Latest blood test results. Can I get some advice please?

[BookLover2020]

Hello All,

Below are my latest blood test results (27th August 2022). I am currently on

100mcg Levothyroxine. Blood sample taken before 8am. Levothyroxine taken after the blood draw.

TSH - 0.54 mIU/L ( 0.27 - 4.2)

FT4 - 20.1 pmol/L (12.0 - 22.0)

FT3 - 4.9 pmol/L (3.1 - 6.8)

Fasting Insulin - 9.7 mIUL/L ( less than 10)

Reverse T3 - 14 ng/dL ( 8-31)

Fasting Blood Glucose - 5.3 mmol/L (3.9 - 5.8)

Fasting Triglycerides - 1.8 mmol/L ( < 2.3)

Fasting Cholesterol - 5.8 mmol/L (Optimum < 5.0)

LDL Cholesterol - 4.1 mmol/L (Upto 3.0)

Non-HDL Cholesterol - 4.9 mmol/L (<3.8)

( I haven't done the Vitamin - D or other Vitamin tests this time)

I still experience the symptoms of brain log, tiredness etc ( relying on strong coffee throughout the work day)

I may have a lost bit of weight but not sure how much.

I have an appointment with my endo next week. He is open to the idea of prescribing T3.

I would like to try T3 this time. I am thinking about two options:

1. Either add a small amount of T3 to currently 100mcg T4 or

2. Switch to T3 completely.

In terms of brands, I have two in mind

1. Thybon Henning T3

2. Cytomel T3

Any suggestions or comments welcome!

[SeasideSusie Remembering]

Is this a private endo or NHS?

If you add T3 then as your FT4 is 81% through range then lowering your dose of Levo by 25mcg is suggested. A week or so later start with T3, 5mcg to start and increase by 5mcg at a time, 10-15mcg might be enough. I wouldn't go over to all T3 without trying combination first.

If NHS endo you won't get Thybon or Cytomel on NHS prescription. Thybon tends to be private prescription.

[BookLover2020 in reply to SeasideSusie]

Thank you SeasideSusie . This is a private endo.

In terms of T3 brands, which one would you recommend?

My understanding is that Cytomel is strong but is expensive.

On the other hand, Thybon Henning T3 is good value for money.

[SeasideSusie Remembering in reply to BookLover2020]

Different brands suit different people. I've only ever used one brand and it isn't either of them as I don't have a prescription, private or NHS.

[BookLover2020 in reply to SeasideSusie]

SeasideSusie

On a different note, I have always felt sluggish, even in my younger days.

I was putting that to laziness but I do know that my sister was and still an active person. My thinking is that perhaps it's because I was unlucky and I inherited the DIO2 gene mutation and she didn't. It's a theory and I don't have evidence that she hasn't inherited. But I do know that I have the DIO2 gene mutation.

So, my question is, this sluggishness (before I started taking Levothyroxine), is it related to the T4 to T3 conversion issue?

Apologies, if the question is unclear.

[SeasideSusie Remembering in reply to BookLover2020]

So, my question is, this sluggishness (before I started taking Levothyroxine), is it related to the T4 to T3 conversion issue?

It could be possible, but could only really be answered if you have test results from then.

[BookLover2020 in reply to SeasideSusie]

Thank you. I do have the old test results but unfortunately, it's for

TSH and FT4 and not FT3 if I remember correctly. Also, I did have cholesterol issues even then.

[Noelnoel in reply to SeasideSusie]

Hi SeasideSusie

I can see FT4 is high but I don’t know whether those numbers show good/bad/reasonable conversion. I l’ve read on here that taking T3 will naturally lower FT4 and I want to understand under which circumstances a reduction in levo is advised

In this case is it because FT4 is high and adding T3 may lower/suppress TSH and that a too low TSH with high FT4 is a bad idea?

Thanks

[SeasideSusie Remembering in reply to Noelnoel]

Noelnoel

I don’t know whether those numbers show good/bad/reasonable conversion.

Besides looking at percentage through range for FT4 and FT3 - in this case 81% and 48.65% respectively - there is another way to look at conversion, we can divide FT4 by FT3 when the units of measurement are the same.

It's said that good conversion takes place when the ratio is 4:1 or less. In this case we have

FT4: 20.1

FT3: 4.9

so 20.1 / 4.9 = 4.1

So not dire but not particularly good.

I l’ve read on here that taking T3 will naturally lower FT4 and I want to understand under which circumstances a reduction in levo is advised

In this case is it because FT4 is high and adding T3 may lower/suppress TSH and that a too low TSH with high FT4 is a bad idea?

It's not usually suggested adding T3 until TSH is below 1 and then the suggestion to lower dose of Levo is generally based on how high the FT4 is. In this case TSH is below 1 so we know conversion is as good as it gets, and with FT4 at this level then lowering dose of Levo is probably right. 25mcg might be too much, 12.5mcg might be better, but it's all a case of experimenting and seeing what's right for the individual and, of course, this takes time and gradual tweaking of dose of each hormone to find whatever levels of each suit.

The OP might be one who is fine with a lowish in range FT4 as long as FT3 is in the upper part of it's range (getting FT3 into the upper part shouldn't be too much of a problem as it's not far below half way so I wouldn't expect a high dose of T3 is needed in this case), but they may also be like me and need both FT4 and FT3 over half way through range, only time will tell. As always, there's no one size fits all.

[Noelnoel in reply to SeasideSusie]

SeasideSusie thank you, I understand now but one more question: why isn’t that conversion rate a good one

It's said that good conversion takes place when the ratio is 4:1 or less. In this case we haveFT4: 20.1FT3: 4.9so 20.1 / 4.9 = 4.1So not dire but not particularly good.

[SeasideSusie Remembering in reply to Noelnoel]

SeasideSusie thank you, I understand now but one more question: why isn’t that conversion rate a good one

Because it's said that good conversion takes place when the ratio is less than 4:1 (some say 3.5 : 1).

In this case it's 4.1 : 1 so as I said it's not dire but not as good as it could be. Take into account that the OP has decent nutrient levels, high FT4 and middling FT3, DIO2 gene variant, high cholesterol plus symptoms then trialling T3 seems to be a sensible thing to do.

I think we have to remember that as ever nothing is set in stone, we are all different but the one thing we have in common here is that we have wonky thyroids for whatever reason. Individuality must come into it and what's right for one isn't necessarily right for another - the ratio of 4.1 : 1 might be perfect some one, others may need it lower, so we have to find what's right for us by experimenting with gradual changes.

[Noelnoel in reply to SeasideSusie]

That all now makes sense. Thank you for explaining