I am looking for a doctor who can prescribe me the correct ratio of T4:T3

[Nayeef]

Hi everyone, I am from outside the UK and I am looking for a doctor who can prescribe me the correct ratio of T4:T3. Do you have any recommendations?

[Buddy195 Administrator]

Welcome to the forum Nayeef

So we can offer better advice, can you tell us more about your thyroid condition, eg when you were diagnosed, ongoing symptoms, current medication & dosage, plus blood test results (with ranges in brackets) for:

TSH

FT3

FT4

Plus any antibody and key vitamin tests (ferritin, folate, vitamins D and B12)

Are you wanting an online or in person appointment with an endocrinologist?

[Nayeef in reply to Buddy195]

Thank you, Buddy, for your reply. I have had hypothyroidism for 15 years and I am currently on T4 100 mcg, but without any improvement. I have all the symptoms of hypothyroidism. I was on 50 mcg, and when I suddenly increased it to 100 mcg, I felt an amazing and very significant improvement. and the fatigue and brain fog were gone, but unfortunately. For only one day, then I raised the dose again to 150 micrograms, and I felt better again, but also for one day, , and there was no improvement after that, even after raising the dose, but my doctor reduced the dose to 75 mcg because my TSH was very low, about 0.01. and FT3 3.3 and FT4 1.67 RT3 0,40 but the last test of TSH was 6.495 So I decided to raise the dose to 100 mcg and the rest of my tests were TPO was high at 16.300, but now, after paying attention to a healthy diet, it has become 15 Ferritin 87 B12 850 Vitamin D 64.60 I have read several books that say that we need to add T3 with T4 to feel better in the long term and not just reach the sweet spot as happened with me, so I am looking for a doctor who can help me with that.

Please excuse me if my English is not good

[Buddy195 Administrator in reply to Nayeef]

Could you please edit your reply Nayeef to include the ranges (in brackets after result) as these vary between laboratories.

[Nayeef in reply to Buddy195]

Yes Sure I performed tests in several laboratories and several countries

TSH 0,01 Iu/ml 0.27 - 4.2

FT3 3.3 pg/ml 2,0 - 4,4

FT41.67 ng/dl 0,93 - 1.7

RT3 0,40 ng/ml 0,08-0,31

TPO 15 U/ml < 34

TSH 6.495 Iu/ml 0.35 - 4.94

TPO 16.3 Iu/ml 5.61>

[SlowDragon Administrator in reply to Nayeef]

So I decided to raise the dose to 100 mcg

my TPO was high

High thyroid antibodies confirms cause of your hypothyroidism is autoimmune thyroid disease

Retest thyroid levels 2-3 months after being on 100mcg levothyroxine

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 steady results.

[Nayeef in reply to SlowDragon]

Thank you, Slow Dragon. Yes, I have Hashimoto’s and I am now trying to find a solution. I know how important tests are. Thanks again for the advice.

[greygoose]

What do you mean by 'the correct ratio'? There is no universal ratio that suits all hypos. The only correct one is the one that suits you.

Welcome to the forum.

[Nayeef in reply to greygoose]

Thank you greygoose Yes, I know that, but the correct dose must be found to reach the required balance of T3:T4 to obtain the optimal result

[greygoose in reply to Nayeef]

Yes, but not doctor can know what that is in advance. You can only find that out by trial and error.

[Nayeef in reply to greygoose]

You are right, but I need a doctor to help me with this, to obtain a prescription, and to follow up with him until I find the optimal ratio

[jgelliss in reply to greygoose]

❤👏👏👏👏👏

[SlowDragon Administrator]

which country are you based in

Please add thyroid and vitamin results

[pennyannie]

Hello Nayeef and welcome to the forum :

We generally feel best when taking T4 only medication when the Free T4 is up in the top quadrant of its range with the Free T3 tracking just behind at around 60/70% through it's range - at around a 1/4 ratio T3/T4.

Your T3 is coming in the range at around 54% through its range with your Free T4 reading coming in at just under 100% through its range -

so it is obviously you would do better dropping a little T4 medication and adding in a little T3 medication - to rebalance both these vital thyroid hormones.

Your reverse T3-which is excess T4 - is over range - so again - you are not converting well T4 and would be better dosed and monitored on a T3 / T4 combo.

Thyroid uk the charity who supports this forum holds a list of thyroid specialist who prescribe all thyroid hormone replacement options, viz - T3, T4 and Natural Desiccated Thyroid maybe email admin at thyroiduk.org for the list so you have somewhere to start.

If you qualify for treatment on the NHS you will need a referral to an endocrinologist as to your need for anything other than T4 monotherapy and it is a post code lottery and financial constraints tend to be seen as more important than public health in some areas of the UK.

