First test results after adding T3 - I’m confused!

[J972]

Hi everyone,

I’d really appreciate your help with my latest results and welcome ideas for suggested next steps.

Just a reminder, I currently self-treat.

In October I posted the following results (Randox) whilst on 62.5mcg of Levo (Eutirox):

TSH 1.44 (0.35-5.5)

FT4 18.2 (11.9-21.6)

FT3 3.96 (3.1-6.8)

The advice was that I was a poor converter and that I should consider adding T3, which I duly did.

I was due to test before Christmas, but, I was bogged down with a bad cold then I realised that I hadn’t stopped biotin, so, the first opportunity I had to test after the Christmas chaos was last week.

Here’s my results (Monitor my Health) whilst on 62.5mcg levo & 9mcg of Tiromel:

TSH 0.99 (0.27-4.2)

FT4 13.3 (12-22)

FT3 3.5 (3.1-6.8)

Both tests conducted as per the suggested protocols on this site. For the latter, I split the T3 so that the 2nd dose was 12 hours before the test (I normally take in one go with the levo in early hours, usually around 4am, so well away from food/drink. If I try to split the dose, I get insomnia).

As you can see, my FT3 has gone down, despite the addition of T3. I should add that I’m still terribly symptomatic.

Why might this be happening? Did I leave it too late to test? Has that skewed the results?

It might be noteworthy that I resumed HRT in November, transdermal application.

Or, might it be possible that the low cortisol levels I previously posted about are affecting things? I still seem to be terribly reactive to carbs; they turn to sugar in my mouth and I feel jittery.

For info, I had a thyroid ultrasound in October 23, all completely normal (I have no concerns).

I’m fully gluten and dairy free. Eat a lot of protein, it’s all I really fancy these days. I supplement core vitamins and minerals using quality products recommended here. Most recent results:

June 2023:

Vit D 114 nmol (100-150) - I will retest soon

Dec 2023:

B12 1494 ng/L (187-883)

Folate 8.4 ug/L (3.1-20.5)

Nov 2023

Ferritin 80ug/L - I supplement with Three Arrows, my ferritin is usually dire, but I must admit that no CRP tested.

Why would my frees go down in tandem with my TSH? Isn’t that back-to-front?

What do you think I should do next? Should I admit ‘defeat’ and try and get help from a specialist?

Thanks, as ever.

🙌🏼

[SlowDragon Administrator]

Your low Ft4 suggests you can now increase Levo dose

Initially perhaps 75mcg daily

Retest in 6-8 weeks

Would suspect adding T3 is improving cortisol, therefore you can tolerate increase in dose

Folate

In week before test when you stop vitamin B complex, suggest you take daily folate instead

[J972 in reply to SlowDragon]

Thank you SD, it’s certainly worth a try. Should I hold the T3 steady?

I hope you’re right about cortisol 🤞🏼

👍

[SlowDragon Administrator in reply to J972]

Only change one thing at a time

Increasing Levothyroxine first

See if that increases Ft3 as well at next test

If not …..after next test ….then consider increasing T3

Slowly, slowly wins the race

[J972 in reply to SlowDragon]

I increased my levo to 75mcg this morning, it seems to have been well-tolerated 🙌🏼 Plus this dose is a lot less faff than 62.5!

[J972]

👌

[Cornwaller]

Some people find that t3 suppresses both the t4 and tsh - which is what seems to have happened. The t3 dropping is slightly counter intuitive but the drop is small and may be random error/variation.

Many find that dosing to symptom suppression is the goal and therefore an increase in dose is probably timely.

[J972 in reply to Cornwaller]

Thank you very much Cornwaller

[Katherine1234]

Hi J972, just an observation, I would be pretty not well with folate that low. Low folate does not allow you to absorb B12 very well. The 2 run side by side.

