This paper by the distinguished author Ito et al shows that FT4 levels often fall out of range when FT3 is in range. TSH was also poor at diagnosing best treatment.
Proportion of serum thyroid hormone concentrations within the reference ranges in athyreotic patients on levothyroxine monotherapy: a retrospective study
In patients receiving thyroid-stimulating hormone (TSH) suppressive therapy with levothyroxine (LT4) after total thyroidectomy for thyroid cancer, thyroid function tests should be performed to adjust the LT4 dose. Specifically, serum TSH concentrations are commonly measured because TSH suppression is necessary according to thyroid cancer risk. The aim of the present study was to elucidate whether free thyroxine (FT4) or free triiodothyronine (FT3) indicates better for adjusting the dose in athyreotic patients on LT4 monotherapy after total thyroidectomy.
Methods
We retrospectively studied the compatibility of free thyroid hormone (FT4 and FT3) concentrations with reference ranges in athyreotic patients on LT4 monotherapy after total thyroidectomy.
Results
We identified 2210 consecutive patients from their medical records. Of these patients, 250 had both FT4 and FT3 concentrations in addition to TSH. Two hundred seven had serum TSH concentrations below the reference range (0.5–5.0 μIU/mL), while 43 had them within the reference range. In the 207 patients with TSH concentrations below the reference range, 61 patients (29.5%) had FT4 concentrations within the reference range (0.9–1.7 ng/dL) and 146 patients (70.5%) had FT4 concentrations above the reference range. In contrast, 10 patients (4.8%) had FT3 concentrations below the reference range (2.3–4.0 pg/mL) and 8 (3.9%) had FT3 concentrations above the reference range; 189 patients (91.3%) had concentrations within the reference range. Of the 43 patients with TSH concentrations within the reference range, 25 (58.1%) had FT4 concentrations within the reference range and 18 (41.9%) had FT4 concentrations above the reference range. While, 11 patients (25.6%) had FT3 concentrations below the reference range and one (2.3%) had FT3 concentrations above the reference range; hence, 31 patients (72.1%) had FT3 concentrations within the reference range.
Conclusion
This study showed that measuring FT3 concentrations rather than FT4 concentrations as the subsequent parameter of thyroid function might be more useful for disease management in terms of the proportion of serum thyroid hormone concentrations within the reference ranges. Furthermore, FT3 measurement could be useful in providing more detailed treatments, including avoiding more aggressive TSH suppressive therapy and identifying the presence of low T3 syndrome in the background.
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diogenes
Remembering
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I wish more endocrinologists would read these appropriate research results and prescribe T3 instead of T4.
They should put more emphasis on 'how does the patient react to replacement thyroid hormones' as some patients may feel worse on replacement thyroid hormones than before they were diagnosed but many Endocrinologists seem to be unaware of this fact.
I personally am aware of the good effect when replacing T4 with T3.
I have an anecdote which might be interesting. For 13 years I worked in Clinical Trials for blood tests developed by the Company, Amersham. I was responsible for the statistical analysis of the results doctors sent in from their triallist experience. The first FT3 test was developed in 1983 and trials completed in that year. This was before the development of sensitive TSH tests - detecting hypothyroidism was easy, but the test couldn't then detect over treatment or hyperthyroidism. The patient group on T4 only gave a very interesting result. As with this Ito paper, I found that all patients diagnosed by doctors as adequately dosed (by FT4 only - note TSH test insufficiency and thus a greater diagnosis by presentation) the FT3 results produced a distribution of patient values exactly mimicking healthy normals. FT4 results quite often exceeded that test's reference range. Note the same conclusions here. I wanted to publish our findings, but the Company refused permission. A sad case of "if only". I always regretted this omission
I 'bit the bullet', not to taking T3 all in one go [which I will try...] but by simply putting my dose back up to where it was in 2015,,, when ludicrously un_diagnosed [endo had contempt for Dr S and Dr P] rendering me more ill by being stupid enough to go back some 6 yrs later. of being told not hypothyroid. My freezing shins then went on for 7+ years [bottom part of the body], then this summer the rest finally - in the heatwave - gave up the ghost. My first step, < a month ago, was to raise myself up to the prior dose [75 mcg in winter, now X 3 doses after dropping to 37.5 until much worse, then back up to 50 mcg due to heart issues] + got some super-duper thermals + instead of needing an elect over-blanket on all night, once my temperature began to rise, I let the body work for itself AND IT DID. Only concern was my heart but years back it 'fixed' my arrythmia to unnoticeable [left for 7 years, with GP;s having even confirmed TSH #s before them].
