T3/T4/TSH testing after starting T3

[Maztee]

I've added T3 about 3 months ago and this is my first test so I want to get it right.I reduced levothyroxine and added 20mcg T3 and am now on (usually) 30mcg with 125mcg.

I see levo should be stopped 24hrs pre test and T3 12-25hrs pre test unless peak T3 are required which they arent at the moment.

Test is at 8.50 (obv fasting, no biotin etc).

My TSH was always very low and I don't believe my T3 intake is enough to lower it more, my T4 always way above range with a low to middling T3.

Assuming Endo will look at TSH in particular and in order to show the best results are these the correct timings for me?

I am hoping for lower T4 and slightly higher tsh. I know it's not an exact science but this is my first chance at a result and to be able to continue getting it on NHS🤞

Grateful for anyone's experience and knowledge Thanks 🙂

[Jaydee1507 Administrator]

Did you forget to add the actual results?

Its usually suggested to start on 5mcgs T3 then add a further 5mcgs after a few weeks if everything is alright. To get to 30mcgs T3 in 3 months is a bit too fast.

On combination treatment most aim for 70% through rnage for both FT4 & FT3.

[Maztee in reply to Jaydee1507]

Sorry I may not have been clear. I started really slowly beg of Feb and that has all gone very well. My first blood test on T3 with T4 is tomorrow so no results yet. I'm trying to get the timing of the doses right for the morning test so when to take the last dose of each. I take my levo at night and start split doses of T3 when I wake up 🙂

[Jaydee1507 Administrator in reply to Maztee]

There's a pinned post here with all the details, but you should have already switched Levo to take it this morning if test is tomorrow.

healthunlocked.com/thyroidu...

[jimh111]

You are taking a lot of hormone, equivalent to over 200 mcg levothyroxine, so your TSH is likely to be zero.I usually say to have the blood taken halfway between doses for the most realistic result. If you leave 24 hours your fT3 will be quite a lot lower that it truly is. Nonetheless I still think your TSH will remain around zero. We'll see when you get the results.

[Maztee in reply to jimh111]

Thanks. Yes my TSH was close to zero and T4 up to 144% of range and had been rising for some time. This is us working on a solution. I was in too much levothyroxine which gave me symptoms And I don't convert well genetically. It's a process to find out what's best. I used to be on 200mcg levo when I was younger and felt well and my daughter is on that now. We're all different of course.

[Maztee in reply to jimh111]

Thanks I'd read that but was just wondering what people's experiences were too...

[greygoose]

My TSH was always very low and I don't believe my T3 intake is enough to lower it more,

Well, I think you're going to be disappointed about that! Your T3 intake is massive compared to most people, and your TSH is going to be zero. Much less T3 than that will suppress it. And it doesn't matter what time you take your hormones the day before, not what time of day you have the blood draw, that TSH is going to be zero. So, if your endo only goes by TSH he's going to blow a gasket!

That said, he should already know your TSH is going to be zero, because that's what T3 does. And even if he cuts out the levo completely, the TSH is still going to be zero. And he should know that. If he doesn't then he shouldn't be treating hypos, because that is a basic Thyroid 101.

[Maztee in reply to greygoose]

I terestjngly my recent results didn't show TSH at all. Endo is happy with my greatly reduced FT4 and increased T3 though so I will continue ...

[Maztee]

Yes I did wonder if there's be anything I could do that would influence it but I thought I'd ask. Unfortunately my test results haven't been great for a while but I also have hyperparathyroidism which may have had an effect.

Endo doesn't seem to be great as I had to diagnose myself and ask for the correcr tests. I asked if my thyroid results could I dictate a pituitary issue but she said not immediately. She doesn't really know my history tbh apart from thyroidectomy 40 odd years ago. There's never enough time.

I feel ok on this dose for now but that may change after adenoma removal. For now I feel relatively normal but what's gone is episodes of high BP and he rate and total exhaustion. I feel.more even, brain has cleared and family has said I seem more.myself. whatever the bloods say that's a good result!

[greygoose in reply to Maztee]

Hyperparathyroidism would have no effect on your TSH. They aren't connected at all. They just get their name from their location, close to the thyroid itself.

Suppressed TSH is only a problem for uninformed doctors, not for the patient. You just don't need it, that's all.