A quick question about T3

[Tythrop]

In health with no supplements , at what time would you expect the highest t3 blood reading?

[SeasideSusie Remembering]

Tythrop

Looks like midnight according to Thyroid Patients Canada

thyroidpatients.ca/2020/07/...

FT3

[tattybogle in reply to SeasideSusie]

lol "SNAP"

[Lalatoot in reply to SeasideSusie]

“FT3 levels peak approximately 90 min after TSH levels at around 0404 h and remain above the median level from 2200–1000 h.”(Russell et al, 2008, “Discussion” section). SeasideSusie This text is on the same page as those graphs you shared.

[tattybogle]

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[tattybogle in reply to tattybogle]

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[Tythrop in reply to tattybogle]

Thanks to all

[amala57]

That's why I take my biggest dose of ndt at bed time. The t3 helps me sleep! 😴

[Tythrop in reply to amala57]

That's interesting, I thought thyroid things give you " get up and go"

[shaws Administrator in reply to Tythrop]

If we're not on the correct dose that suits our bodies we will feel symptomatic.

[helvella Administrator Thyroid UK in reply to Tythrop]

Too many doctors think that!

Further to the other replies, the peak of T3 caused by taking a dose of T4 occurs about 48 hours later. Which makes thinking it through somewhat difficult!

[Tythrop in reply to helvella]

I'm interested in t3 levels because I'm preparing my argument to prove that I'm hypo Hashi, and trying to understand myself .

So when I see a below-range t4 and an IN range t3 I get confused ( am I or aren't I hypo?).

I'm happy that I can now overcome the tsh argument (thanks to Diogenese,' info on "Hysteresis" of Pitutory or " disease related tsh supression" ,).

But then I look at the (one and only) t3 test by NHS which shows t3 in- range but accompanied by a very very low t4 ..

..This muddies the water a bit .So I'm wondering if the t3 number is to do with time of day the blood test was taken ,.. If early morning ( as it is ) and if the t3 pulse from the Thyroid ( albeit knackered due to Hashi) takes place overnight with t3 being used up over the day , could the early morning time of blood draw explaine the satisfactory t3 number ,? ,( I know that the Thyroid gland sends out some t3 but mostly , t4) My T4 is low and has been for years ' coz of advancing Hashi,.

So.....If you were in the decision seat would that argument persuade you that mid range t3 doesnt cancell out low range t4 ?

Here are my readings are with no medication : t3 is 4.9 (3.1- 6.8 ). t4 is 11.4 ( 12-22) And a year or 2 later on very very low dose Armour of 1/4 grain( about 10 microg) :T3 is 1.76 and T4 is 13

???

I need to get a life ,but I feel.too knackered to do so

I bet you wish you hadn't responded .

[helvella Administrator Thyroid UK in reply to Tythrop]

Am not sure whether this reply will help or confuse!

When someone becomes hypothyroid, it is sometimes very clear that, as their FT4 drops, their FT3 at least maintains its level and can even rise.

Our thyroid system tries to "defend" T3 levels as the imperative for our bodies.

[Tythrop in reply to helvella]

This makes complete sense .OK thanks .

[tattybogle in reply to Tythrop]

I think it would be a really good idea to write a post that just had your full history of TFT's in chronological order, , with what /if any thyroid hormones were being taken at the time of test ( +any info about thyroid antibodies/ ultrasound findings and any potential pituitary info eg ?sheehans )

I find it much easier to think something through if i've got something like that in front of me ( and i know i'm not the only one) .

Knowing the 'missing bits' that you didn't mention changes the answers we give , eg we can explain that fT3 is often protected as fT4 falls in early hypo... but.... we think that effect is due to the high TSH , and if you didn't happen to mention you had a low TSH we can end up barking up the wrong tree .

or, if we didn't know you were previously hyper and were on carbimazole and block and replace for 3 years ,it changes the way we think about the questions you pose ... i didn't realise you had that history until i found it the other day because the info isn't presented clearly all in one place.

lay it out like this :

Date / dose / how long on it before test.

TSH: 0.0 [0.0 - 0.0]

fT4 : 0.0 [0.0 - 0.0]

fT3 : not done

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Date/ dose / how long ...

TSH :

etc.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

i'm just going to copy and past my 'Tythrop~ history' list from the other day on here for now because i just had a heck of a job finding it again just now (while trying to remember if it was you who mentioned ?sheehans ).

