I am not on medication I still have symptoms but I am feeling a little better. These bloods were taken at 9.30 am before any food or drink except water.
My recent bloods are TSH 3.49 (.027 4.2 ) ft4 15.1 (10 21) Ft3 4.7 (3.5 6.5 )
I have been offered 25mg of levo but am reluctant to start using if it makes me feel worse and messes up with the healing process of my thyroid following its trauma.
All vitamins levels are in a good place except for ferritin which is 30.6 but is steadily rising with my dietary interventions . I would welcome any advice about my problem. Thanks
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Badmintonteresas
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Mmm ... blood results effectively 'the same' as month ago , but you're feeling a bit better.
if it was me i think i'd hang fire on starting the levo for another ? month to see if you continue to feel better. How you feel often changes before the blood results show it .. TSH especially can take several weeks to reflect any change.
your TSH hasn't got any worse .... perhaps if you give it a bit longer it will get a bit better .. or more to the point .. perhaps you will continue to feel improvements regardless of where your TSH is. How you feel should always come before 'the numbers' .
If you start 25mcg Levo you can pretty much guarantee what will happen ( there is a very common pattern when starting levo ) you might feel no different for a week .then slightly better or even 'quite good' for another week or two , and then return to feeling less good again (like it's worn off) .....then a blood test @ 6/8 weeks .... ( then potentially an argument with GP to get increased to 50mcg ) .. then repeat this 'feel a bit better for a while , then less good again' process for a few more months until you are on a dose that hopefully allows you to stay feeling better . So even if you start to take the levo now, realistically it will be several months before you really know if it going to be an improvement.
Taking levo is always a compromise ... you effectively loose some of you own T3 production ( the important one ) when you take levo ... it doesn't just top up a low T4 , it dynamically affects the whole regulating system and that then turns down your own T4/T3 production a bit each time you add some T4 from levo .
You want to be pretty sure you will need it before you start down the levo road.... most of us are pretty sure we will be getting worse anyway because we know our immune system is attacking our thyroid , but you do have reasonable grounds to believe your thyroid might be getting better not worse.
another month or 6 weeks of waiting now , just to be sure .. might just mean you don't end up stuck on Levo unnecessarily .. perhaps i'm being over optimistic . but it would be a shame to miss the opportunity to find out..
Thanks for the reply . I was heartened to see both T4 and T3 over 46% and over 40% in range which shows a steady upward movement and I think t4 is probably converting. I also know that this problem can take a while to resolve. Many thanks for your advice.
Optimistic or otherwise, it is a very helpful answer! But a thing got me intrigued: you mentioned: "you effectively loose some of you own T3 production ( the important one ) when you take levo".
How can this be? According to my (limited) knowledge, the native t3 production comes from the native t4. So if you add t4 as a pill, wouldn't the t3 production remain the same (our body would just have another way to get the fuel-t4 in order to produce t3). The obly way i can think of to loose oyr own body's t3 production is if you overdose on levo (and thus our body may compensate by reducing the production). Am i missing something?
And Is there any paper or any scientific data mentioning this or do you speak from experience?
T3 doesn't just come from deiodination of T4 ......some 'ready made' T3 is also made directly by the thyroid.
So the thyroid gland produces an amount of ready made T3, it doesn't just produce T4. ( jbc.org/article/S0021-9258(... Journal of Biological Chemistry Sept 2017 :De novo triiodothyronine formation from thyrocytes activated by thyroid-stimulating hormone.
Cintia E. Citterio ,Balaji Veluswamy, Sarah J. Morgan, Marvin C. Gershengorn, Terry J. Smith, Peter Arvan. )
The ratio of T3:T4 produced direct from the thyroid is very different between individuals, the ratio is usually quoted as approx 20:80% ... but that is an average from 14 subjects in an old study by Pilo et al.... individual ratio's are very different to this average . A useful summary is here :
thyroidpatients.ca/2020/05/... (summary-t3-secretion-conversion) this contains direct links to more detail and quotes sources for data used.
ThyroidPatients.Canada is a well respected site , and contains vast amounts of fully referenced articles , with pictures , explaining anything and everything you might want to understand about thyroid hormone production, metabolism, etc etc.
Also .... our individual ratio of T3:T4 produced by our thyroid ,is capable of being increased when our TSH is higher ... producing more 'direct' T3 when eg. our thyroid is staring to fail.
Triiodothyronine secretion in early thyroid failure: The adaptive response of central feedforward control.
Rudolf Hoermann,Mark J. Pekker,John E. M. Midgley,Rolf Larisch,Johannes W. Dietrich
First published: 09 December 2019
".....numerical continuation analysis revealed dependencies of T3 production on different elements of TSH feedforward control. While T4-T3 conversion provided the main T3 source in euthyroidism, this was overtaken by increasingglandular T3 secretionwhen thyroid reserve declined. The computational results were in good agreement with data from untreated patients with autoimmune thyroiditis.
