Blood results- T3 levels consistent? Can I improve them?

[Bluesadawg]

Hello,

Despite feeling overall better for some time I started feeling too regularly worse again.

I suspected low T3 (perimenopause also possible). Yep, my T3 is on the lower end of ‘normal’. These are my results:

TSH 1.53 mlU/L (norm 0.27-4.2)

Free T4 15.6 pmol/L. (12.0-22.0)

Free T3 3.6 pmol/L (norm 3.1-6.8)

Cortisol (random) 219.0 nmol/L (norm 73.8-507.0)

Vitamin levels- all fine

I’m guessing that T3 levels stay consistent unless auto-immune damage of hashimotos causes them to drop? Or do flare ups from eating the wrong thing or stress (or anything else?) cause them to fluctuate - hence feeling rubbish during a flare?

And are there non-medication ways to aid T4 conversion? Liver detox diet etc?

Any knowledgable advice very welcome! I’ve got too many responsibilities feel this unwell this frequently 😢. Thankyou .

Diet gluten free + dairy free (exception DIY kefir, dairy)

Suppliments-

Algae oil 1000mg

Iron vit c folic acid

D3 K2

B vits (B1, B2, B3, B5, B6, B7, B9, B12)

Magnesium (Glycinate, malate, citrate)

Biotin, zinc, selenium for hair loss

[SlowDragon Administrator]

How much levothyroxine are you taking

Which brand

Results suggest you need dose increase in Levo

Free T4 (fT4) 15.6 pmol/L (12 - 22) 

Ft4 is only 36.0% through range

On levothyroxine only many/most people will need Ft4 at least 70% through range

[Bluesadawg in reply to SlowDragon]

Thankyou slow dragon ☺️. I’m on 75mcg levo: 50mcg from accord & 25mcg from wockhardt. But I think i’ll request a lactose free brand next appt in a few weeks

[SlowDragon Administrator in reply to Bluesadawg]

So push to increase to 100mcg daily

How much do you weigh in kilo

[Bluesadawg in reply to SlowDragon]

I’ll ask. Thankyou . 76 kilos

[SlowDragon Administrator in reply to Bluesadawg]

76kg x 1.6mcg suggests likely that eventual daily dose around 121mcg per day

Some people need a bit less than guidelines, some a bit more

pathlabs.rlbuht.nhs.uk/tft_...

Guiding Treatment with Thyroxine:

In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months.

The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).

The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range.

……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.

The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.

[Bluesadawg in reply to SlowDragon]

Thankyou, thats really helpful 👍

[Bluesadawg in reply to SlowDragon]

Hello again. I think you're right about it might be worth trying a higher levo dose & take your recommendation to my GP but couldn't find the info on the 1.6 mcg in the pathlabs.. link. I might just of missed it, but is there a reference page or somewhere I could refer her to about it please? Although she seems quite open to taking on board what I say, I think she might need a bit more persuading on this one as I currently have both a recent nhs blood result & private lab result which both say I'm well & my results normal despite not taking into account my weight & that I feel ill in various ways every day at the moment.

Thankyou

[SlowDragon Administrator in reply to Bluesadawg]

Page 5 on this link

pathlabs.rlbuht.nhs.uk/tft_...

On levothyroxine, most people will need Ft4 at least 70% through range or higher

Currently your Ft4 only 36% through range

NICE guidelines on full replacement dose

nice.org.uk/guidance/ng145/...

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

Also here

cks.nice.org.uk/topics/hypo...

Graph showing median TSH in healthy population is 1-1.5

web.archive.org/web/2004060...

Comprehensive list of references for needing LOW TSH on levothyroxine

healthunlocked.com/thyroidu....

onlinelibrary.wiley.com/doi...

If symptoms of hypothyroidism persist despite normalisation of TSH, the dose of levothyroxine can be titrated further to place the TSH in the lower part of the reference range or even slightly below (i.e., TSH: 0.1–2.0 mU/L), but avoiding TSH < 0.1 mU/L. Use of alternate day dosing of different levothyroxine strengths may be needed to achieve this (e.g., 100 mcg for 4 days; 125 mcg for 3 days weekly).

[Bluesadawg in reply to SlowDragon]

Thankyou again slow dragon for all your really helpful reference research, so many people ago that you may have forgotten by now ha ha. I'm taking my results & discussion to the doctors tomorrow so hopefully it will yield some positive results, she's usually not bad at listening & taking on board information I bring.

To muddy the waters, as you know, so often happens with this illness, I've started to feel a bit better the last few days- typical before a long awaited appointment 😅, I think it may be due to just having started taking a biotin supplement containing selenium, which I've read can help with T4-T3 conversion. Could this be affecting me too perhaps?