Low T3, Endo won't change dose. Help!

[T808]

So my endocrinologist called today to discuss my labs. She said I'm "within range" and to stay on current dose even after I said I was having hypo symptoms still and asked if I could trial even 2 days a week dose increase. Here are the labs. I waited 24hrs almost exactly before last levo dose and fasted with only water. Will my primary go against what the endo says? I need advice please. I only have a few months of extra meds if I increased it manually. I don't want to be stuck on this dose forever when I run out. 😢

TSH 0.84 ( 0.34-5.60 )

FT4 1.03 ( 0.61-1.24 )

Total T3 74 (60-181)

[SlowDragon Administrator]

Are you based in U.K. (Scotland?) or abroad

Total T3 is not as good as Ft3

[T808 in reply to SlowDragon]

I'm based in the US on the west coast

[SlowDragon Administrator in reply to T808]

Testing in USA

stopthethyroidmadness.com/r...

[T808 in reply to SlowDragon]

Thank you 🙏

[Batty1 in reply to SlowDragon]

Slow dragon in the US T3 is the Queen to King TSH and FT3 won’t ever get tested.

Its absolutely ridiculous that thyroid treatment is so antiquated .

[DippyDame]

A bit tricky to answer that...

Unless we have an FT3 reading ( and more) it's difficult to comment.

TT3 is not usually measured now

It is the ( unbound) Free T3 that is important

It looks as if that over range FT4 result has caused your TSH to drop

Being " in range" means nothing other than just that...

It is the point within that range where you feel well that is important.

Medics don't seem to understand this.

They wrongly focus on TSH for dosing!

FT4 may be high ( not in range as endo said!) because you are not adequately converting T4 to T3

Right now we don't know for sure.

We need to compare FT4 with FT3

High FT4 with low FT3 = poor conversion

Increasing levo may make your symptoms even worse if conversion is very poor

FT4 will rise and FT3 may still be too low

Since your FT4 is top of range it's not a great idea to increase ( much more) in the hope of raising FT3

You also need to optimise vit D, vit B12, folate and ferritin in order to support thyroid function.

A full thyroid test is what you need including thyroid antibodies TPO and TG

thyroiduk.org/thyroid-funct...

Post any new results then we can see what's going on.

[T808 in reply to DippyDame]

I'm not at the top range yet. Just over half way. So I have room to wiggle? What do you think? I'm taking 112 now. My ferritin was low 5 months ago. I have been working to get that number up. My ferritin went from 20 to 40 in a couple of months. I need to check it again as my last test was 3 months ago or so.

FT4

[DippyDame in reply to T808]

Ooooops.... apologies, I misread that result!

You do have room to increase T4 but you would still be better to have an FT3 test to evaluate conversion.

IF you don't improve with additional T4, and FT3 is low, you may need to add a little T3.

But ...one step at a time.

Work on nutrients and try 125mcg T4.

Wait 6/8 weeks and test again.

Good luck

[T808 in reply to DippyDame]

Thank you so much! It really helps talking to you guys. I really appreciate everyone taking the time to give me advice. Will retest in 6 weeks from private lab and let you guys know how I get on. Was going to do a private test with ft3 straight away but I wanted to wait to see if the endo did it first. I'll also get vitamins, sex hormones, and ferrtin tested. I've been taking 2000ius D3, 400mg magnesium citrate, 500mg vitC, and a sublingual B complex that has 1200mcgs b12 in it.

[Batty1]

What dose are you on?

[T808 in reply to Batty1]

My story is I had RAI in 2002. Was on 150mcgs for 20+ years with zero issues. 5 months ago a couple months after having Covid and my ferritin got into the low 20s from my blood donations over the past year. I suddenly became overmedicated.

The doctor then had me go up to 175mcgs which made it worse, I lost 16 kilos, then down to 137mcgs, then down to 100mcgs, switched doctors and was put on 112mcgs. I felt better at first. But not normal.

Now I feel on 112mcgs how I did on 100mcgs previously. Constipation, dry eyes, low energy, stomach pains, muscle twitching. I just don't understand how my TSH can be under 1 but the total t3 is at the very bottom of the range. Wouldn't TSH be higher if t3 is low?

[SlowDragon Administrator in reply to T808]

We need OPTIMAL vitamin levels for good conversion of Ft4 to Ft3

If vitamins are low, then poor conversion results in high Ft4 and low Ft3

High Ft4 tends to lower TSH

Low TSH results in poor conversion

It’s chicken and egg

Suggest next steps

Test iron and ferritin levels, see if ferritin has improved

Test folate, B12 and vitamin D

You could try Splitting your dose levothyroxine in to two smaller doses taking half waking and half at bedtime.

[Batty1 in reply to T808]

Im thyroidless and I have been on Synthyroid 112mcg this was(pure poison) it contains and inactive ingredient call Acacia and the issues this stuff can cause is crazy…. You may want to checkout Humanbeans extensive list of inactive ingredients in thyroid meds and if your using different manufactures that could also cause some issues.

[tattybogle]

"I just don't understand how my TSH can be under 1 but the total t3 is at the very bottom of the range. Wouldn't TSH be higher if t3 is low? "

.... replied on end of previous post re. Total T3 vs FreeT3 healthunlocked.com/thyroidu...

Basically ..... you don't know for certain your fT3 is low. you could in theory have ok FreeT3 with lowish Total T3.