Advice please on my latest thyroid test results as feeling tired and was previously
treated with combination of levethyroxine of100mcg and 10 mcg of T3
until the T3 was withdrawn three years ago so I am just now on 100 Mcg
of levethyroxine.Do you I need to see an endocrinologist regarding my
lastest test results. Also I had a partial thyroidectomy 43years ago.
T.S.H. 0. 34 (0.27-4.2)
Free T3 3.5 (3.1-6.8)
Free T4 23.0 (12-22)
These were done at a private lab.
T.S.H. 0. 34 (0.27-4.2) TSH within range but lowish. Dr may be concerned, as they equate low TSH as over medication (may even use the term hyperthyroid - which is inaccurate)
Free T4 23.0 (12-22) 110% of range this fractionally above range so GP will view you as overmedicated & will likely suggest dose reduction.
Free T3 3.5 (3.1-6.8) 10% into range. This is very low.
Your conversion to FT3 is extremely poor.
GPs often go by TSH sometimes looks at FT4.
Have key nutrients been tested recently?
- folate, ferritin, vit D and B12? Optimal levels (not just in range levels) can help improve FT3.
When you test do test early in day, after fasting & delay levo until after draw?
What supplements do you take?
Endocrinologist department may not accept a referral as GP expected to manage hypothyroidism.
Your T4 to T3 conversion is poor....indicated by high FT4 with low FT3
You need the addition of T3!
An endo should reinstate your T3
They have most likely looked at your low TSH ,which is a pituitary not a thyroid hormone, and decided (wrongly) to withdraw T3 ....
thinking you are overmedicated
So long as FT3 is within range you are not overmedicated.
TSH responds to the level of hormone in the serum, so....
FT4 is high causing low TSH
However it does not show low FT3!
FT3 is the important result
T3 is the active thyroid hormone, and for good health...
It is required in a constant and adequate supply by every cell in the body
Low T3 = poor health!
Symptoms appear....or return
You are tired!
Raising FT3 with replacement T3 should help.
The following may also help you build your case for the reinstatement of your T3
bmcendocrdisord.biomedcentr...
Time for a reassessment of the treatment of hypothyroidism
thyroidpatients.ca/2021/07/...
Good luck!
Thank you for your helpful advice which confirms my thinking that I needto be taking T3.I am going to try and locate a reputable endocrinologist as
my GP is a waste of time keep telling me I am over medicated and wanting
to reduce my levethyroxine which I have refused to do.Thanks again for
your advice.Misty.
Did you do this test early morning, ideally before 9am and last dose levothyroxine 24 hours before test?
Which brand of levothyroxine are you currently taking
What vitamin supplements are you currently taking
When were vitamin D, folate, ferritin and B12 last tested ?
Ft3 is very low…..low vitamins likely
Once vitamins are tested and at optimal levels, if Ft3 doesn’t improve you need T3 prescribed again
Email Thyroid U.K. for list of recommended thyroid specialist endocrinologist and doctors who will prescribe T3
tukadmin@thyroiduk.org
10mcg of t3 is roughly equivalent to 50mcg t4 which was probably just enough to keep you stable. You could be converting your t4 to rt3 making things worse .
T3 is usually seen as three to four times the stength of T4 so 30- 40mcg of levothyroxine as a guide for 10mcg of Liothyronine. Different sources suggest different values but 5xs is on the high side. Ultimately its how each individual responds and feels........if doctors would but listen & heed lol....
Not sure because you have had surgery just what has been going on in your situation, but I will share my experience. I was Dx on a lab test and no symptoms at all. When I started taking Levothyroxine I felt like how they describe people taking "speed" . I developed symptoms of someone with hyperthyroid . When I complained I was told "you just have to get used to feeling normal" and they kept increasing the dosage. I suffered from 1/2013 - 9/2017 when I told the doctor I was weaning myself and that is what I have done. After one year on the Levothyroxine I developed low grade elevated BP ( never had anything close to an elevated BP) and placed on 2 BP meds. I was never told that Levothyroxine can trigger elevated BP . I learned in 2017 when weaning myself . I found it in the Mayo Clinic literature which is a well know mainstream hospital here in the U.S.A. . I am discouraged by the either lack of knowledge or willful disregard of the healthcare community. I am grateful for this support site. I wish you well and hope some have more helpful answers than myself cause it is a difficult journey this thyroid stuff.
See e-enm.org/upload/pdf/enm-20...
Key paragraph:
"In a study evaluating tissue function tests before total thyroidectomy and at 1 year postoperatively when using LT4, it was found that peripheral tissue function tests indicated mild hyperthyroidism at TSH <0.03 mU/L and mild hypothyroidism at TSH 0.3 to 5.0 mU/L; the tissues were closest to euthyroidism at TSH 0.03 to 0.3 mU/L [48]."
Reference 48 is:
Ito M, Miyauchi A, Hisakado M, Yoshioka W, Ide A, Kudo T, et al. Biochemical markers reflecting thyroid function in athyreotic patients on levothyroxine monotherapy. Thyroid
2017;27:484-90
ncbi.nlm.nih.gov/pmc/articl...
Okay, you are not a total thyroidectomy patient, but your TSH at 0.3 your natural thyroid function is likely to be very suppressed, so the above literature starts to apply to you.
My instinct tells me that at some point you have had dose creep, which happens with Levo mono therapy. Levo goes up, own function goes down, levo has to go up more, own function goes down more, etc.
Building on this what others have said in their replies, I think you have three directions to take this:
1) Keep the levo as is and take additional T3, i.e. go back to how things were.
2) Increase the levo until your TSH is between 0.03 to 0.3 mU/L, i.e. assume your own thyroid is doing nothing and see through the dose creep to it's natural end point..
3) Reduce your levo and try to coax your remaining thyroid back to life to benefit from your own T3 production. I.e. reverse the dose creep.
(3) sounds totally nuts, but it is logical and it might give you a more sustainable result depending on your background... In the absence of Hashimoto's or something else preventing your own half thyroid from doing it's job or there being a need to suppress TSH (e.g. following thyroid cancer), someone with half a thyroid usually only needs a small amount of Levo to replace the missing half. For example, 50mcg / day Levo is something I have seen amongst my acquaintances.
Simply cutting the Levo would be painful, but if you were able to reinstate the 5-10mcg Liothyronine temporarily then, as fT4 has a greater suppressive effect on TSH than fT3, you would have the breathing room to reduce the Levo in stages down to 50mcg, without your fT3 suffering so much. In the process you should find your TSH comes back up to a healthy level and your own thyroid will kick back into action. Then you will find that you can (or actually have to) reduce the T3 in stages to zero.
With your own thyroid back online you will be much better equipped to cope with changes in your environment, stress and illness.
And, yes, talk to an Endo.
I had a thyroidectomy 43years ago and they left only a tiny bit of thyroidwhich I think will no longer be working so maybe I need to increase my
levethyroxine but GP’s haven’t a clue about thyroid problems.
Request GP to give you a new blood test which should be at the earliest possible, fasting but you can drink water.:-
TSH, T3, T4, Free T4, Free T3 and thyroid antibodies.
Don't take thyroid hormones before - take it after your blood draw.
If GP has not tested Vit D, iron, ferritin and folate request these at your next blood test and post for comments.
Am I over medicated now?
Am i being over medicated? 
Over medicated? 
Blood Test Results - Am I under-medicated? Do I need to Change from Mono T4 to T3 Combo or NDT?
I am under medicated? First 6 weeks test results.