[J972 in reply to Katherine1234]

Thanks very much. I have some separate folate, I’ll start routinely taking it. 👍

[Katherine1234]

J972 I have to take high dose folate (not folic acid) 5000mcg so my B12 just does not pool in blood doing nothing. Which looks like yours might be doing. Do you supplement B12? Folate is so important for our DNA, energy and brain moods.

[J972]

Hi and thanks again,

I’ve got folate 400ug by Vegavero, I think I bought it based on a recommendation by the late, great SeasideSusie. I also take Liposomal B complex which has 500ug B12 and 400ug of folate.

Can you please tell me more about this idea of B12 ‘pooling’?

Much appreciated 🙏

[Katherine1234]

I am someone with very low B12 getting to cells but shows high in the blood (pooling) I got very ill with ataxia, chronic fatigue, the whole 9 yards. I am on B12 injections but if I don't keep my folate at top of range I suffer. Folate allows B12 to absorb at cellular level. Not sure what came first with me the thyroid or the B12. I was lucky to have consults with the wonder RIP doctor. Not sure I am allowed to say his name here. I sent him 15 years of blood test printouts and he diagnosed me with under treated thyroid which in turn had taken down my adrenals, low cortisol and chronic low B12. He had me on a routine of B12 injections, upping my low thyroid medication and low dose cortisol medication. i was to scared to take the low dose cortisol, so I opted for Thorns Cortex and other supplements.

If you were me, I would be taking 5000mcg of natural folate a day for at least 2/3 months and see how you feel and get your folate and B12 checked by blood test. Folate will bring your B12 down as it becomes useable because of the folate. The blood test after 2/3 months might show up that you have a B12 deficiency, which causes lots of problems. I was diagnosed with ME/CFS and housebound. It was my thyroid, B12, folate and cortisol.

[Philogden6]

I am inclined to agree with Cornwaller. I am not an expert. T3 is very suppressive of TSH and therefore of T4 and T3 production by the thyroid gland. Also T3 does not stay in the body very long (unlike T4), and I believe its common for people on low doses of T3 or NDT to become even more hypothyroid as their own production of the thyroid hormones decreases and is inadequately replaced. I think you need to increase fairly quickly until your T4 starts to rise. Otherwise the extra T3 will be detrimental. Back off if you get symptoms of hyper, watch your bloods and ensure your cortisol and iron levels are OK.

[J972 in reply to Philogden6]

I think you need to increase fairly quickly until your T4 starts to rise.

Thank you very much for your response. You say that I need to increase fairly quickly, do you mean by taking more Levo?

🙏

[Philogden6 in reply to J972]

It seems crazy that by taking in T3 and T4 you can actually lower the amount of both in your system. However exactly the same thing happened to me when I started on 1 grain of NDT. I think the thyroid system overreacts to the amount of T3, especially if its all delivered in one dose. You can see this in your blood test results, your TSH has dropped along with both T4 and T3.

To answer your question, the ratio of T4 to T3 is around 4:1 in NDT which seems to work for most people. Therefor I would increase both without exceeding this ratio and would expect things to start stabilizing when your TSH has stopped falling. I am told that good values are with T4 in midrange and T3 high in the range.

The normal reason for a long wait after increasing a T4 dose is that T4 has a half-life of around 1 week. As a result of this it takes around 6 weeks for the T4 level to stabilise. (By stabilise I mean that the amount of T4 you take during the week plus half the amount left over from the previous week becomes constant). However as we have seen, adding T3 actually stops the T4 from accumulating so there is no point waiting initially, especially as you may have more hypothyroid symptoms as a consequence. Once the T4 starts building (after the TSH suppression has been completed) with increased dosage then the 6 week stabilisation period will again apply.

Given that the TSH value may finish up very low, and that people can initially become more unwell when taking T3 or NDT its no surprise that many doctors might have concerns about T3 treatment and prefer T4 only (which is also cheaper). However it appears that many people do much better on T4/T3 combinations, especially if they have conversion issues I guess.

[J972 in reply to Philogden6]

Thank you.