I'm enjoying the warmth, changes to life and how I feel... I don't care too much where my FT3 level is [always used to be over 'range' but, apparently, PP now seems to see this as sometimes necessary!]. I check my vitals and keep a look out for irregularities.
Next step Dr John Lowe here I come. Best wishes, shaws xox Best to diogenes for all of your/teamwork.
I also had the privilege of consulting both Dr S and Dr P and the difference in their attitudes and knowledge far outweigh those of the present day. They also reassured the patient that they could improve and feel better.
One of my GPs phoned to tell me that my TSH was too low, T3 too high, T4 too low. I said "that's because I take T3 alone " and he responded "but T3 converts to T4!
Eek! What a response! Not sure I'd be alive had it not been for Dr S and Dr P - finest of doctors. Those other types simply don't get it... not within them to see other perspectives and to LISTEN.
Yes, we have so much to be thankful for because of those fine doctors, of course Dr Lowe and those who were/are capable of corrigible thought. xox
Indeed - of course we know our bodies and this scandalous conduct has gone on long enough.
Good you at least have supportive GPs. Powers That Be... yeah, I've yet to encounter such a bunch of... NOT acute or 'proper' medicine - which this needs to be - yet we seem to be left with, as my father used to say [poor soul died at 54 y/o with MND], "Quacks who've just scraped though"! I've a Family Horror Health Tree, not necessarily him [ludicrous polypharmacy for 20+ years and that era criticized but still were fed notions of their grandeur, not so much our generation] but the others... poor souls and now it's my/our turn to face them.
Yes, the contempt for those doctors was/is appalling, so no one is able to step outside of their 'little ideas' or face their wrath. Appalling. Dr John Lowe, Dr Mark Starr and many others had so much to give... all have been sneered at.
Unfortunately unable to access the whole document, so it's quite difficult to use the limited text that is available as evidence that the conclusions are entirely accurate. It's a promising argument though
All we need now is this to filter through to clinical practice. Hopefully, it won't take decades for it to do so.
It was disappointing to see that only 11% of patients had fT3 and fT4 tested. Maybe this research will help wake medics up to the importance of doing so.
We were brought up to believe, " doctor knows best"
Been there too!
I only found my voice and my confidence to self medicate after I arrived here and started to read research papers etc and to learn from some of the experienced and knowledgeable members here.
it can be a tough lonely journey...in fact I was saying to my husband tonight that if it hadn't been for this forum I don't know how I would have managed to keep going....I knew it wasn't just me, and that has been critical.
Oh, I certainly was stupid, I KNEW what to expect in that Dept.... yet I was so desperate, it seemed I had no choice. That was the start of a long fought for diagnosis being unraveled FIVE+ years after with the NHS funding Armour T. To be undiagnosed, following Dr S and then Dr P re "You'll need T3 for life", and my being SUFFICIENTLY STUPID to wean down from a dose that clearly had become insufficient, was very silly of me. I have paid a price since 2015 for that. The whole charade is still having ramifications for me to this day. in the wider health sense... disgraceful behaviour. .
In acceptance that some 'fear doctors' - pig-headed ignorance [err, theirs!] was the problem facing me. I so wish I could post the photos on here... depicting my time throughout this, they've been given them. Oh, if you challenge them, they seek to 'make you pay'.
Agreed: this forum has been invaluable, with such knowledgeable and conscientious people. My own background was helpful with research papers and what a wealth of fabulous materials come our way! THANKING everyone who posts [our stalwarts, diogenes and helvella!] and everyone who contributes for the good of the many. Yes, hearing the history of others has been as valuableo as the rest... knowing that others too have/are/will face these difficulties. When will this scandalous conduct change!?
