Hello, I'm 24, hypothyroid with Hashimoto's. I just got labwork done because after some recent trouble sourcing medication and taking different things, I've finally been on T3 only for 6+ weeks, which I have done in the past and felt well on. I'm currently taking 50 mcg a day, dosing based on symptoms.
My symptoms have been good for the most part, except for occasional deep fatigue in the afternoons, which doesn't tell me a lot because it can happen with both too much and too little medication. Hence the labwork.
I ordered TSH, free T3, and free T4 and was interested in comparing them to the optimal levels given by Stop the Thyroid Madness. My TSH has been 0.005 for the last couple of years since I was doing T3 only also at that time. So I am not sure why it is now rising. Is anybody familiar with lab work done while on T3 only? Does this look like I might be slightly hypo still?
Also, I didn't order the thyroxine, the T3 uptake or the free thyroxine index but they still tested them for some reason. Are they helpful at all and if so, what do the levels show?
Thank you!
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silverequus
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I've been pondering over your results today as they are conflicting.
Generally unbound ‘free’ thyroid hormone is measured because this is the form that becomes active (when conditions are right). TSH & FT4 are low as expected when taking T3-only meds, but your FT3 result is presenting very low for a medicated dose of 50mcg.
‘T3 uptake’ indirectly measures the binding capacity of TBG which binds and carries thyroid hormone around the body, and free thyroxine index is a calculation of total T4 divided by the T-uptake ratio. (If you understand an iron panel, then this is similar).
That was actually October for that particular one, some of the last tested dates are May 2021, while TSH, FT3, and FT4 are from October 2022. For that October test I had been taking 62.5 mcg of T3 up until maybe 2 weeks or so before testing. I had run out of T3 and I think I was taking 2 grains of The Real Thyroid NDT, though I also used a thyroid glandular around that time. So it might not be too accurate since I was just using whatever I had on hand while trying to get the doctor to give me a T3 prescription.
I can't suggest why you have such low FT3 levels when medicating 50mcg T3-only, but if you are not symptomatic maybe this test isn’t presenting right either 🤷♀️. Sorry I can't be more helpful but maybe others will contribute.
Thanks for responding! I'm not too worried since I'm not feeling terrible with what I'm doing, but maybe I'll try more labs in a few months and see if anything's changed. I'm a bit confused too.
Elevated oestrogen can encourage the liver to produce high levels of a protein called TBG (thyroid binding globulin) which risks binding thyroid hormone and decreasing the amount assimilated into cells. Testosterone does the same only with a protein called SHBG.
High levels of T3 are known to increase SHBG anyway and the T3 uptake test (T3 resin) indirectly measures the binding capacity of TBG. The free T4 index can be calculated using T3 uptake and TT4 (not free) and both were low.
A main cause of low T3 uptake is elevated TBG in the blood because it measures the percentage of TBG bound to thyroid hormones, ie an elevated TBG means there’s more to bind thyroid hormone and less uptake. These results can be difficult to interpret (much like RT3) but I was trying to assume what levels protein carriers were to find a reason for FT3 only being 20% through range when O/P is medicating 50mcg T3-only.
- premature menopause (early 30s) / did not get HRT
- 2017, age 48, diagnosed with hypothyroidism (Hashimoto's) - my mother and siblings had all previously been diagnosed so...after a bit of tweaking, have been taking 75 mcg levothyroxine daily.
- 2019, age 50 diagnosed with osteoporosis, lumbar spine T-score was -3.9 on 1st DEXA. From Jan. 2020 through mid-July 2021, endocrinologist prescribed and I took alendronate (oral bisphosphonates). It caused digestive tract issues. Took a 4 month holiday. In November 2021, at my endocrinologist's urging, I had my 1 zoledronic acid infusion. My endo was expecting me to have a 2nd infusion this past November but I have put that on hold for now.
I don't want to take the traditional osteo-meds because I don't think the bisphosphonates are actually helping the way they are supposed to. My endocrinologist failed to do any testing prior to prescribing meds, he looked that my DEXA summary and pulled out his prescription pad, and I didn't know any better. I've found an OB/GYN who is now willing to prescribe HRT and many women see improvements in BMD when doing HRT.
I am starting to think that maybe my thyroid was whacky long before 2017--no one has ever figured out why I went through such an early menopause and when I recently dug up a Thyroid test that I had in 2000 my TSH at that time was 3.30, which is in the "normal" range but from what I gather many doctors think that the "normal" range is way to wide and that it is more normal to be closer to the lower in of the normal range.
I have no idea if HRT will work for me I'm 20+ years postmenopause, but it might be worth a shot.
I live tired. For decades I have gone around talking about being tired and I really thought I was just one of those people who said things out loud and everyone else was probably tired too but just not saying it. Now, I'm thinking maybe more can be done to tweak my thyroid and potentially help my bones out in the process.
Here in the UK the prescribing of body-identical HRT is slowly becoming more common practice as is so beneficial, and being introduced at any age thought necessary, ie before start of menopause, during or after. There is also thought if benefits are seen we should stay on it for life.
I was diagnosed oesteopenic in my late forties and immediately offered bone preserving treatments which I declined. Subsequent DEXA scans have evidenced improved BMD which I attribute directly to now adequate FT3 levels and HRT but also what this has allowed in the sense of improved functioning and all round better resilience, ie improved nutrient absorption, more varied exercise, good healing, improved stamina, etc. We almost have to function well to keep well.
The other thing to consider is Vit D that helps your body absorb and use calcium. It is a fallacy we need to supplement calcium for our bones, and both calcium and Vit D levels should be measured before supplementing. I’m still having regular bone profile labs taken (think the GP's repeat button has got stuck on!) and so can monitor my calcium levels and have always gained sufficient from diet. Vit D I test privately annually and supplement generally October to April.
Ensure HRT is body-identical and both oestrogen and progesteron are prescribed.
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