what are optimal levels on combined t4/t3 please?

[Knackeredandcross]

I was on 125mcg levo and had optimal tsh (under 1) and t4 in top 75% but my t3 was at the very bottom of range.

I’ve lowered my Levo to 100mcg and slowly added in t3 and am on 12.5mcg per day. I’m due to test in a week and I’m just wondering what optimal levels of tsh and t4 I should be looking at now please?

Any advice much appreciated 🙏🏽

[Jaydee1507 Administrator]

I believe both FT4 & FT3 should be around 60-70% of their ranges. Probably highly individual and healing can take many months so trigger changing dose probably not advisable.

TSH becomes pretty irrelevant as will likely be suppressed due to the direct T3 hormone.

[Knackeredandcross in reply to Jaydee1507]

thank you 🙏🏽 I initially felt significantly better when I started the quarter tablet of t3 but when I added in the second quarter I didn’t feel any added benefit. Would you stick with it still?

[Jaydee1507 Administrator in reply to Knackeredandcross]

That would depend on blood results. What you feel when you first start taking T3 will be different to how you feel in say 4 months time. Stick with it as your body heals.

[Knackeredandcross in reply to Jaydee1507]

thank you for your advice. I will come back when I’ve got bloods. My gp has just requested bloods too which I’m dreading as she doesn’t feel my tsh should be lower than 2.5 and doesn’t believe t3 is necessary even though I’m clearly a poor converter. How do people deal with routine tests when they’re self medicating??? 🤷🏼‍♀️

[Jaydee1507 Administrator in reply to Knackeredandcross]

Its probably harder when you're self medicating but the NICE guidelines do say that it is the patients responsibility, so long as you accept the (scaremongering) possible side effects of having a suppressed TSH. The NICE guidelines are also not mandatory for doctors to follow even. No doubt I will also be faced with this at some point this year as many are. Just have to stand your ground and know a little to counter their arguement.

The first paragraph in the NICE (NHS) Thyroid Disease, Assessment and Management guidelines says :

nice.org.uk/guidance/ng145

"Your responsibility”

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian. "

[Knackeredandcross in reply to Jaydee1507]

that’s useful to argue my corner, thank you 🙏🏽