Very low T3, high T4

[RunningGeek]

Hi

I have just got a thyroid panel back from Medichecks as follows:

TSH - 1.69

T3 - 2.4 (reference range 3.1 - 6.8)

T4 - 22.2 (reference range 12 - 22)

B12 - 145

Folate - 46.8

Ferratin - 151

Vitamin D - 74.2

TPO antibodies - 37.6

Test done in the morning 24 hrs after last dose of thyroxine & having only drunk water.

I expected my folate level to be fine as I am taking supplements (currently dealing with chronic fatigue syndrome & working with a functional medicine practitioner). B12 & ferratin are clearly fine but am wondering whether I ought to supplement vit D as it's at the lower end of the reference range (50 - 250).

To me it is clear that I am not converting T4 to T3. Does anyone have any advice as to how to kick start this? I only started the supplements (B vitamins excl B12) at the beginning of August.

Thanks.

[FancyPants54]

Why do you think your B12 test result is fine? Is that an active B12 test? If it's serum it's woefully low. Anything under 500 is low according to the B12 experts such as the Pernicious Anaemia Society.

[TiggerMe in reply to FancyPants54]

Medichecks only test for active B12 37.5-150

Folate way above range so not sure if that needs investigating, certainly stop supplementing ( or has the range changed, I've 2 results from Medichecks with different ranges but this result is well above both?)

Aim to get your Vit D 100-150 and choose one that contains K2 also look at adding magnesium as this helps with uptake

grassrootshealth.net/projec...

Looks like a slight dose reduction is needed as too much fT4 inhibits conversion but with such low fT3 it's highly likely you just need to add some

[RunningGeek in reply to TiggerMe]

Thanks TiggerMe

Situation is complicated as I am currently trying to work my way out of chronic fatigue triggered by Lyme disease. On folate supplement on advice of functional medicine practitioner but we will review these results when I next speak to her. Already taking magnesium & an electrolyte with selenium in it.

My fT4 was much higher, reducing the thyroxine to current levels also reduced my fT3!

[greygoose]

You are, indeed, a very poor converter. But pretty certain you can't 'kickstart' it. Optimising nutrients doesn't seem to have helped much, but have you tried taking selenium? Have you had your zinc and copper tested? Every little helps, even it it doesn't improve your conversion by very much. Reducing your levo will also help a little, as TiggerMe says.

You haven't given a range for the antibodies but it looks like they might be slightly over-range, meaning that you have Hashi's. And Hashi's people are often poor converters and there's nothing to be done about it. You just have to procure T3 from somewhere and add that to your levo.

[RunningGeek in reply to greygoose]

Thanks greygoose

Selenium covered by an electrolyte that I am taking. Not checked zinc & copper.

Yes, I am working on the basis that I have Hashimoto's. Gluten, sugar & dairy free at the moment - am also trying to work my way out of chronic fatigue triggered by Lyme disease!

[Cornwaller]

Your results suggest you are not able to convert t4 to t3 efficiently. This results in t4 unconverted and t3 low. T3 is physiologically active, t4 is for the most part not, so despite the high t4 you still have hypothyroidism which may well explain your fatigue.

[pennyannie]

Hello RunningGeek :

When on T4 - Levothyroxine we generally feel at our best when the T4 is up in the top quadrant at around 80% with the T3 tracking just behind at around 60/70% through it's range, with conversion running at around a 1/4 ratio T3/T4:

It's painfully obvious that you are not able to convert T4 into T3 - have you discussed this with your doctor and had or are waiting for a referral to an endocrinologist ?

Has it been suggested you trial liquid T4 and see if that make a difference to your blood test results - let alone relieve some symptoms for you ?

Could there be absorption issues - have you been tested for stomach issues, leaky gut, food stuffs such as gluten, dairy, wheat etc - any other health issues or medications that may negatively impact thyroid hormone replacement medication?

The usual suspects for poor conversion are non optimal levels of ferritin, folate, B12 and vitamin D - any physiological stress ( emotional or physical ), inflammation. antibodies, depression, dieting and ageing -

so even allowing for some ' room for improvement ' on these co-factors - I can't see it making a big enough difference and resolving this conversion issue and think once having covered all the above bases the logical next step is to try a different thyroid hormone replacement option.

