letter from consultant

[Rowing2]

hi, this is the letter I received from the consultant today 🥴😡🤬🤬🤬🤬🤬🤯

[Rowing2]

Consultant letter

letter

[Lalatoot in reply to Rowing2]

I wouldn't be overly angry. That is the sort of letter that many of us have had from consultants.File it and move on.

There are no ranges with your results. You don't mention the gap between taking your liothyronine and the blood test.

If those were my results assuming average ranges then the ft4 would be too low and the ft3 too high . That would be making me symptomatic. I would consider lowering the t3 dose and increasing the levo dose. I started out on a combo of 50mcg levo and 20 lio but that still left me very symptomatic . My ft4 was 0% through range and my ft3 76%. What I have ended up on dose wise is 100 levo and 7,5mcg lio. This keeps my ft4 at 50% and my ft3 at 72% and this suits me so much better.

[SlowDragon Administrator]

What’s the range on Ft4. Result looks low

And Ft3 likely too high

No folate or B12 results

What vitamin supplements are you currently taking

Are you on strictly gluten free diet or dairy free diet

Do you always get same brand levothyroxine at each prescription

I would agree with Lalatoot you likely want to experiment with taking less T3 and increase in levothyroxine

Suggest you increase levothyroxine to 100mcg and reduce T3 to 3/4 of tablet of T3 per day

Retest in 6-8 weeks

Can you get prescription for 100mcg daily?

You may be better splitting the T3 as 3 x 1/4 doses spread through the day ……waking, mid afternoon and bedtime

Some of us also prefer splitting levothyroxine…..half dose waking and half dose at bedtime

[Carolynncg]

Hello - in one way you are lucky - you at least have been to see a consultant I was never referred to one and was only prescribed Levo for a short period of time because I did a private blood test which advised I see my GP! I see other experienced members of the forum have offered advice. I wish you well going forward x

[samaja]

The most important question in all this is how you actually feel? You are still symptomatic according to the letter and your results are fairly typical for someone on T3 and we can go to and fro on whether the higher fT3 is becuase of the insufficient gap between the last dose and the draw or being a bit overmedicated but as you don't mention your signs (heart rate, blood pressure and temps) it's all just guessing and speculation.

What we also don't know is how good a converter you really are and this is important because if all the levo you are taking is going largely to rt3 than increasing it will not give you any improvement while decreasing it further and increasing your t3 might be much more effective.

[DippyDame in reply to samaja]

samaja ...a thought!

If all the levo you are taking is going largely to rt3 ...

Rowing2's FT4 is only 12 pmol/L which (even without a given ref range ) looks low....

However...

FT4 this low won't be converted to rT3 .....that happens to excess FT4 not " all the levo you are taking"

So rT3 is unlikely to be affecting T4 to T3 conversion in this case.

Rowing2 's high FT3 is more likely to be the result of too much exogenous T3 which in turn is reducing her FT4

[DippyDame]

Typical endo response particularly his words "it is difficult to comment....."

They fly by the seat of their pants!

To omit ref ranges is clueless .....or deliberate.

You need what you need to feel well not what it says on a screen that you should take.

It may have helped if you had increased your levo from 75mcg ( initially 100mcg) to nearer top of ref range before thinking of adding T3

Do you know if your T4 to T3 conversion is good? Almost impossible to judge once T3 is added.

Did you add T3 because conversion is poor.....or because you just thought it might help.

I'd be incline to lower your T3 by a quarter tablet ( 6.25mcg) Wait 6 weeks and re-test. You might then raise levo to 100mcg. We try to change only one thing at a time otherwise it's difficult to work out what is doing what!

Just a thought.