I would be grateful of folks advice. I was diagnosed with hypothyroidism just over a year ago following episodes of exhaustion. My T4 and T3 were in range but my TSH was 12.9. My Levothyroxine was incrementally increased to 100mcgs which sent me hyperthyroid with a TSH of 23, so I am back down to 75mcg and most recent results (done privately, before 9am):
TSH 2.99mu/l
FT4 20.2 pmol/l
FT3 3.1 pmol/l
(My Anti-TPO and Anti-TG were within range when tested previously).
I do feel much better but still have episodes of lethargy. Would a small dose of T3 help considering my TSH is still a little high for someone on Levothyroxine and upping my Levothyroxine sends me hyperthyroid??
My weight is 47.5kgs so 75mcg Levothyroxine is about right.
Many thanks everyone-what a great support this post is.
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AFMB
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I have a couple of questions that will help with replies, could you edit your question with the ranges for TSH, FT4 and FT3.
Even without those ranges it looks like you have poor conversion.
Have you tested any vitamins and minerals? Low levels can affect conversion of FT4 to FT3.
Which brand Levothyroxine are you taking.
If you are hypo it’s unlikely you can be hyper, but you may have had symptoms of over replacement. It sounds petty but there is a distinct difference.
But if your TSH is high this means your pituitary is still signalling your thyroid to produce more. When over replaced you’d expect to have a very low TSH.
Hi, your results not dissimilar to mine before I started adding T3.Your T4 level is good but T3 is awful. Most reference ranges for T3 have lower end reading of 3.1 and that's currently what your number is.Conversion way off centre at 6.5(ideally should be 4 or under)
Personally I'd trial a little T3, just 5mcg or so daily but as most have experienced on here you may have a fight getting it.My GP wouldn't even increase my Levo unless TSH was over 10 so in the end I had to self medicate.
We really do need the ranges to give you a proper answer :
We generally feel best when the T4 is in the top quadrant of its range at around 80% through with the T3 tracking just behind at around 70% through its range with a TSH down towards the bottom of its range.
It is recommended that oce on thyroid hormone replacement the TSH is kept under 2 :
The accepted conversion ratio - once the T4 is up 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 can in this range at 4 or under - so if I divide your T4 result by your T3 result - I'm getting your result at 6.52 -
so wide of centre and showing you not converting well the T4 - thyroid hormone replacement.
T4 is a pro-hormone and needs to be converted in your body into T3 the active hormone that runs the body and conversion of T4 into T3 can be compromised by non optimal levels of the core strength vitamins and minerals - ferritin, folate, B12 and vitamin D so suggest you get these run and post the results back on here for considered opinion - as no thyroid hormone replacement work well if these building blocks are maintain at good, solid levels.
Conversion of T4 into T3 can also be compromised by inflammation, antibodies, chronic other health conditions, any physiological stress ( emotional or physical ) depression, dieting and ageing :
just being in a range ' somewhere ' is not going to give you back your good health nor well being as some NHS ranges are just too wide to be sensible and ' normal ' does not mean anything - but that you are in the ' range ' :
A TSH of 23 would be a sign of hypothyroidism - as it is the TSH rising that is a signal that you need more thyroid hormone replacement - or possibly that you are not absorbing and / or utilising the T4 that you are taking :
Hyperthyroidism presents with a low / possibly under the range TSH :
Hi, thank you so much for all your replies, I just needed to say it was my FT4 (not TSH as posted) that was 23 pmol/l in May this year when I was on Levothyroxine 100mcg with a TSH of 0.656mul/l and T3 of 4.14pmol/l. My antibody results at this time were:
No worries - you can amend the message by pressing the More icon within the post and selecting the edit option and when finished press the edited icon bottom right within said post.
I disagree with these comments of optimal / high - alongside your results -
is this a Medicheck blood test - I've never noticed this on my results ??
A T3 @ 3.10 is the bottom rung of a range of 3.10 - 6.80 and certainly not optimal -
and @ 0% !!
A TSH of 2.99 once on thyroid hormone replacement is certainly not optimal -
A T4 near the top of the range is high : What was the bottom of the range ?
Hi the range for T4 was given as 12-22pmol/l. My bloods were taken at a local private chemist, not sure which lab was used. My plan going forward is to use Medicheck and will book in for Vit levels.
You don't appear to be converting the T4 into T3 -
Have any symptoms been relieved ?
Your antibodies are not showing over range / positive - so presuming you are not dealing with a thyroid auto immune disease - were you offered a diagnosis when first prescribed ?
Are you taking any other medications that may impair thyroid hormone conversion
Did you arrange this as a fasting blood test and leave around a 24 hour window from your last dose of T4 ?
Dose by weight is just a guide line - and not to be used as a finite statement.
I do wonder how accurate this blood test is and suggest you organise a full thyroid panel to include the TSH, Free T3 , Free T4 and antibodies, inflammation, and ferritin, folate, B12 and vitamin D as this is where we all start off and start a new post with the results and ranges for us to see a fuller picture of what is going on.
It must be a fasting blood test, best drawn by around 9.00 am and ideally actioned in the first few days of the week so the sample does not get stuck in the system over a weekend.
Stop any supplements around 7 days before the blood test so we measure what your body is storing rather than that just ingested - and do not use anything containing biotin as that can ' mess ' with some of the laboratory assay measures.
I am definitely feeling less exhausted, but still have episodes of lethargy. They diagnosed me as hypothyroid after a year of increasing TSH levels and put me on Levothyroxine once it went over 12mu/l. I went privately for TPO and antibodies (my GP wouldn't do them) as my niece (and previously my mother) were diagnosed with Hashimoto's (my niece is really struggling on T4, her endocrinologist refuses to trial T3-I have given her details of your post and hopefully she will get in contact).
I am on HRT, no other meds. I will organise a full thyroid panel to include the TSH, Free T3 , Free T4 and antibodies, inflammation, and ferritin, folate, B12 and vitamin D.
Thank you again-I at last feel someone is listening and explaining.
Ok then - so some symptom relief despite your blood test results - good :
When you take your T4 - remember you need to take it on an empty stomach with just water and wait around an hour before eating or drinking anything but water.
Remember to follow the instructions as to How To Take a Full Thyroid Blood Test which I think you can find on Thyroid UK - thyroiduk.org which is the charity that supports this patient to patient forum and where there is a full page listing of Private blood test companies to choose from :
Were your TPO / TgAB antibodies positive and over-range on the Private Blood test ?
What were your T3/T4 readings - or are these those above ?
I read that some - already settled on T4 - found they needed to increase their dose of T4 after they had started HRT ?
Reading around on the forum is another of learning and picking up relevant information and ' tips ' - if you get lost - just press your Profile icon which sits alongside the My Hub - Chat - Post - Alert and Menu icons - top right facing me on my laptop so probablt bottom left on a different gizmo :
Your niece might like to dip into the work and research of Dr Izabella Wentz which is well respected and followed by many forum members - thyroidpharmacist.com and she will learn a lot just reading around - it took me around 6 months before I plucked up the courage to write anything -
We all have to start somewhere - and it's one step at a time - but once you grasp the basics you will both be better able to advocate for yourselves and with continued support from forum members, who have ' been there ' and have ' the T shirts ' you too can reclaim your health and well being - and likely come back on and so say ' thank you ' by paying back the help and guidance you received.
My test earlier this month was done before 9am with only water and my last Teva T4 dose 24hrs before hand (thanks to the information I found in your post-but those before were not because I am embarrassed to say I didn't know and no body told me). I am only taking Vit D 10ug now after stopping my multivitamin. I will book a blood test with Medicheck.
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