Advice on latest results

[Pen1966]

TSH 1.2 range 0.3 to 5.5

T4 28 range 12 to 22

T3 3.9 3.9 to 6.8

Test done at 8.30 no food or drink before and no thyroxine 24 hrs before currently on 125mgs one day 150mgs next day no biotin 2 weeks before and all other vitamins were normal.

[SeasideSusie Remembering]

Looks like poor conversion. Less Levo and add some T3.

But, are your nutrient levels optimal, they need to be before adding T3, have you tested recently?

[Pen1966 in reply to SeasideSusie]

What are nutrient levels ?

[SeasideSusie Remembering in reply to Pen1966]

Vit D - recommended to be 100-150nmol

B12 - recommended to be top of range for Total B12, for Active B12 then over 100

Folate - at least half way through range

Ferritin - half way through range although some experts say that the optimal level for thyroid function is 90-110ug/L

[Pen1966 in reply to SeasideSusie]

B12 is 452Vitamin D is 150

On ferrous fumerate as iron levels low

[greygoose]

Am I hallucinating, or did you forget to put the restult for the FT3? Looks like just the range, to me.

[Pen1966 in reply to greygoose]

Sorted

[greygoose in reply to Pen1966]

👍😊

I agree that your conversion is very bad. And, whilst optimal nutrients are crucial, I doubt if they will have much impact on your conversion, it's too bad. You're not on a low-calorie diet, are you? That will scupper conversion.

[Pen1966 in reply to greygoose]

No im not I have no hope of getting T3 from endo in Bournemouth all they keep doing is altering my dose of levo which in turn makes me feel awful. I do have a box of tiromel that was gifted to me 25mg tablets not sure what to do

[Bean101 in reply to Pen1966]

Hello Pen, I live in Bournemouth and I have seen all the Endos in Bournemouth and Poole. I have been on this merry go round for 25 years. Unfortunately you will not get T3 prescribed. I am a poor converter.. and went private. I see a functional Dr

Good luck

[Pen1966 in reply to Bean101]

I live in Muscliff cannot afford to go private 😒

[greygoose in reply to Pen1966]

Yes, it can be very hard to get it prescribed. Which is why most people buy their own on-line, with no prescritpion. But, no point in starting unless you know you have a steady supply. One box won't go very far.

However, if you do manage to find a supplier (ask on here for people to PM you their trusted sources) then you would just follow the normal protocol for adding in T3: start with 1/4 tablet, and increase by 1/4 tablet every two weeks, until you feel well - possibly at 3/4 to 1 whole tablet - then hold that dose for six weeks and retest.

As your FT4 is so high, you might want to reduce that by 25 mcg one week before starting the T3.

[Pen1966 in reply to greygoose]

will do thank you

[greygoose in reply to Pen1966]

You're welcome.

[Gingernut44 in reply to Pen1966]

Your Endo is doing you no favours and I certainly wouldn’t pay to see him privately. You have a packet of Tiromel- presumably 100 tablets? They should last you enough time to see if they help if you follow greygoose ’s suggestion - drop your Levo by 25mcg per day for a week before adding 1/4 of a tablet (6.25 mcg) etc etc. DO IT, you have nothing to lose and maybe a lot to gain.

[Pen1966 in reply to Gingernut44]

Will try that x

[greygoose in reply to Gingernut44]

I think that's a bit risky. What if they do help but the OP can't find where to buy any more? Or if it's takes a long time to help, as it sometimes does? I think it's best to secure a supply before starting, because starting and then stopping is not a good idea.

[Gingernut44 in reply to greygoose]

True but they are available to buy without prescription and OP could ask for suppliers via PM.

[greygoose in reply to Gingernut44]

Yes, and that should be her first step.

[pennyannie]

Hello Pen :

The accepted conversion ratio when on T4 - Levothyroxine only is said to be 1 - 3.50 - 4.50 T3/T4 with most people feeling at their best when they come in this range at around 4 or under.