No thyroid hormone replacement works well until your core stenght vitamins and minerals are up and maintained at optimal levels - so we can also advise on your ferritin, folate, B12 and vitamin D - as just being in the ranges somewhere - is not optimal - and where you need to maintain these important co-factors.

[Nayeef in reply to pennyannie]

Thank you very much, Pennyannie. Unfortunately, T3 is not available in my country, so I would like to come to the UK to find a specialist doctor so that he can help me reach the optimal range of T3 and T4. In the past, I have tried different doses of T3, from a dose of 20 mcg to a very low dose of 0.075. T3 Slow Release as recommended by Dr. Kenneth Blanchard to get a score of 98.5, but I did not feel any results.

[pennyannie in reply to Nayeef]

Blood tests are just one measure of what is going on -

relief of symptoms are much more important to the patient - which don't always correlate with blood tests that tend to run behind blood tests by a few weeks.

Where do you currently live as many of us are self sourcing our T3 from outside the UK anyway and self medicating as we can't access the system here unless we pay and know who to go to - hence why I said get the list from Thyroid UK.

I think I read further that you have Hashimoto's - so you might like to also read around on Dr Izabella Wentz 's website - thyroidpharmacist.com

From everything I've read treating, dosing and monitoring thyroid hormones takes time - do you intend to live here - or keep popping in and out - are there no thyroid specialist and no treatment options in your country ?

[Nayeef in reply to pennyannie]

I am from Saudi Arabia and I just want to come for treatment and then come back. Hormones such as Levothyroxine in my country do not require a prescription and can be purchased directly online or from a pharmacy, but unfortunately we do not have T3 here and I need help from a specialist doctor so that he can prescribe T3 to me in the appropriate dose

I wish I could order T3 online

[pennyannie in reply to Nayeef]

Can you get Natural Desiccated Thyroid in Saudi ?

This is derived from pig thyroids and the original and successful treatment for hypothyroidism for over 100 years before Big Pharma launched their T3 and T4 synthetic options -

With NDT - thyroid extract - desiccated thyroid - each tablet - referred to as grains - contains trace elements of T1. T2 and calcitonin + a measure of T3 at around 9 mcg + a measure of T4 at around 38 mcg - which is all the same hormones as the human gland would be supporting you with.

You simply start off taking 1/4 of a tablet a day and each week /fortnight simply increase your dose another 1/4 tablet/grain until your symptoms are alleviated.

[Nayeef in reply to pennyannie]

Unfortunately, NDT is not available here, I can order it online, but it also requires a prescription. I hope to find a way.

[pennyannie in reply to Nayeef]

Who treats you in Saudi - surely an endo or thyroid specialist could write you a prescription for NDT - surely there is recognition that you need more than T4 monotherapy -

Do you have any blood tests and ranges you can share with forum members so we can understand better what's happening - and what about your core strength vitamins and minerals as these need to measured and likely supplementing to optimal before any thyroid hormone replacement will work well for you ?

[Nayeef in reply to pennyannie]

I wish I could find a thyroid specialist here who would write me a prescription for this, but it is a difficult task, as you know, traditional medicine only recognizes T4.

Some time has passed since the last tests I had. They show that I have a deficiency in zinc levels, while the rest of the vitamins and minerals seem normal. Perhaps because I take a lot of supplements and I need to stop them before I do tests, so I will do new, more accurate tests to share them here.

[pennyannie in reply to Nayeef]

Yes - stop all supplements the week before the blood test so we measure what your body is holding rather than that just ingested.

We need to see TSH, Free T3 and Free T4 inflammation, thyroid antibodies, and ferritin, folate, B12 and vitamin D :

You need an early morning blood draw - fast over night - just taking water - and do not take your T4 for that day until after the blood draw - so leaving around a 24 hour window from your last dose of T4.

Normally do you take oyur T4 on an empty stomach and wait around an hour before eating or drinking anything ?

There are 3 main recognised thyroid hormone treatment options - as not everybody can take T4 medication anyway -

So some people can get by on T4 = Levothyroxine only.

Some can't tolerate T4 at all and need to take T3 only - Liothyronine.

Some, especially those without a thyroid or with an AI disease that is slowly disabling and destroying their thyroid gland need to take a small amount of T3 alongside their T4 medication in order to rebalance these 2 vital thyroid hormones.

Whilst others take Natural Desiccated Thyroid which contains all the same known hormones as that of the human gland - namely trace elements of T1. T2 and calcitonin + a measure of T3 and a measure of T4 in each tablet - generally referred to as grains.

This is basic information and I'm struggling to understand that there are no medical professionals within Saudi who would not know this and not treat the patient with the most appropriate thyroid hormone treatment option :

Probably at a price - but I'm afraid you would face the same costs in the UK when you factor in visits and accommodation etc.