Help! T3 decreasing on Levo

[Seekinginfo9]

Hi I’m hoping you can help please. I started on levo last July and am currently on 100mcg. I have many of the symptoms and result was ‘sub clinical’ but dr agreed to prescribe on basis of nice guidelines. Some blood tests over the last year are below. All taken between 8.30-9. Before medication/ food. I don’t have all the GP results (I know I could get them) but have done others through monitor my health (MMH) and Medichecks (MC) as I’m aware GP results don’t generally have the t4 and definitely not the t3. These are at follows:

Before medication

19/4/21 MMH - TSH 4.46 (0.27-4.2) t4 16.8 (12-22), t3 5.3 (3.1-6.8)

23/6/21 (MC) TSH 5.53, t4 13.9, t3 5

20/7/21 started on 50mcg

26/10/21 started 75mcg

25/1/22 MMH TSH 3.18, ft4 18.2,ft3 4.8

1/2/2/ GP TSH 2.46, t4 17.4

7/2/22 started on 100mcg

21/4/22 MMH TSH 1.68, t4 18.5, t3 4.4

My Concern is that although TSH has come down and t4 gone up, my t3 has gone down from 5 to 4.4 as this has stepped down with each increase. Is there a reason for this? As I understand from what I’ve read t3 is the most important result. Is there any benefit to having a higher t4 and lower TSH than before when t3 is also lower? It looks like I was better off before starting levo, should I stop taking it? Reducing gradually?

On this pattern it seems an increased dose would reduce t3 further. I weigh 94kg and am 5’10 so still a way to go on the dosage by weight calculation. I’m due to discuss with GP next week, he was incredibly dismissive of any private tests at the beginning and got cross previously when I referred him to the results (apparently he can only trust results from their labs). So he will only have the Nhs results (with similar TSH and t4 to the private ones) but no t3. I haven’t really noticed an improvement in symptoms. Previous test negative for antibodies. I had broken my leg in May last year and that is still not fully resolved also. Some blood test have been delayed due to blood bottle shortage, covid and surgery on leg (dec 2021).

Any advice would be much appreciated I would love to feel better but at a bit of a loss what to make of results. Is is not thyroid related? But then why the symptoms and raised TSH?

[SlowDragon Administrator]

Essential to test vitamin D, folate, ferritin and B12 at least annually

What vitamin supplements are you currently taking

Have you had BOTH TPO and TG antibodies tested?

If both are negative suggest you look at getting ultrasound scan of thyroid done £100 approx

20% of Hashimoto's patients never have raised antibodies

healthunlocked.com/thyroidu...

Paul Robson on atrophied thyroid - especially if no TPO antibodies

paulrobinsonthyroid.com/cou...

[Seekinginfo9 in reply to SlowDragon]

Thanks yes both antibodies negative.

Previous tests pre starting levo;

Vit d was low at 61, have been supplementing but not yet retested.

Active b12 was 112 (>37)

Ferritin 30 (13-150)

Serum folate 15.2 (2.5-19.5)

[SlowDragon Administrator in reply to Seekinginfo9]

So your ferritin is far too low/deficient

You need full iron panel test for anaemia

cks.nice.org.uk/topics/anae...

In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency

Look at increasing iron rich foods in diet

Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption

List of iron rich foods

dailyiron.net

Links about iron and ferritin

An article that explains why Low ferritin and low thyroid levels are often linked

preventmiscarriage.com/iron...

irondisorders.org/too-littl...

davidg170.sg-host.com/wp-co...

Great in-depth article on low ferritin

oatext.com/iron-deficiency-...

drhedberg.com/ferritin-hypo...

This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.

Thyroid disease is as much about optimising vitamins as thyroid hormones

healthunlocked.com/thyroidu...

restartmed.com/hypothyroidi...

Post discussing just how long it can take to raise low ferritin

healthunlocked.com/thyroidu...

Never supplement iron without doing full iron panel test for anaemia first and retest 3-4 times a year if self supplementing. It’s possible to have low ferritin but high iron

Medichecks iron panel test

medichecks.com/products/iro...

Iron and thyroid link

healthunlocked.com/thyroidu...

Posts discussing why important to do full iron panel test

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Chicken livers if iron is good, but ferritin low

healthunlocked.com/thyroidu...

Good explanations of iron

theironclinic.com/iron-defi...

theironclinic.com/ironc/wp/...

[Seekinginfo9 in reply to SlowDragon]

Thanks very much I’ll do the full iron panel. Any thoughts in the meantime as to what to do about decreasing t3 and possible increase or decrease in levo (my reply to your other post) thanks so much.

[SlowDragon Administrator in reply to Seekinginfo9]

First step is get all four vitamins optimal

This frequently improves conversion

Only make one change at a time….retest 6-8 weeks after any change

always get same brand levothyroxine at each prescription

Trial strictly gluten free diet

Try splitting Levo into two smaller doses, half waking and half at bedtime

But , even after all these steps it’s common for Ft3 remain lower than Ft4 on just levothyroxine

Naturally our own thyroid makes approx 80%-90% Ft4 and 10-20% Ft3

High dose Ft4 tends to lower TSH

Lower TSH reduces conversion

Splitting dose levothyroxine into 2 or 3 smaller doses spread through the day may increase TSH

[Seekinginfo9 in reply to SlowDragon]

Thanks so is it normal for t3 to decrease on starting levo, I was rather hoping it would increase!

[SlowDragon Administrator in reply to Seekinginfo9]

Unfortunately not ….it’s why so many eventually need addition of T3 prescribed alongside levothyroxine

[SlowDragon Administrator]

FT4: 18.5 pmol/l (Range 12 - 22)

Ft4 is 65.00%

FT3: 4.4 pmol/l (Range 3.1 - 6.8)

Ft3 only 35.14%

So you have room for dose increase in levothyroxine

Getting all four vitamins tested and optimal may help improve conversion levels

You could try splitting your levothyroxine dose, taking half waking and half at bedtime…..this can also sometimes improve conversion/raise TSH a bit

[Seekinginfo9 in reply to SlowDragon]

Thanks for your time in replying. My concern in Asking for an increase is that every time does has increased so far t3 has gone down, (5.3/5 to 4.8 to 4.4) so am I in a worse position rather than better? Why would t3 be decreasing?