Felt anxious but low T3.. confused by results.

[Fizzyinch]

I’ve made a lot of lifestyle and diet changes working with a nutritionist, naturopath and Functional Medicine Practitioner and hence lost a lot of weight and slowly reduced my thyroid medication (levo). I thought the dose was okay (75mcg / day) until I developed a feeling of anxiousness and tension and generally feeling ‘on edge’. My skin hasn’t been great (dry scalp, eczema on lips) and generally just lost that energy I had recently gained. I thought I was over medicated due to the jittery feelings but the T3 result has thrown me.

I have an appointment with my practitioner in Friday and GP next week. Please could anyone let me know what they think I should be speaking to them about dose wise?

I have not had this ratio of results before with T3 and TSH being low with T4 high.

thanks.

TSH: 0.42 (0.35- 5.50)

T4: 18.1 (10.5 - 21)

T3: 3.2 (3.5- 6.5)

(test was done before 9am, fasted, no levo which I do for all of my tests).

[Lalatoot]

You need calories to convert t4 to t3 so if you're diet has been quite restrictive then you may have affected conversion.The symptoms of hypo and hyper or under and over medicated in reality are not like those clearcut lists you read on the internet. I was hyper and am now hypo so can say from experience that I have had the same symptoms for both states.

[Fizzyinch in reply to Lalatoot]

thank you. I’m treating SIBO which involves low carbs, no sugars etc. and so that makes a lot of sense re: calories. I probably have been having a lot less than usual.

[SlowDragon Administrator]

Do you always get same brand levothyroxine at each prescription

What vitamin supplements are you currently taking

What are your most recent vitamin results?

[greygoose]

What was your last FT4 reading before this? What made you think you could reduce your levo? And, why would you want to?

[DippyDame]

How much levo were you previously taking?

How did you feel on that dose?

I suspect those treating you are not fully conversant with thyroid hormones

Those labs show your T4 to T3 conversion is poor.....high FT4 with low FT3

The question is....why?

it is essential to optimise vit D, vit B12, folate and ferritin to support thyrousd function/conversion

75mcg clearly wasn't sufficient to produce a reasonable level of T3 for your needs

Anxiety is a symptom of undermedication.....although it can also be overmedication but your labs don't support that possibility

Are you following a restrictive diet with low calories this can impair conversion

This diet may contain insufficient nutrients

T3 is key to our well being, it is required by every cell in the body in a constant and adequate supply

Your FT3 level is miserably low and most likely the cause of your problems

You need to work to optimise essential nutrients and at the same time raise your levo, initially, to 100mcg

Maintain that steady dose for 6 weeks then re-test

Test before 9am and 24 hrs after your last dose of levo

TSH is not a reliable marker, it is a pituitary, not a thyroid hormone and fluctuates during the day

According to science FT3 followed by FT4 are the most important labs

The results will point the way forward

[Fizzyinch]

Previous dose was 100mcg;

March 2023:

TSH 0.14 mU/L (0.35 - 5.50 mU/L)

Free T4 18.4 pmol/L (10.5 - 21.0 pmol/L)

I didn't feel good on this dose at all. Endo said i was overreplaced. Previous results i have felt best with TSH is around 1 so trialled reducing to 75mcg.

Felt much better on 75mcg for a while, until just recently.

I haven't had vits checked for a while. latest results:

Ferritin: 56.2 ug/L (10.0 - 291.0 ug/L) March 23

Folate: 23.9nmol/L (8.83 - 60.8)

B12: 145pmol/L (37.5 - 188)

Vit D: 107nmol/L (50 - 250)

Currently taking pure encapsulations O.N.E multi and Omega 3.

[Fizzyinch]

So general takeaway is i am clearly not converting from t4 - need to look into why that is (likely not enough calories and nutrients to convert). I should not be reducing my medication further. I don't think the GP will know what to do!