Last year I was diagnosed with hypothyroidism and Hashimoto, on the path of trying to conceive for +4years .
I started treatment with levothyroxine, which initially helped relieving symptoms (exhaustion, hair loss, weight gain, fertility issues), but now I'm feeling even worse than when I started!
I recently saw a functional medicine practitioner who recommended adding T3 to my T4 med, but my endocrinologist refused that approach.
Based on the evolution of the results below, and current symptoms, what is your opinion?
All minerals and vitamins are being also addressed.
Dec 22
TSH 1.71 mui/l
T3 2.58 pd/ml
T4 1.09 ng/dl = 10.9 pd/ml
ratio = 23%
May 23
TSH 2.288 mui/l
T3 ??? 2.55 pd/ml
T4 1.02 ng/dl = 10.2 pd/ml
ratio = 22.4%
Aug 23
TSH 2.94
T3 2.51 pg/ml
T4 0.88 ng/dl = 8.8 pg/ml
ratio = 28.5%
Feb 24
TSH 2.064 mui/l
T3 ??? 2.45 pg/ml
T4 1.20 ng/dl = 12.0 pg/ml
ratio = 20.5%
May 24
TSH 1.4 mui/l
T3 2.4 ng/l
T4 1.4 ng/dl = 14 ng/l
ratio = 17%
Functional Medicine says ratio should be 30% minimum.
Gratitude and All the best!!!
<3
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xtrelinhax
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I don't really understand what you're asking here, but before anyone can try and help, they need the ranges for all those results. Ranges vary from lab to lab so we need those that came with your results.
I would suggest you forget about ratios. Ratios are for healthy people. Hypos need what they need, and that doesn't always correspond to the ratios of euthyroid people. Besides, I've never seen a ration expressed with a percentage sign. Are we talking about ratios or percentages through the range?
I'm trying to understand if I should follow funcional medicine advice and start adding T3, or if continuing with traditional endocrinologist approach with only levothyroxine.
Even though my TSH is getting lower with levothyroxine, the T4-T3 ratio is more unbalanced.
From the FM point of view, the ratio in percentage should be above 30%.
When I started the treatment I was 22%, and now I’m 17%, so that probably explains why I’m not feeling better.
Well, there's not much I can say, apart from the fact that you're under-medicated - because I still don't understand expressing a ratio as a percentage. That doesn't make any sense to me - either it's a percentage through the range OR it's a ratio. You can't have both at the same time. And, I still say that ratios are not important to hypos because you need what you need. And I don't think you're getting enough thyroid hormone for your needs.
yeah it’s really confusing to me we well. The percentages here were given to me by the FM doctor that says ratio T4-T3 should be above 30%, and I’m always below.
Should I aim to add T3 and increase levothyroxine?
But 30% of what? A percentage has to have a range. Really doesn't increase my already low opinion of FM doctors!
July 24
TSH 1.92 mui/ml (0,27-4,2) Too high for someone on thyroid hormone replacement.
FT3 3.82 pmol/l (3.1-6.8) 19.46% - that is percentage through the range, and it is too low. Most hypos need it at least over 50%.
FT4 14.04 pmol/l l (10.0-24.5) 27.86% - too low, most hypos need it somewhere in the reagion of 75%.
So, yes, they both need increasing. Your conversion doesn't seem too bad but you haven't really got enough T4 to convert. So, the first thing you should do is get an increase in your levo and see how it goes from there. Also, forget ratios and tell your FM doctor to take a few maths lessons - he apparently needs them!
In my understanding the ratio and percentages here mean that we calculated FT3/FT4 ratio, and then converted that to a percentage.
For the above example my FT3 is 3.82 and FT4 is 14.04, this gives a ratio of 0.272 and converted to a percentage = 27,2%, which is lower than the 30% that the FM doctor suggested as a minimum.
Your calculations are straightforward and helpful to give me a better understanding of what numbers I need to use to guide myself.
Well, I'm far from being good at maths, but I still say that a percentage has to have a range. You can't just have a percentage floating unattached to anything. The percentages I gave you are calculated using the tops and bottoms of the so-called 'normal' range for your results. So, we have a percentage through the range. So the question still stands: 30% of what?
For clarity the ratio is the amount of T4 you have in relation to T3. Everyone whether medicating or not has their own best ratio, eg the amount of T3 to T4 you function best with.
The percentage is the amount through lab range, eg if the result is halfway through range, it is 50%.
Just for reference when on T4 monotherapy we generally feel best when the T4 is in the top quadrant of it's range at around 80% with the T3 tracking just behind at around 60/70% through its range.
The accepted conversion ratio - when on T4 only and once in the top quadrant of its range - is said to be 1 / 3.50 - 4.50 T3/T4 with most people feeling at their best when they come is this ratio at 4 or under.