"just done some digging in your history :

post partum hyperthyroid>>> carbimazole >> Carbimazole/PTU plus Levo for 3 years (block and replace) >>> then nothing for many years.

Then>>> history of low fT4 but TSH did not rise appropriately / TPOab positive, but GP and ENDO both refused to treat 5yrs ago.

So in the end you self medicate NDT. and titrate up to 1.75 grains.

you had these results on 1.75 grains

Sept 2020 ~1.75grains NDT

TSH: 0.005

fT4: 14.6 [12-22]

fT3: 6.81 [3.1-6.8] this suggests to me that you can get decent levels of T3 if you take enough NDT ,, but it does supress your TSH (which is not surprising, regardless of whether TSH is down regulated or not) .

~ but you reduced back to 1 grain ( concern about Docs potential reaction to self medicating if you got covid ?) . but you didn't say how you actually felt on that dose ?

Then you end up back on 1.5 grains , feel good for the summer of 2021 , then less good again end of august (which you usually do ? SAD) ,

so you increased (too much) to 2 grains (shame you didn't try 1.75mcg ) and felt overmedicated, (sweating /anxious) no test results on 2 grains.... so stopped briefly , started again 1grain , then 1.25 grains :

July 2022 after a few months on 1.25 grains NDT

TSH 0.49(0.27 to 4.2) (4 am !)

FT3: 3.93 (3.1 to 6.8)

FT4: 9.5 (12 to 22).

You then tried increase to 1.5 grains for approx 6 weeks, but in early November you reduced back to 1.25 grains (suspecting that tingles in feet indicated overmedication)

Nov 19th ? stopped NDT in consultation with private psych ready for NHS tests in 6th December. ( which is not anywhere near long enough to properly assess your 'unmedicated' TSH )

mid-December..... You get a prescription of Levo from private psych.. only 25mcg ,so presumably you are still taking just 25mcg Levo .??

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Some thoughts:

1)You were taking T3 (as part of NDT) , which we know has a greater lowering effect on TSH than Levo only does , So your results from NDT use may not be helpful when discussing 'down regulated' TSH as the T3 is also having that 'effect' to some degree.

2) Your December NHS blood test was invalid for assessing TSH as it was not long enough 'off' NDT to allow TSH to rise and settle. ?19th Nov - ?6th Dec is less than 3 weeks . So .. not much help in discussing what your TSH is doing or why .

3) ? Sheehan's ~I note you mentioned blood loss at birth ~ years ago, just before you went hyper..... and if i remember correctly this pituitary 'shock' can explain a 'lower' TSH.,, but maybe i've remembered that wrong ,not sure . ... but if it's correct .. why not 'use' this when you have to 'explain' why your TSH is lower than expected . If they can't easily find your records for the hyper episode ,then maybe they also can't disprove an account of significant blood loss .

Anyways >>>>> let's see what happens on 25mcg levo .. and let us know the blood results when you get them done "

[Tythrop in reply to tattybogle]

I'm embarrassed that I've put you to such trouble .Please do not prioritise this .

Below in chart see my blood results from 2004.

Prior to.2004 : Glandular fever 1997

1999: childbirth which kicked off hypErthyroid / thyrotoxic episode which was more like extreme thyroiditis. Not hospitalised coz looking after newborn .

Consulted Endo under work health insurance as GP out of depth and I very ill. Endo( a very good one) gave it time to settle down on own like most postpartum thyroiditis does . It didn't and got worse.

Endo put me first on Block meds alone ( Carbomozol) then Block and replace when numbers came down under Cbmzol

I recall also being given Propyruracil (? spelling) either after or as well as Carbimozol. Poss CBMZ due to breastfeeding...can't recall.

Anyway the "replace" bit was t4 AND t3 ( those were the days) .

This worked.

I saw the Endo who tweeked the thyroid strength from time to time but all went OK.

He congratulated me on how well I complied with medical regime as numbers so stable .I couldn't see why I would not comply .Saved my life etc .

Around 2003 or 4 we gave a "go" to stopping meds .Endo satisfied that my body OK alone and handed me back to GP but Endo told me to have blood tests sixmonthly to begin with as more than likely it would develop onto HypO as Hashimoto .