Conclusions
Dependencies revealed in the expression of control differ in thyroid health and disease, using a physiologically based mathematical model of combined feedback-feedforward control of the hypothalamic-pituitary-thyroid regulation. Strong T3-protective mechanisms of the control system emerge with declining thyroid function, whenglandular T3 secretionbecomes increasingly influential over conversion efficiency. This has wide-ranging implications for the utility of TSH in clinical decision-making... "
One of the authors of the above study, (and other papers looking at T3 production), is a member on here diogenes
.. if you have any difficulties with understanding the technicalities of how they measure production vs conversion you could ask him for clarification. ... ( a lot of it is 'over my head' , lol )
His recent reply on another post mentions further research on the subject to be completed soon "We've just finished a 2 year clinical trial with 100 patients before and after total thyroidectomy. We hope to be able to get a better grip on the percentage of direct T3 production by the healthy thyroid, with many more patients and no "iodine-interference" than was the case with the Pilo et al paper (now quoted as gospel on 14 controls - 20% comes from the thyroid direct in health with huge variation). With our number of patients we should be able to quote a mean and range for this. If as we suspect the Pilo mean was lowered because of the T3-inhibiting effect of Lugol to protect the volunteers thyroid from radiodamage the thyroid direct contribution could be significantly raised with all the implications for T4/3 treatment in athyreotic subjects. Perhaps we can enter this Bianco led review/papers study." healthunlocked.com/thyroidu...
Thanks for the load of information! I was aware that we produce some t3 directly, but i was under the impression that this was the exception and the majority of it comes from the t4 conversion. And of course I didn't know (even though its pretty logical now that i think of it) that this direct t3 percentage is adjusted by the body and is not always stable. Special thanks for the links provided!
Your reply says pretty much exactly what endocrinologists (and GPs) have said since around 1956!
It is why taking any T3 has been dismissed so completely.
The reality is that you would only produce enough T3 if your T4 levels are somewhat higher than would be expected for you as an individual - you might even see this if you are a rarity - someone with thyroid test results going back before you were hypothyroid.
Hey helvella ,I am a bit confused by your comment. You mention that in order to get sufficient t3 you need more t4. So basically by getting more t4 you don't reduce your own t3 production but actually increase it? So you disagree with tattybogle?
With a working thyroid gland, your T3 level will come from the conversion from peripheral conversion of T4 into T3, plus any T3 supplied by the thyroid gland (whether made as T3 or by conversion within the thyroid).
With a working thyroid gland, your FT4 might be, say, 16. So add the conversion of that to any T3 from the thyroid gland and that produces the T3 you need.
Take away the thyroid gland completely, and you are knocking out all the T4 it used to produce, as well as all the T3 directly from the thyroid. Instead, you supply all your T4 as a tablet. In order to compensate for the loss of T4 from the thyroid, you need to take enough T4 to take your level back up to 16.
But you have also lost the T3 from your thyroid. In order to replace that, you need to take more T4, and your FT4 will need to be higher than 16. Maybe it would need to be 20. That is, higher than when you had a fully working thyroid.
We are both describing different part of the same thing.
my original comment related to someone starting low dose Levo with a struggling thyroid gland (at that point they have fairly decent T3 production and conversion (boosted by their high TSH) .. when you add T4 to that , you loose the T3 'boost' effect because the T4 lowers the TSH .
Once someone is on a full replacement dose of Levo with lowish stable TSH... the thyroid's production of T4 and T3 is lowered to minimal , and at that point then yes, more T4 from levo will equate to more T3... but only up to a certain point ... there is a glass ceiling of T4 to T3 conversion... if you go above it then you get less T3 again ,because if T4 is 'too high' you increase the speed of conversion of T4 to Reverse T3 and also de- activation of T3 into T2.
Helvella refers to the relatively higher T4 levels needed by levo treated patients in order for them to achieve the same level of T3 that they had before .
If you were a 'rarity' in that you knew what your levels were in health , you might have had eg : (random numbers just to illustrate the point)
TSH 1 ..... FT4 16..... FT3 5
but once on Levo , in order to get the same fT3 level of 5 out of your Levo without your thyroid 'helping' ,you would need a relatively higher fT4 of 24 .
( in reality you might not be able to get 5 no matter how much levo you took ... as you increased Levo you might get FT3 up to 4.5 and no more , and then as you added more Levo , FT3 would get less ... back to 4
Your TSH on Levo would be lower than it was in health (for the same level of T3) due to the higher T4 level. You might end up with :
TSH 0.05 ..... FT4 24 .... FT3 5
Except that you wouldn't be allowed to have this by most GP's /endos because they'd be overly concerned about the low TSH and not give a monkeys about you achieving a an fT3 level of 5 ... so you would be prescribed less levo to keep TSH in range ,and end up something like this :
TSH 0.8 .... fT4 18 ....... fT3 3.9 ( net T3 loss /feel shit / at greater risk than you were before from any potential affects associated to T4 levels eg some types of cancer cell proliferation )
This TSH 'disjoint' on Levo is evidenced by some other of diogene's groups papers.
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