You take care: thank you, I always enjoy your contributions! xox
I am reassured by your emotional response to finding a way to health .It's interesting isn't it ,that when people find out what makes them feel better , AND that they were misadvised for years by patronising experts , that instead of just skipping off into the sunset with joy and health , they feel anger ,and almost take their me.ories of ill health ...(trauma). WITH THEM into the sunset. It would be easier for us to leave the negatives behind ..but we can't because we are SO cross at the waste of potential health , and how these ignorant and patronising charlatans still get away with it. We want to stop others from.having to go through what we have done ,and yet history keeps repeating itself unnecessarily I the lives of others
Yes, most of us know when to 'let go' of stuff that can only further damage... but this level of abuse - with its smug arrogance [aka ignorance] - is simply appalling.
Very good point.Sometimes when unmedicated but Hypo we feel that we would welcome a good fire , coz it's more like being held down in a frozen lake with Hashi
I've been best for years by adding [back up to the prior level of T3 before 'whack job' intervened] before being prescribed steroid eye drops... simply not knowing what these can do!!! Eek - wrecked! Couldn't stop once I discovered... oh well, never again.
Just when you think it's safe to come out of the water... 🦈🦈🦈
I would like to know what T3 feels like? I know it's got a short half life ,so I guess it wears off in system quickly and doesn't show up in blood tests ?? I gather you take 3 pills a day to keep the levels up in system. Does it give you a little short lived boost or what .?I've found an expensive source in USA, thinking of getting some to try out but dithering .It would be self medicating to supplement t4 which I've just been prescribed on prescription on low dose to start with ....just wondering .
When T3 is working for you - you just feel as you were before 'ill as that dog'. No, nothing like 'speedy', just feeling good as you once did. Why do you feel you need T3? I now do take x3 doses of hormone each day - trying to work to allin one go... I've the strength of an ox and the b*lls of a lion... but just got my heart back to being fine again... One day, I'm hoping to do it.
Apparently there is an insider joke that doctors are lucky in their profession because “their mistakes are always buried”. We with hypothyroidism must be a real pain to doctors, as both we and they, can watch as they kill us slowly with their ignorance. Cheers.
Although my story is not as bad as yours my emotions are the same ...impotent fury . We are disempowered ...who owns our health or lack of it ? Who owns our bodies ? It feels like we are treated like peasants who are the property of an overlord( NHS) It's like we have no agency over ourselves .. Surely the NHS ..being a HEALTH SERVICE to the community is at our service whereas they see themselves as our masters or overlords . I am totally in sympathy with you and in your debt that you've taken the time and mental energy to share this with me. Two questions are you now feeling a bit empowered now taking t3 ? Are you feeling a bit better,?
I've been taking T3 since 2011 - way better with it - especially since seen by Dr P... I don't rely much on anyone BUT where this kind of stuff is concerned, we need better than those thrown at us! Yes, as stated, I'd likely be dead without T3 - with the correct dose for me, I'm almost as before being ill [except for the illnesses acquired on the way!!]. Great stuff. 💚💛🍀
Hey, we all have our own tale to tell, many of them grotesque. These docs, many of them schoolboys with science 'A' Levels - moving into [some of it out of necessity] a highly prescriptive 'routine', seem unable to look and see what is before their eyes. Therein lies a huge problem. Without a grounding in statistics and methodology, philosophy and psychology, they are way too underequipped. Yes, people paid for by the 'Public Purse' used to be referred to as 'Public Servants' [well, docs likely escaped the servant bit, but when the State pays then, they really ought not to forget themselves]. Of course, there are excellent doctors in all fields yet the thyroid and CFS/ME seem... I have no words.
I'm fine, I only write so much because I can - as stated - no longer precis but also because all manner of things do happen to people; something might resonate, IF they get past the huge amount!
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SORRY! xox 
TSH, FT3 & FT4 results
Adjusting T3/T4 dose 
ideal FT3 and FT4 levels on NDT