There are basically 3 thyroid hormone replacement options -

T4 - Levothyroxine - is a pro-hormone and needs to be converted in the liver in the body into T3 the active hormone that runs the body - much like fuel runs a car - and your brain and heart will take a large portion of your T3 just to keep your brain and heart ticking over and the rest is converted from the remaining T4 circulating in your blood stream as and when needed throughout the day.

T3 - Liothyronine is more expensive and the active hormone said to be around 4 times more powerful than T4 - and I read we need around 50 mcg daily just to function - with some taking T3 monotherapy but understand the vast majority find their health and well being restored taking a T3/T4 combo - with some needing just around 10 mcg T3 daily to kick start the conversion / metabolisation of the T4 Levothyroxine - thyroid hormone replacement.

Natural Desiccated Thyroid - this is the most expensive treatment option and the original successfully used treatment for hypothyroid for some 100 years - and contains the same known hormones as that of the human thyroid gland - namely trace elements of T1, T2 and calcitonin + a measure of T3 + a measure of T4 in each grain / tablet.

Currently your primary care doctor can only prescribe the cheapest option T4 - with anti depressants generally offered as a second line treatment - which do not work, if your need is one of requiring more, or a treatment option of thyroid hormone replacement.

You will need a referral to a NHS endocrinologist for any other treatment option and you may find you can get T3 prescribed - as it has become something of a post code lottery due to ICB financial constraints rather than medical need being implemented throughout of the country.

If you go into - openprescribing.net you can see by surgery and ICB area how supportive your area is as to prescriptions of either T3 - use - Liothyronine - or for NDT - use Armour - the leading brand - in the search engine as the drugs.

Obviously if you can afford to go privately you will likely find a very different landscape.

Thyroid UK - the charity who supports this patient to patient open forum hold a list of patient recommended thyroid specialists and endos - NHS & Private - so this might be a useful and many consultants still offer video consults so distance need not be a problem -

just email admin @ thyroiduk.org for the patient recommended list of thyroid specialists NHS & Private :

There is a lot to read - on the Thyroid UK website - thyroiduk.org - including a page listing of Pharmacies - one of whom - Roseway now offers a doctor video consult ( much cheaper than seeing a specialist ) and are supportive of thyroid patients and whom prescribe and support all treatment options :

P.S. Just looked back at your previous posts - and yes - should have done that first :

Anyway I see you asked recently for sources of T3 - so presume you have chosen to go the self source / medication route.

Did you crash on the Couch after all these other posts regarding running and were you thinking this running was your penance as ' feeling guilty and lazy for sitting on the Couch ' -or did your health decline after this period in your life ?

[RunningGeek in reply to pennyannie]

Thanks pennyannie

The situation has come about after I started seeing a functional medicine practitioner to help me navigate out of chronic fatigue triggered by Lyme disease. Prior to this any alteration to my thyroxine dose had very little/no effect on me. Before all of this I ran, cycled & walked so I am pretty fed up at the moment!

Have a private endo consultation next week - GP asked for expert advice from local hospital & they told him to stop testing T3. My GP is on side having had a couple of interesting conversations with him & has said that he can prescribe T3 if that is what is recommended - & I can see that my surgery does prescribe T3, thanks for the link.

[pennyannie in reply to RunningGeek]

Oh well - that is a positive from your doctor - lucky you.

If your ICB area are prescribing T3 to new patients you should be fine.

Worst case scenario you doctor could write you a private prescription which can get filled at one of the Pharmacies detailed on the Thyroid UK website and monitor you himself -

I read Henning Thybon 20 mcg is the ' favoured ' brand and needs to be specified on the prescription and at a very reasonable cost.

If your increased dose of Levothyroxine had little or no effect there are several reasons for that - and could mean one or some of these factors :

You were not on enough T4 - or having absorption issues and / or dealing with high thyroid antibodies, inflammation, physiological stress ( physical or emotional ) dieting, depression and or ageing.

Non optimal levels of core strength vitamins - ferritin folate, B12 and vitamin D :

Other health issues and or medications may impact on your ability to convert T4 :

Genetic issues can effect T4 to T3 conversion : some people get tested for this but it doesn't guarantee getting a NHS prescription.

and in my case - without a thyroid and having lost my own T3/T4 thyroid hormone production think enough of a reason to need a more ' full spectrum ' thyroid hormone replacement than T4 only - to restore the natural T3/T4 ratio and kick start my metabolism.