He explained that the first stage was the Hyper, and sometimes called Graves ,( not because it took you to an early one although It felt like it at the time)

.He said then you are OK for years.....or maybe forever but usually go onto Underactive phase called Hashimoto ..

The rest is recorded in below chart

In about 2016 I started asking GP. for supplementation coz not doing well. Because my dad had hypEr then HypO thyroid in 1960s I was familiar with illness . But in his day doctors used clinical judgements rather than just sticking to tsh blood tests .Also NDT like Armour was the go-to med.

I now know that my tsh numbers (, which Medics focus on to the exclusion of all else), was wonkey due to the the down regulation "H" ... thing) .

Asked again in 2018 but GP refused ditto a new Endo in second opinion, so I got fed up and started reading into the subject .Via TUk and HU found about Armour .

Got some Armour from USA. With extreme trepidation and started on 1/4 grain titrating up to 1.5 over 2 years then down a bit coz of burning feet. Armour results in yellow highlight on chart .

Came off ndt in early Dec 2022 for GP blood test to qualify for change in ssri antidepressants free on NHS through GP. This was coz I was now see8ng a private Psych as very very low and anxious ( my lovely therapist suggested I should look into help for GAD or ADHD / INATTENTIVE but only psychs can prescribe ).

(It seems that AHDD inattentive has links to Thyroid issues)

Anyway had to withdraw from Armour for 3 weeks for blood test in Dec 2022 coz didnt want NHS to kniw I was " plsying away" .I sent blood test results to psych as GP didn't contact me marking the test as " borderline" .. I thought that a T4 of 8.6 ( range 12-22) didn't look borderline to me esp with those hellish symptoms .....For that 3 weeks without Armour I experienced increasingly horrible and typical clinical hypO symptoms.

When Psych received copy blood results, by return of email he sent me an online prescription for 25microg of t4 ( a no brainer it seems to him,)

I took t4 ( synthetic via psych) which produced immediate, but not complete , relief of extreme symptoms. I wanted to feel better for Christmas so after a week or 10 days I started adding in 1/2 of a 1.5 grain tablet of Armour which is maybe 1/2 grain given that it crumbles a bit .

I'm due to see psych face to face next week. He's OK. I'm going to ask for increase in t4 and with a miracle, he might add a bit if t3 too . .He is Private not NHS .

I want to build a case ( its a lawyer- thing sorry) to prove to NHS GP ( and to myself) that I really am clinically Hypo and so qualify for NHS thyroid meds as don't see why I should have to keep paying for them

My Thyroid numbers

[tattybogle in reply to Tythrop]

don't be embarrassed , you didn't make me do it. i just did it cos it interests me , and i'm the sort of person who needs to pair the socks up on the washing line ...maybe it's a "detective" thing ..... i don't speak "lawyer " .... i make big tents , so i need a nice diagram and some sticks laid out on the ground in front of me , stuff that i can measure with a tape measure. and see the whole thing .

Will read your reply tomorrow as i never have anything useful to say after dinner as you can see from the above lol . nite nite

[Tythrop in reply to tattybogle]

You're lovely

[tattybogle in reply to Tythrop]

Thanks..... sometimes i am .. (sometimes i'm not )

Any chance of getting a confirmatory letter detailing the hyper history/ treatment from that first endo ? ......i assume the NHS don't have much record of it.... which won't help .

Do you know if the first Endo tested TRab antibodies ? .result's might be useful to know .

RE. the latest NHS thyroid blood tests.. If wanting to push for NHS treatment at some point it is probably important that you DO inform them of the T3 use prior to that test ... and the fact there were only 3 weeks without it .

These facts can both be used to (partly) explain why the TSH was not as high as they might expect.

Also, letting them know that your symptoms were so debilitating that despite your reluctance to do so, their lack of treatment for your low fT4, combined with your history of hyper which you had been told meant you may end up hypo at some point , and your symptoms ) , you felt you had no alternative but to resort to self treatment to try to improve your symptoms .. yes, they will tell you off for going 'off piste' , but surely it will add to the weight of evidence that they need to do something for you .. after all they don't want to be responsible for you "buying prescription drugs online" do they ?... not that i'm suggesting blackmail ... but a bit of gentle coercion never did anybody any harm

p.s just noticed we were 'going wrong' at the same time, i had my 2nd kid in 1998 , and afterwards maybe went a little bit hyper , nothing drastic but ended up skin and bones and a bit 'nuts' for a few months, not sure about that though cos nobody tested,.... then got slower and slower and walked through treacle until 2003 ,by which time i was hypo .and got levo .

