TSH is in the range (v.high/low), whether Free T4 is normal or low, the Free T3 remains the same in range and fairly stable (in the middle)?

Thanks in advance.

[PurpleNails Administrator]

Welcome to forum

It’s said FT3 is the last marker to “alter” it’s one of the reasons doctors says its not important to measure or they often they just say FT3 isn’t relevant because they do not fully understand.

It is relevant to patients as the hypo symptoms can persist if low even if TSH & FT4 looks good.

Do you have results to share? If you list the results (and range, which vary between labs) by date and note medication changes we may be able to interpret more accurately what’s affecting your results. It’s possible differing ranges give appearance of similar results but the % through range means a difference.

Were tests performed under same circumstances. Early in day, after fasting overnight delaying dose until after draw? Did you take supplements containing biotin as this can interfere with results.

Were nutrients tested? Folate, ferritin, B12 & Vitamin D all need to be optimal for Levo to work effectively.

[Andrew1978 in reply to PurpleNails]

Hi Purple Nails, Thank you for you reply!

Here are some results:

December 2019 (125mcg Levo)

TSH 3.74 (0.27-4.2)

FT3 4.88 (3.1-6.8)

FT4 14.8 (12-22)

November 2021 (no medication for 3 months)

TSH 11.1 (0.27-4.2)

FT3 4.2 (3.1-6.8)

FT4 11.4 (12-22)

The reason for the question is that when increasing thyroid medication is introduced a whole myriad of symptoms appear such as hypoglycaemia with all additional symptoms related, bad anxiety etc.

Just to reiterate, I am just really interested as to why the FT3 would remain the same?

Thanks again

[PurpleNails Administrator in reply to Andrew1978]

December 2019 (125mcg Levo)TSH 3.74 (0.27-4.2)

FT3 4.88 (3.1-6.8) 48.11%

FT4 14.8 (12-22) 28%

November 2021 (no medication for 3 months)

TSH 11.1 (0.27-4.2)

FT3 4.2 (3.1-6.8) 29.73%

FT4 11.4 (12-22) -6%

The body should preserve the FT3 levels. When they thyroid start to fail sometimes the FT3 will rise in comparison to FT4 to compensate for the low levels. The FT3 range is very small so the 4.2 to 4.88 actually represents a 20% difference.

When taking Levo your FT4 was already quite low in range but your FT3 was just above mid range. Your TSH of 3.74 is too high if taking levo the aim is around 1 and the FT4 & FT3 in the top half of range. Often FT4 top third & FT3 top half as FT3 tends to be lower than FT4.

The December results should have prompted a 25mcg daily increase and retest in 6 weeks after unchanged dose.

Hope this answers your specific question.

Assume you have since resumed medication and have more current results? post if you do need further advice.

[Andrew1978 in reply to PurpleNails]

Hi PurpleNails,

Thank you for the detailed response.

The problem has been that when meds are increased very immediate and dangerous symptoms get worse. Hypoglycaemia with all its related symptoms and elevated food intolerances, amongst a load of other unpleasant reactions.

This was the reason to come off the meds. I am looking at Paul Robinsons T3 replacement therapy incase there is some kind of T4 issue.

[PurpleNails Administrator in reply to Andrew1978]

How much did you try to increase by?

How long do you leave an unchanged dose?

Do you always stay with same brand of medication? The fillers in tablets can cause reactions.

Whilst on medication your levels were too low. As both FT4 & FT3 in lower half of range.

[DippyDame in reply to Andrew1978]

Your body is struggling to maintain some level of T3T3 is the active thyroid hormone essential to every cell in the body

The lower the T3 level the poorer health becomes

Even at your present levels you are undermedicated

Nov 2021 FT3 is only 29.73% through the reference range

Both Frees ( FT3 and FT4) should be approaching 75% with the caveat that we are all different so there is no single set point.

TSH, a pituitary hormone, is a signal to the thyroid ro raise or lower production of thyroid hormones

Your raised TSH shows that the pituitary is recognising the low hormone levels consequently it is working hard to encourage/ signal ( high TSH) the thyroid to produce more hormone....evident when on no medication.

Your FT3 may appear fairly consistent but without medication it is likely to eventually fall further ( it has already dropped) resulting in deteriorating health.

FT3 is vitally important.

You need to be medicated

This needs to be introduced very slowly, it will take your body some time to adjust from the current low level to that provided by a therapeutic dose.

How much levo/T4 were you taking and how long did it take to reach that dose?

I understand that you are just really interested as to why the FT3 would remain the same...

I've tried, therefore, to avoid mentioning FT4 but you should be aware that your FT4 labs are ridiculously low too and this in turn will affect FT3 levels because there is little FT4 to convert to FT3!

Not a brief answer I'm afraid, but hope this helps

[Alejandrita17 in reply to DippyDame]

Too much t3 can also induce insuline resistance over time. And there's no way to avoid t3 peaks if you take Cytomel.