So first we need to see ranges - to know if your T4 is at good levels in its range -
secondly we need to maintain optimal levels of ferritin, folate, B12 and vitamin D -
If your endocrinologist was through the NHS - it has become something of a post code lottery getting T3 prescribed as in certain areas of the country ICB financial restraints seem to be over riding medical need.
and then analyse you can see how supportive your surgery and / or ICB area are in prescribing T3 - Liothyronine - though its harder to assess if new patients are being prescribed - all you can do is follow the graph up or down - as there is a movement afoot in some areas to switch patients settled on T3 back to T4 monotherapy.
Can your functional doctor prescribe T3 - if it's deemed necessary ?
Your Functional doctor is suggesting around a 1 / 3.3 - T3/T4 ratio whereas the above suggestions tend to be slightly wider at around a 1/ 3.50 - 4.50 T3/T4 - with most people feeling better below 1/4 - T3/T4 ratio.
This understanding was really helpful, thank you!!!!!!!
Yes my FM doctor can prescribe T3, apparently, i left it in stand by because i was not sure if that is the way to go. There are so conflicting opinions between doctors and health professionals, its insane.
With this last post you haven't replied to anybody - but since you just pinged me a ' like ' maybe you meant to message me ?
So if we take your July 24 result your TSH is at 1.95 which is a little too high and signalling you need more thyroid hormones -
and this is borne out by the fact that both your T3 and T4 are too low in the ranges :
as I'm getting your Free T3 at around 19% with your Free T4 coming in at around 27% :
Was this July 24 blood test from a different Laboratory as the readings/ranges look different - and is this T4 range correct as if from Medichecks the range is usually 12.00 - 22.00 ?
How much T4 - Levothyroxine are you taking and do you take it on an empty stomach and wait an hour before eating or drinking anything other than water.
When you have a blood draw, is it an early morning fasting blood test ideally before 9.00 am and you take your T4 for that day after the blood draw so having left around a 24 hour window from your last T4 dose ?
OK - no worries - we were all new here once upon a time !!
Well I just think you need you dose of T4 increased as detailed previously as we generally feel best when the T4 is in the top quadrant - and currently your T4 is not even at 30% :
We also need optimal levels of ferritin, folate, B12 and vitamin D - do you have any readings of these ?
Since you have Hashimoto's you may like to read around on the research and suggestions of Dr Izabella Wentz - who writes as thyroidpharmacist.com
P.S. so go back to your post which was not addressed to anybody :
Press the More button and select edit -
then at the top of the post - add in the names of the people who you want to see the results now you have added the ranges
e.g. greygoose but press @ directly before you type greygoose - and then you should see her name come up and her name appear in blue :
If taking a T3/T4 combination of thyroid hormone replacements we generally feel best when both T3 and T4 are up in their relevant ranges at around 60/70 % through -
You may well need T3 but first off I'd work on getting your T4 up into the top quadrant by slowly increasing your daily T4 medication and test again at around 8 weeks and possible increase again by another 25mcg :
Since you have Hashimoto's you are liable to erratic own daily thyroid hormone production and can experience temporary 'hyper type swings ' in symptoms as this auto immune disease systematically attacks and destroys your thyroid -
but these swings will swing back and you will find yourself needing more thyroid hormone support as your thyroid becomes further disabled and ultimately you will likely feel better on a T3 / T4 combination.
Many forum members with Hashimoto's need to be checked out for celiac disease and often find that certain food stuffs such as gluten, dairy, wheat cause additional stomach and gut issues - which lead to absorption issues of thyroid hormone replacement and vitamins and minerals - so this another area that you need to look into - and believe Dr Izabella Wentz covers this in greater detail :
I can understand the endo not suggesting T3 - as currently your T4 is too low anyway -
What exactly did the endo suggest you do as I see now you are not in the UK and not with the stupid restrictions we find ourselves trying to negotiate ?
Very helpful!! Thank you for the recomendation too, I've read all Dr. Izabella's books!!
I'm gluten, dairy, soya, sugar,.... free for a long time now, but still i feel im not improving besides all the diet and lifestyle changes ive implemented, seen many doctors...
My endo is not very expressive, but he says we need to stabilize T4 before adding T3. He is doing it rather too slow maybe? (every 4+ months)
i'm having second thoughts about his approach. I'm not feeling better, and with IVF planned for September..
I'd like to make sure this is correctly addressed and that i'm doing everything it can be done.
Ok - were you tested - prior to doing the food elimination yourself - for celiac disease and pernicious anaemia as these 2 other AI diseases tend also occur in some patients?