So to find your conversion ratio you simply divide your T3 into your T4 and I'm getting yours coming in at just over 7 - showing very poor conversion of the Levothyroxine.

Just to be sure your T3 is at 3.90 and your T4 at 28.00 - is the range for T3 - 3.10 - 6.80 ?

If so your T3 is at around 22% through the range and your T4 over range at 160% :

We generally feel at our best when our T3 and T4 are balanced in the ranges at around a 1/4 ratio - T3/T4 :

T4 is a storage hormone, a prohormone, and needs to be converted by our body into T3 the active hormone that runs the body and said to be around 4 x more powerful than T4 :

OK - I've just looked back and see you haven't a thyroid so this results makes a lot more sense to understand and you must be feeling quite poorly running on such a low T3.

A fully functioning working thyroid would be supporting you on a daily basis with trace elements of T1. T2 and calcitonin + a measure of T3 at around 10 mcg + a measure of T4 at around 100 mcg.

It seems pretty obvious to me that you need to be prescribed T3 - Liothyronine to replace that ' lost ' when you had the thyroidectomy :

Some people can get by on T4 only :

Some people find the T4 seems to stop working as well as it once did and need to add in a little T3 - Liothyronine to the T4 medication, making a T3/T4 combo :

Some people can't tolerate T4 and need to take T3 only :

Whilst others find their health restored better taking Natural Desiccated Thyroid which contains all the same known hormones as that of the human gland be derived from pig thyroids, dried and ground down into tablets referred to as grains.

No thyroid hormone replacement, whether it be T3, T4 or NDT works well until ferritin, folate, B12 and vitamin D are up and maintained at optimal levels and conversion can also be compromised by inflammation, any physiological stress ( emotional or physical ) dieting, depression and ageing :

Obtaining a prescription for T3 of NDT - which contains both T3 and T4 - on the NHS has become something of a post code lottery due to financial constraints rather than medical need.

Thyroid UK the charity who support this forum hold a list of patient to patient recommended specialists and doctors both NHS and private, who are ' sympathetic ' to thyroid patients and it makes sense to referred to someone on the list is you choose to go this route - just contact admin @ thyroiduk.org for the list :

In the first instance I would suggest you talk with your doctor about these results and just see if s/he sees a problem and knows your T3 is too low compared to your T4 .

YourT3 and T4 readings should be balanced in the ranges at around a 1/4 ratio T3/T4 :

and move in a similar ratio to the base numbers stated on the T3 and T4 ranges :

The T3 range starting at 3.10 in relation to a T4 range starting at 12.00 = around a 1/4 baseline ratio of T3/T4 :

Your T4 is over range and the obvious knee jerk reaction is to reduce your T4 medication but this maybe at the expense of your T3 reading and I seriously think you need to have a specialist monitor and dose you on both T3 an T4 restore hormonal balance and health and well being.

Doctors in primary care can only prescribe T4 and the obligatory anti depressants and you will need to be referred to an endocrinologist so best to go to one from the Thyroid UK list if at all possible.

[Pen1966 in reply to pennyannie]

Thyroid removed 32 years ago take spray b12 once a day and am on ferrous fumarate 210mg once a day

[pennyannie in reply to Pen1966]

Yes I 've just rewritten everything as I looked back !!!

[Pen1966 in reply to pennyannie]

I am under an endo at the hospital who is adamant that I do not have a conversion problem and said only tsh and t4 are monitored by them.Sadly if I were to gonprivate in my area hes the same one I would see.Cannot afford it anyway as my hours of work have been cut to 16 due to ill health with being diagnosed with fibro and CFS recently am now on benefits and have no other help

[pennyannie in reply to Pen1966]

I'm just reading your previous posts -

It's absolutely disgraceful :

I too haven't a thyroid - RAI thyroid ablation for Graves back in 2005 - and I found no help through the NHS back in around 2015/16 and after being refused NDT and T3 and referred o as a conundrum and started to distance myself - details on my profile :

I now self medicate with Natural Desiccated Thyroid and am much improved and haven't been back to the doctor in last 5 years as fighting the system was simply exacerbating my symptoms.