[DippyDame in reply to Alejandrita17]

I didn't mention Cynomel or excess T3

[Alejandrita17 in reply to DippyDame]

I mean, you always have t3 peaks in blood if you take t3 medication. There's no way to avoid that.

[tattybogle in reply to Alejandrita17]

? but Andrew1978 was asking about natural T3 levels alejandrita, not the peaks from taking T3. He wasn't taking any T3.

I do remember reading about a connection between taking T3 and blood sugar rises in some people. I think? it's mentioned in the patient information leaflets for T3 tablets.

Recent research posted by diogenes has shown no cardiovascular effects or energy expenditure effects from the expected 'post dose' peaks when taking T3. healthunlocked.com/thyroidu...

Andrew1978 when the TSH is high ,the Thyroid gland can increase it's ratio of T3 to T4 production .. and higher TSH will also upgrade the deiodinases that convert T4 into T3 in the cells. making T4 to T3 conversion more efficient when TSH is high... both these methods of increasing T3 are presumably attempts to compensate for a struggling thyroid gland .

So this explains why ,when your TSH was higher without any Levo , your fT3 didn't fall as much as your fT4 did .

[TSH110 in reply to Alejandrita17]

If I have T3 peaks I don’t notice any sign of them on NDT

[Andrew1978]

Hi DippyDame, Thank you very much for your response.

I appreciate the labs are very low and this was expected when stopping Levo - The entire purpose being that it was causing terrible illness that worsened by taking more & more Levo over the correct time frames/ dose increases. Symptoms that cannot be at all tolerated.

Using lab results only in this instance is not possible as where the labs are 'better', health was actually much worse! To simply add more meds to satisfy a report would result in catastrophic outcomes in reality.

[DippyDame in reply to Andrew1978]

Have you considered T3-only?I cannot tolerate levo and need T3-only to function.

This is hurried... but it might be of interest

thyroidpatients.ca/2019/08/...

We've all fallen foul of medics who want to dose by numbers only!

Madness.

[Andrew1978 in reply to DippyDame]

Thanks again DippyDame,

I have some T3 and am very much considering starting on this. Ive also recently run a saliva cortisol test but am yet to receive the results.

Can you advise a starting dose on T3?

Whats the smallest starting dose and over how many doses? Im concerned there might be some underlying issue with adrenals. What is the minimum starting dose to see if there might be a bad reaction?!

[DippyDame in reply to Andrew1978]

Advice on that might vary, but with your history I'd be inclined to start very low, say 5mcg ( a quarter of a 20mcg tablet, and see how you react. Low and slow is the usual advice, otherwise it's like putting rocket fuel in an old Mini!!

The T3 might take a long time to slowly settle into the body

Wait 2 weeks ( longer if you feel that works better) and, if you tolerate that reasonably well then try adding another 5mcg.

You can repeat that until you reach 20mcg

Wait 6 weeks the test

I didn't start from zero T4 but from 150mcg Levo reduced to 125mcg

I had taken levo for 20 years until I could barely function

I titrated T4/T3 for many months before deciding T4 had to go, by that time I was taking 25mcg T3 so I very slowly added another 6.25mcg ( my tablets are 25mcg) and continued that gradual increase

My thyroid journey has been long and complex...detailed in my profile if you are interested.

I'm sure others will pop in with other possibilities...

Post as many questions as you wish

It might be a long haul but things will improve in time

Good luck

[Andrew1978 in reply to DippyDame]

Many thanks again DippyDame, I very much appreciate your detailed response.

Can I ask if you can split 1/4 tablet & spread the doses out throughout the day?

I would like to avoid the rocket fuel in the old Mini scenario but it would be good to ensure I'm not farting at sails!

[DippyDame in reply to Andrew1978]

I guess you could crush the quarter into crumbs and pick them up by dipping a finger into the them and licking some off the finger, at intervals....or try nibbling crumbs off the quarter. I have heard of people doing this but you may lose crumbs!I doubt cutting smaller than in quarters is possible....but never venture etc

You will probably be fine just taking the quarter as cut.

When adding/increasing hormones you can feel worse to begin with, it doesn't necessarily mean the dose is too much/wrong....it's the body adjusting.

Unless FT3 is over range ( and you are far from that) then you are not overmedicated.

You may do very well using Paul R's method....very many do..

You can leave comments etc on posts on his blogs and there is a Contact page too.

paulrobinsonthyroid.com/blog/

I followed the late Dr John Lowe's protocol and take my T3 (100mcg) in a single dose....at bedtime. I have Thyroid Hormone Resistance, as he did.

I'm not a medic so can only share my own experience rather than advise.

The collective knowledge of members here is vast....their support probably saved my life!

So there is usually someone around to offer help....just ask.

End of rant!!

[TSH110 in reply to DippyDame]

I love the rocket fuel in an old mini analogy. When I first took NDT it was as if someone had turned the lights back on and put a broken me back together gain and that was just a 1/4 grain!! It was magical but I think a full replacement dose would have been high octane rocket fuel straight off & far too much for this old mini. I titrated up very gradually .