Advice on new bloods following T3 trial - Improvement in T3 😃 but v low TSH 🙁

[Slowrunner1208]

My latest blood tests are below. I’ve had these done as I’m due for annual GP bloods in a week and wanted to know more than simply my TSH.

I’ve been trialling T3 (sourced privately) and this has made a big difference, my % through range is much improved. I’ve been feeling better - less exhausted, fewer joint aches etc. Some things not improved as much - brain fog and feeling cold most of the time.

As there’s been an improvement I was hoping not to change anything. However my TSH is very low and T4 very high.

Should I reduce my levothyroxine (currently 125mcg) by a little?

Does anyone have any other comments / advice on my results?

I followed all protocols for the tests and am also waiting for results on my iron panel.

Thanks for any advice!

TSH 0.026 (range 0.27 - 4.2)

T4 21.3 (range 12 - 22) 93% through range

T3 6 (range 3.1 - 6.8) 78% through range

[GlowCoach Administrator]

Many people need FT4 & FT3 at around 70% through range so indeed your FT4 is a little too high and may account for some of your symptoms.

You may need to drop up to 25mcgs Levo but could do that in stages so as not to miss your sweet spot. Perhaps drop 12.5mcgs initially and retest in 6-8 weeks. You could even allow a bit longer to retest as the dose can take even 10 weeks to settle fully.

What are you supplementing with? Your B12 was a little on the low side previously.

[Slowrunner1208 in reply to GlowCoach]

Thanks GlowCoach I’m waiting for some other vitamin and iron results to come back and will post those when they do. 😊

[FallingInReverse]

Quick reply from a fellow former marathon/runner who also now gets winded walking up the stairs! Thanks Thyroid!!!!

At this point ignore TSH entirely (especially if it stays low/below 1). Taking T4/T3 makes it an unreliable marker for any dose change.

T3 is indeed the prize - well done! I’ll let others comment on whether a Levo reduction per FT4 results makes sense .

But! Your recent ferritin was super low based on your profile. Have you gotten a full iron panel or done anything to remediate that yet?

[Slowrunner1208 in reply to FallingInReverse]

Hi FallingInReverse I’m waiting for iron panel to come back, I’ve been working on improving things so 🤞

I’ll post when I get them 😊

[Buddy195 Administrator]

Did you reduce Levo at all before adding Liothyronine Slowrunner1208?

It’s very much trial & error to find your sweet spot, where you feel most well.

I cannot tolerate my FT4 as high as yours, but have found I’m ok with FT3 high in the range.

My recommendation is to adjust slowly (both increases & decreases)- I only adjust either Lio by 2.5mcg or Levo 12.5mcg, waiting until well tolerated I consider making further changes.

[DippyDame]

T3 naturally reduces TSH ...

How much T3 are you taking with the 125mcg levo ?

Your GP will alter your dose based on labs so...

If you change dose before next week's appointment you won't achieve a reliable result....a dose needs to be consistent for at least 6 weeks before testing

T3 also lowers FT4 so your levo dose appears to be too high.

[Slowrunner1208 in reply to DippyDame]

Thanks DippyDame I won’t change my dose before next week. I just wanted to be up to speed before I see GP. I’m nervous as they don’t yet know I’m taking the T3 and I live in an area which is actively anti T3. As I still have some brain fog I want to prep for the appointment. Last time I was made to feel like a hysterical old woman, want to avoid that!

[DippyDame in reply to Slowrunner1208]

It's awful isn't it!

Your poor conversion is most likely keeping your FT4 high so you may need to lower the dose

High FT4 is not advisable.

Depending on your T3 dose you may need a slight increase instead, to ease remaining symptoms

We're not hysterical old women...it's their reaction because it freaks them out that we are well informed

Good luck.

[Noelnoel in reply to DippyDame]

Your poor conversion is most likely keeping your FT4 high so you may need to lower the dose

Can I cautiously deduce from that then that my conversion may at least be reasonable? My FT3 is good but FT4 very low

I take Metavive and I know it’s difficult, once replacing T4 and T3, to ascertain conversion

I perhaps should’ve pm’d you but I’m not sure you notice all pms as I didn’t receive a response for one of my questions to you. And that’s not a criticism, I know you must be busy with lots of pms about monotherapy

[DippyDame in reply to Noelnoel]

Sorry.... I've checked....but no PMs.

I realised it wasn't a criticism...it's fine.

I usually notice any alerts/ chats that pop in.

No you can't deduce that I'm afraid.

I was referring specifically to Slow Runner's labs in that quote...It's not really possible to judge conversion after replacement hormone is added... and more so after Metavive , with no stated hormone content

You will know that T3 lowers both FT4 and TSH...

So, your T3 intake is likely causing your "very low FT4".....nothing to do with conversion.

Do you have current labs.....numbers and ref ranges?

Do you have a copy of your diagnostic test results?

