Total t3 and free t3

[abartme]

Hi all-Just would like to know how important the total t3 is on a fasting blood test. The weird thing is, my free t3 has gone up, now in the mid range which is good,it's never been so high.. but my total t3 is at the very bottom range, while my tsh is now below range, near suppressed. T4 is good, above mid range. The thing is, I feel totally hypothyroid. Weight gain, puffy, fatigue, all that. Just does not make sense. On tirosint 88 and cytomel 7.5 mg. I listen more to what I learn from here, than I do to doc's. I guess my question is, how important is the total t3 in the big picture. Thanks much ! I value the knowledge here

[greygoose]

It's not very important at all. Total T3 is just what it says: bound T3 + Free T3. Without distinguishing between the two. Your body can only use Free T3, so you need to know how much of that you have available.

What is your FT3 result and the range?

[abartme in reply to greygoose]

T3 Total 85 80 - 200 ng/dL

TSH, High Sensitivity 0.23 L 0.27 - 4.20 mU/L

T4 Free Non-Dialysis 1.2 0.8 - 1.7 ng/dL

T3 Free Non-Dialysis 2.9 2.0 - 4.8 pg/mL

My results as of one week or so ago. Thanks so much for taking a look ! I know my doc will thing the tsh is too low but I tend to agree with you on tsh. Honestly don't think it matters a lot. Doc's worry about bone loss, and Afib heart problems.

[greygoose in reply to abartme]

Well, your TSH is low - although not that low! - because you are taking T3. And your doctor should know that that's what T3 does. But, even so, your FT3 is still quite low considering you take T3. Do you always take it well away from food/medication/supplements?

[abartme in reply to greygoose]

I take a whole 5mg on an empty stomach in the morning, the other dose 1/2 a tab about a half hour after lunch. Supposedly food doesn't effect liothyronine but I question that. My free t3 before the liothyronine (on 100 mg Tirosint) was only 2.2 but my tsh was the same. One thing I'm taking now for spinal disc disease is low dose hyrocodone. Between 2.5 and 5 mg tabs a day. Could be affecting thyroid, not sure.

[greygoose in reply to abartme]

Well, it won't be affecting the thyroid itself because your thyroid is no-longer working. But as long as you take it two hours away from thyroid hormone, it shouldn't affect absorption.

I too question the idea that food doesn't affect lio. I agree it doesn't affect it as much as levo, but I'm sure it does to some extent having looked at hundreds of blood test results on here of people that take it with food and those that don't. But, I would take it two hours after lunch, just to be sure,

[abartme in reply to greygoose]

I'll go with your expertise here, thanks for helping me out with this stuff (-:

[greygoose in reply to abartme]

You're welcome.

[abartme in reply to greygoose]

Actually my tsh was 0.55 on 100 mg tirosint only, the free t3 was only 2.2

[SlowDragon Administrator]

Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

On T3 - day before test split T3 as 2 or 3 smaller doses spread through the day with last dose 8-12 hours before test

is this how you do your tests

What vitamin supplements are you taking

When were vitamin D, folate, ferritin and B12 last tested

[abartme in reply to SlowDragon]

I do this except for the Tirosint . Doc says I can take that in the morning before testing but not the liothyronine. No Biotin several days before. I do take D and B12 as well as B100 . Green protein drinks too.

[helvella Administrator in reply to abartme]

So how long was left between Tirosint and that blood draw?

[abartme in reply to SlowDragon]

Oh yes I have had those all tested, all good

[abartme in reply to abartme]

about 3 hrs before blood draw

[helvella Administrator in reply to abartme]

That time period is when FT4 will be massively higher due to the recent ingestion of the levothyroxine. Whether Tirosint or another form.

This is a link to the graph:

ncbi.nlm.nih.gov/pmc/articl...

This is the paper the graph comes from:

A Novel Levothyroxine Solution Results in Similar Bioavailability Whether Taken 30 or Just 15 Minutes Before a High-Fat High-Calorie Meal

ncbi.nlm.nih.gov/pmc/articl...

That is, shortly after taking it, Total T4 rises to around 50, and falls off for around 6 or so hours, dropping to around 25 by the same time next day.

It is ludicrous to take levothyroxine less than at least 8, preferably 12 or more, hours before a blood draw. You simply cannot account for that very sharp and high peak using any sort of fudge-factor or calculation.

(This trial was focussed on whether food had an effect. They claim it had little effect. But, if it had any effect, it would have been to reduce the sharp peak a bit.)

Graph showing how T4 level is much, much higher for several hours after Tirosint

[abartme in reply to helvella]

I see, very interesting, thanks for that ! Don't know why doc's don't think it's an issue. It has to do with the half life in their eye's. At least some anyway. There are still doc's here that ONLY look at the tsh..unbelievable

[helvella Administrator in reply to abartme]

The only reason I have ever come up with is ignorance.

Though it is just about possible that some believe they have some sort of superpower to interpret the results regardless.

However, it is important that there is some consistency as well.

I mean, if for your next test you don't take your Tirosint until after, then it would look odd to someone who doesn't realise. Or if sometimes you have had blood drawn at 09:00, others at 12:00 and still other at 16:00.

[abartme in reply to helvella]

yes..my husband (a retired nurse) calls it "the white coat syndrome". People think they are all knowing, never question anything

[FancyPants54 in reply to abartme]

Oh dear! I've blown that out of the water. I disbelieve just about everything they tell me.

[abartme in reply to FancyPants54]

yep me too ! Really makes them angry when you question them LOL

[Batty1 in reply to abartme]

The doctor don’t think taking T4 before test is an issue because they can then tell you your over medicated and to reduce your meds … sneaky!

[SlowDragon Administrator in reply to abartme]

So Ft4 is falsely raised in results

Retest correctly

FT4: 1.2 pmol/l (Range 0.8 - 1.7)

Ft4 only 44.44% through range

If tested correctly likely only around 30% through range

FT3: 2.9 pmol/l (Range 2 - 4.8)

Ft3 only 32.14% through range

Please add actual results and ranges on vitamin levels

[abartme in reply to SlowDragon]

From one year ago Vitamin B12 1053 232 ­ 1245 pg/mL

Vitamin D, 25­Hydroxy, Total 51.7 ≥20.0 ng/mL

[SlowDragon Administrator in reply to abartme]

These are good

Any folate or ferritin results?

[abartme in reply to SlowDragon]

Well I thought so, but I guess not, can't find that