would I benefit from T3?

[RoseStar]

hi,

currently on 50mcg Levothyroxine but still struggling with fatigue (although I also have PoTS). My latest results are:

T4: 16.5 (11.9-21.6)

TSH: 0.49 (0.27-4.2)

T3: 4.6 (3.9-6.8)

would T3 be of any benefit?

[greygoose]

I expect it would, given that it's the active thyroid hormone. But, first of all it would be wise to try an increase in levo. 50 mcg is only a starter dose, and should have been increased six weeks after starting it. How long have you been on that dose?

[RoseStar in reply to greygoose]

About 6 weeks. I got put on 100mcg straight off the bat in March and it swung me into hyper so every 6/8 weeks it was lowered and bloods retested 75mcg to 75mcg alternating 50mcg to 50mcg until my results were finally in range. I should have been put on 50 in the first place!

[greygoose in reply to RoseStar]

Well, you may be in-range but you're now under-medicated. It's time to go up to 75 mcg.

Some people tolerate starting on 100 mcg very well. We're all different. But, you didn't 'swing into hyper', you were over-medicated. I do think it's so important to use the right terminology so that we all know what we're talking about. Unfortunately, doctors set a bad example where that is concerned!

But, what exactly did you mean by that? Low TSH? Over-range FT3? And, how did you feel on that dose?

[RoseStar in reply to greygoose]

Ok. What makes me under medicated with those latest results? Both low TSH and over-range FT4 (I hadn’t had my FT3 done until now as doctor said it’s not something they would routinely do). I felt awful - flushing, breaking out in rashes, anxiety - so welcomed the GP’s decision to lower my dose

[greygoose in reply to RoseStar]

Your FT4 is not over-range in the results given above. It's not quite mid-range. And your FT3 is below mid-range, and it's that that makes you under-medicated. Euthyroid is around mid-range, and hypos usually need it even higher than that.

Maybe your FT4 was over-range in your last tests, and that doesn't always agree with some people, but the real test of over-medication is over-range FT3.

Doctors don't like testing FT3 because for the most part they have no idea what it is or what it does! And testing FT3 can lead to people wanting to take T3 which the NHS really doesn't like.

[RoseStar in reply to greygoose]

Thanks, that makes sense. The endo just called me and said my T3 isn’t too bad but because of my fatigue, he’s going to provide a private prescription for 5mcg T3 twice a day 🤞

[greygoose in reply to RoseStar]

Well, that's nice of him. But, as too your T3 not being 'too bad', if you don't feel well it is too bad. It's about how you feel, not so much the numbers.

[RoseStar in reply to greygoose]

And it doesn’t help having other illnesses that can cause fatigue as they are quick to say it must be that and not my thyroid because my numbers are “fine”

[SlowDragon Administrator in reply to RoseStar]

guidelines on dose levothyroxine by weight

Even if we frequently start on only 50mcg, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near full replacement dose

pathlabs.rlbuht.nhs.uk/tft_...

Guiding Treatment with Thyroxine:

In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months.

The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).

The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range.

……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.

The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.

[greygoose in reply to RoseStar]

Yes, but the question alwasy is: do you really have other illnesses or is it all down to under-treated thyroid? The answer often turns out to be: treat the thyroid correctly and the other things disappear.

[SlowDragon Administrator in reply to RoseStar]

You don’t need T3 at this stage…you need increase in levothyroxine

Up to 75mcg

Retest again in another 6-8 weeks

Likely to need further increase after that

Meanwhile ESSENTIAL to test Vitamin D, folate, ferritin and B12

What vitamin supplements are you currently taking

Have you had thyroid antibodies tested

[Jaydee1507 Administrator]

Just checking how you took the test. Did you allow 24hrs between your last dose of Levo & the test?

Did you only have water that morning and did you test at 9am or as close as possible? Testing like this is very important for consistency in results and showing highest TSH.

What time was the test taken?

Free T4 (fT4) 16.5 pmol/L (11.9 - 21.6) 47.4%

Free T3 (fT3) 4.6 pmol/L (3.9 - 6.8) 24.1%

Your FT4 is too low as is your FT3.

How are your vitamins looking? What supplements are you taking?

at bedtime works well for them.

When hypo we get low stomach acid which means we cannot absorb vitamins well from our food, regardless of a great diet. For thyroid hormone to work well we need OPTIMAL levels of vitamins. Have you recently or could you ask your GP to test levels of ferritin, folate, B12 & D3? Private tests are available, see link for companies offering private blood tests & discount codes, some offer a blood draw service at an extra cost. thyroiduk.org/help-and-supp...

There is also a new company offering walk in (includes free blood draw) & mail order blood tests in London, Kent, Sussex & Surrey areas. Check to see if there is a blood test company near you. onedaytests.com/products/ul...

Only do private tests on a Monday or Tuesday to avoid postal delays.

Do you know if you had positive thyroid antibodies? Many with autoimmune thyroid disease aka Hashimoto's benefit from a gluten free diet. A smaller percentage of those also need to remove dairy from their diet to feel well. These are intolerances and will not show up on any blood test.