Is my problem poor T4-T3 conversion also Endo recommendation please.

[nannieJen]

Hello all this is my first post although I have been a member of this group for quite a while and have taken so much advice from all the posts. For the past year I have been working on gut health and maximizing my Vitamins. I have been taking Vits – D with K2, B complex with folate not folic acid (stopped before blood test), Magnesium Glycinate / malate/citrate. Although my last blood tests were disappointing for Folate and Vit D.

I am never tested for T3 by my GP but I have done my own private tests over the past year. This has shown what I think is a poor conversion of T4 to T3. I have gradually increased my Levo from 25mcg to 75 then 100 and in July 22 increased to 125mcg 5 days a week and 100mcg 2 days. That has now just changed to 6 days and 1 day.

After only a few months on an increased dose without fail all my symptoms start creeping back.

I have uploaded test results in my profile but the last private test on 17/1/24 are

TSH 0.81 (0.27-4.2)

T417 (12-22)

T3 3.5 (3.1-6.8)

My last vitamin levels were

B12 734 (197-771) 6 weeks after having my 3 monthly B12 injection

Ferritin 109 (13-150)

Vitamin D 65 no range given

Folate 3.4 (3.9-26.8)

I have been taking Pink tribe B complex specifically with folate, which I stopped a week before test. This has boosted my B12 reading, but done nothing for my Folate. A week ago I reluctantly started a course of Folic acid with GP.

I have requested and been refused an appointment with an NHS Endo, didn’t even get past the triage stage at the hospital (who knew). I am now looking to go Private to establish if I need T3. McPammy has very kindly shared details of her endo however I have the chance to have the consultation paid for by medical insurance if I see someone on their list.

Can any of you knowledgeable people firstly advise if you think I have a problem with my conversion.

Also so I can make the right decision I would be very grateful if anyone with knowledge good or bad of the following Endos could please DM me.

Prof Frank Joseph

Dr Sunil Nair

Dr Dushyant Sharma

Dr Vineeth Chikthimmah

[Forestgarden]

Hi there, you seem to be doing all the right things, but, yes it looks like you're a poor converter. Join the club! I'm similar. Your folate definitely needs a boost too, and I'm sure someone will be along to make some suggestions about that. Make sure you pick an endo who looks favourably on prescribing liothyronine, because you need it. Have you looked at the endo list on ThyroidUK? You could actually raise your levo a little, but that really depends on how it makes you feel. When my fT4 is top of range I start feeling very anxious and jittery. Plus increasing your levo probably won't significantly improve your ft3 level anyway. Good luck, you're on the right track

[nannieJen in reply to Forestgarden]

Hi thank you for your reply. Yes, I have a copy of the list from Thyroid UK there are only 2 Endos on there for Liverpool but 1 of them is from my list which is promising. I have actually increased my levo last week but just by an extra day to 6 days pw on 125mcg . Last time I was on 125 every day my TSH went under range to 0.07 (0.27-4.2) so my GP reduced my dose even though I felt OK. Hopefully I can get on a trial of T3

[greygoose]

TSH 0.81 (0.27-4.2)

T417 (12-22) 50%

T3 3.5 (3.1-6.8)10.81%

Pretty sure you do have a conversion problem, but you are also under-medicated. Most hypos need there FT4 higher than that. So, your fist step should be to increase your levo and see what happens.

After only a few months on an increased dose without fail all my symptoms start creeping back.

That is perfectly normal, and happens to most people. It just means that you're ready for the next increase in dose. And your blood results back that up.

How much folate is in the B complex you're taking? It might not be enough. But I doubt the folic acid will help because it's not very well absorbed. Are you still taking the B complex with it?

There may not be a range with your vit D result but at 65, it's too low. A little supplementation would be in order, together with it's co-factors: vit K2-MK7 and magnesium.

[nannieJen in reply to greygoose]

Hi Greygoose, my T4 has been higher on my last but one monitor my health test 16/8/23 all the same ranges as before

TSH 0.49

T4 18.9

T3 4

I have increased Levo but only slightly from last week.

The folate level is 400ug and I have been taking them for a year . I am still taking the B complex with the Folic acid, I never thought that maybe I should stop.

I have also been taking Vit D3 with K2 (Sun Vitamins) for a year and Magnesium (Orzax) 200mg