I think your endo right in that you need to first build up your T4 dose -
but yes, your bloods should be rerun every 6 - 8 weeks -
and adjustments made to stabilise and build up the T4 to at a more solid level within the range -
I was tested for celiac disease after starting eliminating. It seams like I have the genes and do not process gluten well, but im not celiac.
Recently had some ocasional bites on greek spinach pies, though. Do you think that it could explain the recent raise of TSH?
About pernicious anaemia, I havent heard. B12 values are good now since i stared eating more meat, bone broth etc. They were quite low 2 years ago but i was mostly vegetarian.
Oh - ok - so 2 years ago your eating habits were totally different and you've spent this time putting yourself back together again from being ' almost ' vegan - we see this often - as the body has evolved over thousand years and needs certain nutrients you can't find anywhere else but in certain foods - well done you.
Gut issues seem very common with Hashimoto's and healing the gut one of the first steps to healing the body.
I hope the Greek spinach pie was as nice as it sounds - as for the cause of your TSH spiking - I've no idea - but with all things - balance the key - you need to live and enjoy your life - and just need to try and stay on as gluten free a path as best as you can.
Hi , it's not very clear how you are working out the %'s you refer to in your results , but however you are calculating it, it is not the usual method of working out a T4:T3 ratio (or a T3:T4 ratio for that matter) hence why folk are finding it confusing.
also , working with ratio's can present a specific problem when using results from several different labs , because different reference ranges can make for quite big differences in the resulting ratio calculations.
It is much simpler to use a "% through the range calculation to work out T4 and then T3 '% through range' separately , and then just compare these %'s with each other to get an idea of how much T3 you have , compared to how much T4 you have. (Here is a link to a % through range calculator thyroid.dopiaza.org/ )
The post below was my attempt at understanding and then explaining how the more usual methods of calculating T4:T3 ratio's and T3:T4 ratio's are worked out : healthunlocked.com/thyroidu....
You also need to understand that it's not just about the ratio .... you need to look at all results together to see the whole picture of what is going on T4 level ,T3 level, TSH level, and ratio.
~ for example , on one set of your results your ratio (as you have calculated it) APPEARS to show an improvement to 28.5% , BUT when you look at the levels of T4 for that test , you can see that the reason the ratio has improved is due to a large drop in the amount of T4, to very low levels ... and on that test the TSH has correspondingly gone up, as it should when thyroid hormone levels are too low ... so this set of results is actually showing that you were more hypothyroid ( worse) at that point... despite the ratio appearing to be better to what your Functional doctor is suggesting it should be .
Aug 23
TSH 2.94 (0.35 - 4.94)
FT3 2.51 (1.58 - 3.91) meaning your fT3 'percentage through the range' was 39%
FT4 0.88 (0.70 - 1.48) your fT4 'percentage through the range' was 23%
ratio = 28.5% dunno how you got his number , but:
your T4:T3 ratio here was :
(T4) 2.51 divided by (T3) 0.88 = 2.85 (for T4:T3 ratio's, a result under 4 shows 'better conversion ' / and over 4 shows 'worse conversion'.
your T3:T4 ratio here was :
(T3)0.88 divided by (T4) 2.51 = 0.35 (with T3:T4 ratio's it's the opposite way around , ie . a larger number means better conversion than a lower number ~ meaning a result over 0.31(ish) shows better conversion than a result below 0.31)
hope some of this reply helps you get your head round ratio's , but as a general rule it's a lot easier to forget about the exact ratio and just work out the "% through range" for your T4 and T3 results and then simply compare them directly with each other ... ie. you are aiming for roughly similar %'s such asT4 @ 70 % ish with T3 @ 60 % ish (just as an example) .......rather than T4 at 90% and T3 at 10%
in the set of result i used above , the ratio 'looks' pretty good because the %'s through range are so close together and because there was more T3 than T4 ,,, BUT both T4 and T3 are too low in range .. T4 is only 23% and T3 is only 39%... and as a result of those levels being too low for you, your TSH had gone up to nearly 3 ~ meaning you were quite hypo at that point regardless of how good the ratio between T4 and T3 was.
but just to clarify~ ratio's are not expressed as %'s , the only thing expressed as a % is "% through range" which (unless i'm losing the plot completely lol ) has now't to do with ratio.
yes it would make sense to increase levo dose by 25mcg try that for at least 6 wks preferably 8 , then retest. No point complicating your life by adding T3 unless levo alone won't cut it.. and until you have got T4 higher than this (ie. at least 50%) and TSH lower than this (ie. around 1 or lower) you can't tell if you will be able to get enough T3 out of levo or not .
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Comments on my TSH, Free T4 and Free T3 please
Guidance on levo dosing 
RESULTS: LOW T4, NORMAL T3?
recent labs hypo?
Thyroid test results 
