Free T3 not increasing with T4 increase

[Hippocamp]

Hi, in May I had been prescribed 20mg of T3 (and not advised to start low) so after 2 weeks I was naturally feeling horrendous with such a high starting dose and my T4 was still very low (52% through range). Thus on advice from the amazing guys on this forum, I stopped the T3 altogether and have been increasing my Eltroxin from 57 to 75 and now 100 since May (and have been working on my vitamins). Last week I restarted the T3 at 5mg per day and I had no side effects so after 4 days I added 5mg in the afternoon and I had a crash of energy for 2 days but I am back to feeling ok today- no palpitations, raised BP and only slightly raised HR.

But my query is this: last week, 1 day after starting T3, I had blood tests done so that I could get a repeat prescription of Eltroxin at my new higher dose. I followed the proper protocol for blood tests and had only had 5mg of T3 the day before (24 hour before blood test). My T4 has shot up from 16.9 in May to 19.4 (range 11.9-21.6) (77% through range). Note it was 4 weeks since I increased dose to 100mg. But my T3 has remained low, from 38% through range in May to 49% end July and now 44% through range. Does this mean that I am a poor converter? And if so am I right to start on T3?

To note my Vit D has increased from 46 to 77 (range 50-125) so I am happy with that as I have been supplementing. What should I be hoping to get it to?

My folate has increased from 3.9 to 6 (again what should I be aiming for?

And my B12 has remained fairly constant (639 to 626) (range 197-771) but I had been supplementing B12 for a few months before the May blood test.

They didn't test my ferritin but it was very low in May (35, range 13-150) and I have been supplementing with Three Arrows haem and eating lots of liver pate so I will pay for a private test for my full iron panel to see if that has increased.

[GlowCoach Administrator]

Any blood test is only as reliable as the conditions its taken under.

It takes 6-8 weeks on a stable dose to get a reliable blood result. You said you were on the same Levo dose for 4 weeks and then took 5mcgs T3 for 1 day so your blood results wont be accurate, FT4 & FT3 need to stabilise.

How long have you been supplementing? Best to give it 3-4 months before retesting.

How much vit D are you taking? Are you also taking K2 to help it go to your bones?

Are you taking a B complex, if so which one?

[Hippocamp in reply to GlowCoach]

Thank you, yes you are right I need to give a little longer. I had 6 weeks of a stable dose after my first increase to 75mg, and then only 4 weeks after the next increase. So I would have expected my T3 to rise accordingly with the rise in T4. Dr has asked me to retest again in 6 weeks as my TSH was supressed (he doesn't know about me starting T3 but I did tell him that I had increased my levo myself). I have been supplementing B12 for 5 months, Folate and vit D for 3 months and iron for 2 months. I am taking 3 sprays of 3,000IU vit D with K2 daily. Not taking a B Complex as I am taking B12 and methylfolate (400UG) separately. I couldn't find a B complex without folic acid locally.

[GlowCoach Administrator in reply to Hippocamp]

So when you retest, having been on a stable dose for 6+ weeks (the longer the better to allow levels to stabilise and settle). Still test at 9am or earlier, stop B complex or biotin 4-7 days maximum before, take Levo 24hrs before the test and time last T3 dose to be 8-12hrs before the test.

You will have to explain your suppressed TSH so being honest with your GP is a good idea.

Add an extra spray a day for vit D.

You wont find the best supplements in local shops or supermarkets. Better to buy them online. I'll post links to recommended B complex's and you may also need the 400mcgs methylfolate as well.

B complex suggestions: Slightly cheaper options with inactive B6:

amazon.co.uk/Liposomal-Soft...

Contains B6 as P5P an active form:

bigvits.co.uk/thorne-resear...

healf.com/products/basic-b-...

Explanation about the different forms of B6:

helvella.blogspot.com/p/hel...

B complex comparison spreadsheet:

healthunlocked.com/thyroidu...

[Regenallotment Ambassador]

great work! This is all going in the right direction. As already said you need to take the next tweaks sloooooowly. (I speak from experience) over range is no picnic.

The private prescriber at Roseway says 12 weeks for T3 increases and to expect the FT4 and TSH to move around as they settle. Your FT4 may come down a bit over time, or it may stay right up there. You definitely have converted better haven’t you!

🌱

[TiggerMe Ambassador]

I'd be inclined to hold off with the T3 until after your next test, your conversion isn't terrible and you still have room for improvement with folate (aim for double figures) ferritin, Vit D? odd range usually aim for 100-150 nmol/L, even another small increase in T4

That one dose of T3 will have lowered your TSH and likely skewed your fT3 result

Things are going in the right direction and if you need to add T3 it's going to be a very small amount but worth seeing where you get with T4 and optimal vits and mins 🤗

[TiggerMe Ambassador in reply to TiggerMe]

I was just about to add that you have been dealing with idiots and then I looked back at your first post and I've already said it! 😅