Advice needed - T3 levels

[Bagster2]

I was diagnosed with sub-clinical underactive thyroid in 2016. My test results were

TSH 7.91 (0.27 - 4.2); T4 12.2 (12 - 22); T3 4.4 (3.1 - 6.8)

I was started on 25 mcg Levo, which over the years has been titrated up to 112 mcg. I’ve been monitoring levels via private blood tests every 3-6 months. My most recent blood test in November was

TSH 0.36; T4 18.5; T3: 3.6 (same ranges as above).

TPO has always been low - 12 (0 - 34) TG 90 (0 -115). These levels haven’t changed significantly over the years.

Honestly it’s only today that I decided to compare my current T3 levels to the levels when I was first diagnosed. No change at all to speak of. My symptoms when I was first diagnosed were itchy dry skin (which resolved pretty quickly) and breathlessness after exercise which hasn’t resolved really. My query is where to go from here? I’m tempted to gradually reduce levo and see if it makes any difference. When I did this recently my TSH went up, T4 dropped but T3 increased slightly. I’m sure my doctor won’t prescribe T3.

I’ve had all key vitamins tested and Vit D and B12 are at the high end of optimal. My Ferritin levels are high. I’m not overweight.

Any advice would be very gratefully received.

[DippyDame]

How do you feel? What symptoms do you have? This is almost as important as a list of numbers!

thyroiduk.org/signs-and-sym...

Low TPO and Tg thyroid antibodies means you can eliminate Hashi's which is a very common cause of hypothyroidism. They don't need to be tested regularly because you already know the outcome

TPO has always been low - 12 (0 - 34) TG 90 (0 -115).

If you reduce your T4 the body will naturally lower FT4 and raise TSH

Your T4 to T3 conversion seems OK.

I wouldn't be inclined to lower your levo on the basis of that slight FT3 rise....it's a red herring.

Your doctor is probably dosing by TSHwhich is entirely wrong and is leaving you undermedicated. Science proves TSH is not a reliable marker. FT3 isthe most important result followed by FT4. Refuse a dose change based on TSH alone.

thyroidpatients.ca/2021/07/...

112mcg levo is not a huge dose and you have room to increase your dose...I suggest you ask for an increase to 125mcg then test again after 6weeks

I don't see that you need T3....just more T4!

Aim to have both Frees roughly approaching 75% through their respective ranges bearing in mind we are all different

The new results will point the way forward. I suspect you may even need a further increase....but time will tell.

[Bagster2 in reply to DippyDame]

Thank you very much for your response. All increases in levo over the years have increased T4 but had little effect on T3. In fact, when I recently reduced T4 to 100mcg over a two month period, my T3 went up slightly. How am I feeling? Mainly fatigued - as I say I get breathless quite quickly when I exert myself even though I’m really quite fit. I’ll give what you suggest a go and then re-test.

[SlowDragon Administrator in reply to DippyDame]

her Ft3 is dire

Conversion very poor

FT4: 18.5 pmol/l (Range 12 - 22) 65.00%

FT3: 3.6 pmol/l (Range 3.1 - 6.8) 13.51%

Like many people likely to need T3 prescribed alongside levothyroxine

[DippyDame in reply to SlowDragon]

Ah....brain fog!!

I was looking at Bagsters' diagnostic labs which showed a higher FT3 before levo was added.

Maybe the thyroid was ramping up T3 at that point.

I think I'd still want to raise the levo dose to at least 150mcg before adding T3 incase that raised FT3 a fair bit....less hassle than battling to get T3 prescribed.

I need high dose T3-only to function but feel levo needs to be fully explored before introducing T3....she is currently on 112mcg levo with plenty room to increase.

Her nutrients appear OK....so maybe a bit of trial and error.

Happy to be set straight though...I still have lots to learn.

[SlowDragon Administrator in reply to DippyDame]

agreed

I would initially push for dose increase in Levo to 125mcg daily

Retest in 6-8 weeks

[DippyDame in reply to SlowDragon]

That's what I advised above....it's a tricky one!

And even if she eventually needs to add T3 to a higher levo dose, a smaller T3 dose may be enough....and easier to persuade an endo to prescribe than a larger dose.

I don't have a hope in Hades of getting my T3 prescribed!

[SlowDragon Administrator]

When I did this recently my TSH went up, T4 dropped but T3 increased slightly. I’m sure my doctor won’t prescribe T3.

GP can not initiate T3

Must be via endocrinologist

Here’s link for how to request Thyroid U.K.list of private Doctors emailed to you, but within the email a link to download list of recommended thyroid specialist endocrinologists who will prescribe T3

Ideally choose an endocrinologist to see privately initially and who also does NHS consultations

thyroiduk.org/contact-us/ge...

I’ve had all key vitamins tested and Vit D and B12 are at the high end of optimal. My Ferritin levels are high.

Please add actual results

High ferritin…..are you post menopause

Higher ferritin after menopause to be expected

[SovietSong]

Your T3 was 35% back in 2016 and now it's just over 13%.Your T4 is currently 63%.Someone will correct if I'm wrong but I think your conversion is just over 5(should be 4 or under)Maybe an increase will boost the numbers but that T3 level is way off the recommended 75%.

[greygoose]

T4 18.5 (12 - 22) 65.00%

T3 3.6 (3.1 - 6.8) 13.51%

I would say your conversion is pretty bad. Percentage-wise, the gap shouldn't be that wide. You must be feeling terrible with that low FT3.

But the answer is neither to raise the levo nor reduce it. What you need is T3. And if your doctor won't prescribe it - actually he can't, the initial prescription has to come from an endo - then would you consider buying your own?

[Bagster2 in reply to greygoose]

Thanks Greygoose. Yes happy to buy my own T3 if I can get hold of it. I remember reading one of your responses not too long ago where you suggested that lowering levo dose might result in better T3 conversion. Certainly my T3 went up slightly when I slightly reduced levo,

[greygoose in reply to Bagster2]

Yes, that's true. But the important word there is 'slightly'. In your case it's never going to be enough to bring your FT3 up to optimal.

If you want to buy T3 on-line, write a new post asking people to PM you links to their trusted sources. But, beware of trolls! Always check with an admin before buying anything.

healthunlocked.com/thyroidu...