Whichever way you choose to go, you will need to get those vitamins and minerals up at good levels and maintain them.

I now need to maintain and supplement daily/weekly my ferritin to be around 100 : folate around 20 : active B2 around 75++ and vitamin D around 100 :

[Pen1966 in reply to pennyannie]

I cannot afford private this has truly affected my life and finances at my Watts end with it all

[pennyannie in reply to Pen1966]

I understand - and why I decided to self medicate as the NHS were keeping me ill, housebound and with severe mental and cognitive functions :

Let alone having to replace around a dozen teeth.

It was my dentist who insisted I get checked out as he first thought I was dealing with after effects of cancer treatment and then I explained that I had Graves Disease and had RAI treatment around 10 years previously.

He then just smiled and mumbled and then wavered his part of the fees for fixing me up with front teeth that didn't fall out if I wanted to speak to anyone for longer than 5 minutes !!

I'm guessing the rules and guidelines in Bournemouth are such that all doctors are under the ' cosh ' so guess you've discounted seeing another doctor ?

[Pen1966 in reply to pennyannie]

Yes as are all the same

[SarahJane1471]

You could try getting a referral to another endo on the ThyroidUK list who is NHS. As far as I am aware you can be referred to anyone in the country but you would need to make you own way to the appointment. This may have changed policy wise in recent years.Find one in a different CCG area, but nearby, who is T3 friendly

[Pen1966 in reply to SarahJane1471]

Dont think my gp will do that all i can do is ask

[SarahJane1471 in reply to Pen1966]

Check because your GP can’t refuse. That’s the whole point of choice in the NHS. Unless I’ve missed a new directive you can name someone. I did for a genacologist a few years ago. Ended up travelling to London when I found the top consultant.

[Pen1966 in reply to SarahJane1471]

Called them and refuses

[pennyannie in reply to SarahJane1471]

Yes, and with the current situation many are doing video chats and appointments on line so distance may not have to be the deciding factor.

[Pen1966 in reply to pennyannie]

No joy with referral to different endo from gp says they are not able to refer out of area

[pennyannie in reply to Pen1966]

I do not think that is correct -

but don't know for sure -

hopefully someone will come along and help me out -

I thought you were allowed a second opinion by a specialist of your choice - whether that be in or out of the county where you reside :

I confess I couldn't continue with my fight for better treatment with the surgery, hospital and CCG and jumped ship and did it for myself as the stress of all simply exacerbated the health issues I was trying to resolve - think I've got PTSD from it all and haven't seen a doctor for over 5 years orso and don't know how I would react should I need to.

[SarahJane1471]

You can ask for a second opinion anywhere you want 🤷‍♀️

[SarahJane1471]

I’ve just checked on the NHS website and you can choose anywhere you want for a referral ( I don’t know how to post a link).

[Pen1966 in reply to SarahJane1471]

Still has to be actioned by gp and mine is not willing

[SarahJane1471 in reply to Pen1966]

Have you seen the NHS guidelines? You can make a complaint to the practice manager…… your GP is going against the guidelines

[Pen1966 in reply to SarahJane1471]

No i have not

[Persevere99]

Hi Pen1966

What are your thyroid related symptoms please?

Numbers are secondary to how you actually feel.

All the best

Persevere99

[Pen1966 in reply to Persevere99]

I am having numerous issues and have been for many months limbs ache and are weak not sleeping well waking up in a sweat 3 to 4 times a night. Headaches feeling nauseous fatigue low moods continuous thrush infections of the mouth. I also get periods of internal fizzing gastric and bowel issues as well. Dry throat dry nasal passages etc etc. Gps have said i have fibro and cfs but i really believe that i have a conversion issue but the endo at the hospital will not see me despite me asking.