Hi I’ve posted several times before regarding my Thyroid journey but not yet filled in my profile. In brief partial Thyroidectomy in 1995 & stable for many years on 75mcgs of Thyroxine till TSH started creeping up & up regularly over 5. After lots of arguments with my GP I eventually managed to see an NHS Endocrinologist in 2022 who told me I had been under medicated for many years. I had 2 increases of Thyroxine & currently taking 125mcgs daily. My TSH last July when I saw the Endocrinologist was 3.9 (0.27-4.2). T4 18 (12-22) & T3 3.2 (3.1-6.8). The Endocrinologist increased my Thyroxine twice & then said my results were going in the right direction & discharged me in September. At that time my levels were TSH 1.1. T4 23 & T3 3.4. I felt a bit let down as I felt things wernt much different to when I first saw him. I’ve had a few private blood tests done with Medichecks. Feb 23 results were TSH 0.47 T4 20 & T3. 3.4. I’ve just had another private test done ( the ranges are the same as my initial blood results) TSH now 0.27. T4 21.64 & T3 3.8. My question is that my TSH is at the cut off of range which on the calculated dopiaza reads at 0%
I guess I need a slight reduction in Thyroxine but also still concerned about my low T3. At this rate it’s going to take years to get it to an acceptable level. My B22 is currently 579 ( GP has reinstated my B12 injections). Folate 13.1 low but improving as was 7.1 in July 22. Ferritin 96 & Vit D 94. My GP refuses to test T3 or 4.
Just asking for your input before writing again to the Endocrinologist to see if he will see me again or seeing a private Endocrinologist. Thanks
Written by
Otto11
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What your doctors are missing is that your conversion of T4 to T3 is very poor.
T4 18 (12-22) & T3 3.2 (3.1-6.8)
FT4 is 60% through range with FT3 at 2.7%
and assuming ranges for all tests are the same
T4 23 & T3 3.4.
FT4 over range at 110% with FT3 at 8.11%
T4 20 & T3. 3.4.
FT4 is 80% with FT3 at 8.11%
T4 21.64 & T3 3.8.
FT4 is 96.4% with FT3 at 18.92%
TSH is useful for diagnosis but once on thyroid hormone replacement it doesn't have much use in showing thyroid status, only the thyroid hormones - FT4 and FT3 - show our actual thyroid status so that's what we should look at.
Point your poor conversion out to your endo and suggest he gives you a trial of T3 added to your Levo. If he suggests reducing dose of Levo then if your FT4 is 60-80% we would say you don't need to reduce it, if it's top of the range then yes a reduction would be sensible but no more than 25mcg.
Time for a reassessment of the treatment of hypothyroidism
John E. M. Midgley, Anthony D. Toft, Rolf Larisch, Johannes W. Dietrich & Rudolf Hoermann
Poor T3 converters with persisting symptoms may thus be the most suitable candidates for trials of T3/T4 combinations. T3 addition may also avoid LT4 dose escalation resulting in T4 excess, as T4 has been implicated in non-genomic actions, not mediated via T3, such as actin-related cell migration
So sorry just realised I didn’t reply. Your post is really helpful. There is a lot to take in. As I said I have been discharged from Endo but am going to write to him again & if no joy guess I will have to go privately.
But your information will help tremendously. Thank you so much.
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blood test results
TSH rise 
Could T3 be my last hope of being well, even if blood levels are 'normal'?
T4 too high when TSH in range. Please can you look at my results?