[Tythrop in reply to tattybogle]

Ref hypEr records :- I'll try to put a photo of my unhelpfull and ecpendivev 2018 Endos letter on here . But that was all focusing on HypO by then .As for the lovely one in 1999 to 2003 I don't know how to get records that far back . Last time I tried they only went back to 2004 .The lovely Endo of 1999 etc went on to specialise , and get gongs for, work in diabetes. He gave up his private practice to work on it for NHS .His name is Jerry Rayman of Ipswich

[tattybogle in reply to Tythrop]

What method did you use to get old records ? i used S.A.R (filled out a paper form) Subject Acess Request.~ I requested ' everything from 2001 onwards', but actually received everything from about 1986 when i moved to this region . Mind you, i can imagine if you saw him privately it might be trickier to track record down.

ps , probably best not leave his name visible on the open forum , even though complimentary , mentions of prescribing T3 on here can sometimes bring unfavourable attention from their collegues.

[Tythrop in reply to tattybogle]

He is all NHS now

He is is on t' internet.Photos an' all .He only does diabetis now .

Ref records: I consulted GP for recites. I will look up this Sunject Access Requrst thingy .All.nlood tests in 1999 etc don't through GP surgery I'm still with .But when it was all computerised stuff went missing.

[arTistapple in reply to Tythrop]

My brief foray (if ill thought out) into T3, restored temporarily, what I would say was my circadian rhythm without concerning myself with it coinciding in any way with the rhythm itself . I had the best sleep I have had in years. I look forward to sorting it out again soon. I took it early am with my levo.

[Tythrop in reply to arTistapple]

Strangely, with Hyper or at least the Thyrotoxic state I had in 1999 Sleep was impossible with too much T

[arTistapple in reply to Tythrop]

As I understand it (maybe not) if you were hyper at the time your thyroid would have been pumping out T3 - as if your life depended on it - it did! So any further intro of T3 would have been pretty dramatic, symptom wise. Hopefully someone will put me right if this is incorrect!

[amala57 in reply to Tythrop]

They do. Thyroid hormones give us our energy. However, the brain uses a lot of energy. Until I increased my ndt dose at night I could never sleep through.

[arTistapple in reply to amala57]

Yes sleep is the time the brain uses to sort itself out. I imagine it needs lots of T3 then. Instead of sorting it out 24/7 when in short supply of T3.

[Tythrop in reply to arTistapple]

To Tistapple and Tatty ..So this could explain whyin health the biggest t3 pulse is overnight ? .

Whilst languishing in bed with pleuresy ,I've had guilt free time to read up on stuff ,and there is lots on the use of using t3 for "augmentation" ( which I take to mean "boosting" ).of the effect of antidepresssnts especially Tricyclics but to a lesser extent ssri' s. This info suggests to me that t3 does good work on the brain . I'd like to know more , but pleuresy + antibiotics are giving me muzzy head .

If you are interested in these articles I can put links on here but dont want to be too Nerdy.I DO hope I can get Psych to prescribe t3 .I've had it in 1999- 2002 so I know tricky to take ( three times a day on a properly empty stomach )., but I was motivated to get better.TTFN

[tattybogle in reply to Tythrop]

"but don't want to be too Nerdy.... " lol ... too late for that, you have been placed firmly in the nerd box

[Tythrop in reply to tattybogle]

Hay ho

[arTistapple in reply to Tythrop]

”So this could explain why in health the biggestT3 pulse is overnight.”

Not sure I understand what you mean here Tythrop. When you feel better can you explain a bit more please? I might be adding two and two together here and making six!

[arTistapple]

Right funnily enough I just read the paper highlighted elsewhere on this forum from the Canadian site - the Finker research results from 1959. Tanya’s excellent research. This explains the circadian rhythm of T3. You are off the hook Tythrop and thank you for raising it from your sick bed!

[Tythrop in reply to arTistapple]

Ta .I'm never really off the hook ...off something though. Can you send me the Canadian link ..give me something to do.

[helvella Administrator Thyroid UK in reply to Tythrop]

Finkler, 1959: Liothyronine as a replacement for thyroid therapy

January 18, 2021

thyroidpatients.ca/2021/01/...

[Tythrop in reply to helvella]

Ta