High FT4 with low FT3 = poor conversion

To avoid overmedication keep FT3 within ref range

Keep a record of any symptoms you have and any dose changes

Take care

[Noelnoel in reply to DippyDame]

Sorry.... I've checked....but no PMs

It was a question about a month ago that was hidden within a long-ish reply. Doesn’t matter now

TSH suppressed

FT3 77%

FT4 12%

Yes, aware that T3 content will lower FT4 levels so I’ve introduced bovine Metavive to the mix for its higher T4 ratio

TPOab was slightly over range six years ago but since starting Metavive it’s remained within range. Haven’t measured it for a while, as a rather pointless exercise once diagnosed with Hashi

Thanks for your comments

[McPammy]

T4 way too high especially as you didn’t take T4 med 24hrs prior to test. As soon as you take T4 med the level goes much higher. That’s why your TSH is so low. It’s telling you to reduce T4. Possibly T3 could do with a very slight reduction too. Remember we are all trying to mirror a healthy persons thyroid result which are in range but optimal to try and achieve a TSH around 1.00. And importantly to have no symptoms.

[mountainice in reply to McPammy]

I always thought if we were on T3 our TSH is bound to be low. Mine's been suppressed since I started T3. Is that right, though I know we have to look at the individual.

[Slowrunner1208 in reply to mountainice]

Hi mountainice I’m learning and there are much more knowledgeable people here (thank goodness).

T3 will mean the TSH is low, mine is very low and according to some research I’ve found on here puts me at much greater risk of osteoporosis and AF. I want to understand and mange risks as best as possible whilst striving to improve symptoms/ quality of life 😊

[FallingInReverse in reply to Slowrunner1208]

T3 will mean the TSH is low, mine is very low and according to some research I’ve found on here puts me at much greater risk of osteoporosis and AF.

Hi I don’t know off the top of my head, but worth a deeper dive search on this board. There are debunked untruths about T3, bone health, and heart health. Including clinical studies. I e never jumped down that rabbit hole but almost every week there is someone asking about it and getting an earful to correct the misperceptions. I think doctors use that as an argument to not prescribe T3, so it comes up a lot here.

edit: with a disclaimer as with all things here that of course there are people with bone and heart and a fib problems.

[mountainice in reply to Slowrunner1208]

AS FallingInReverse says debunked untruths. I find it hard to know the proper answer (if there is one!).

[McPammy in reply to mountainice]

I’m one of the lucky ones who’s TSH isn’t suppressed on T3. It’s about 1.00 usually. Maybe due to my t3 originally being very low at 8%. And I’m taking liquid levothyroxine and so I can tailor my dose very well. I also split both T3 and T4 meds which reduces the chances of spikes which can cause TSH to suppress if spikes repeated regular.

[FallingInReverse in reply to McPammy]

do you mean “lucky” because it makes the NHS conversations easier for getting what you need prescribed?

Important to note, low TSH when on HRT is not a risk factor to track or worry about. It is an indicator in conjunction with the more important T4/T3, but not a cause of anything or symptom to treat.

[McPammy in reply to FallingInReverse]

‘Lucky ‘ meaning I get my T3 prescriptions without any questions. I was threatened in the beginning by my NHS Endo that if my TSH went suppressed whilst on T3 that they’d stop prescribing. Terrible thing to say to a patient who clearly needed and needs it.

[Fluffysheep in reply to FallingInReverse]

Do you have any links to anything written to back this up please? I have supressed TSH which my edno hates, although fortunately he does continue to support my prescription for T3 medication of 60mcg.

However, I am now taking 80mcg, and he refused point blank last week to support that, and went off on the usual ill-informed rant about osteoperosis and atrial fibrillation. He did mellow ever so slightly when I told him I was taking HRT, and he also agreed to my request for a Dexa scan (this was me telling him I'd take any test he wanted for my bones and heart to show I'm not harming myself with a low TSH, so hopefully this doesn't backfire on me!). Meanwhile I'm continuing with my 80mcg per day of liothyronine.

I always bookmark useful articles/journals etc in case I need to use them, so something like this would be really handy to have.

[Brightness14]

If I had your results I would be running again. These would be perfect for me. How do you feel. I know that my FT4 is always high even on NDT and my FT3 should always be around 6.

I don't think that your FT4 is too high if you feel well.

[Brightness14]

How much T3 daily are you taking.

[Slowrunner1208 in reply to Brightness14]

hi Brightness14 I’m taking 10mcg of T3 alongside 125mcg of levo. I do feel so much better than I did, which is great. I’ve been doing some research on here about v low T4. Ideally I want to raise my level whilst getting to the sweet spot for me. I’m concerned about osteoporosis more than AF from such a low T4.

It’s such a rubbish condition and I’ve learned I need to be patient - not a strong point for me!

[Brightness14 in reply to Slowrunner1208]

Exactly and it's great that you are feeling so much better. I am not patient either waiting six weeks for a blood test is a no no for me. I was a sprinter and long jumper in my youth and still ran until my sixties. It's hard not feeling well when we have been so fit in the past.

I do believe though that my previous fitness, i.e. never smoking, drinking, or over eating, plus all the exercise has kept me going now.

Good Luck.

[sparkly]

Not sure of your age so might not be relevant.

Perimenopause/menopause

Just commenting on brain fog. Mine only cleared up with testosterone replacement. Thought my memory issues would disappear too but that didn't happen. Brain fog and memory issues are 2 separate things for me. I'm on T3 only and full hrt including testosterone