I am taking a trial of T3/T4 combined. I’m in my early 70s and my Endocrinologist told me they have no proof how people my age react to this combination of meds, as far as osteoporosis and heart problems are concerned.
Thus I need separate results of these 2 chemicals not the overall TSH. My recent doctor tried for 6 months to attain these results but NO joy.
I have asked Medichecks to do this blood test. . I opted for the home finger- prick test. Unfortunately all the advice given to do before the blood extraction, didn’t help…. my result was abysmal..I couldn’t fill the phial.
I opted to pay more and have a home visit.
Their sorting in 2 days is now into a second week with urgent beside my name.
Is this a common problem? My fault living in the country, but I’m only 10 minutes drive from my very busy local NHS health centre.
Below are all NHS Blood tests within their bands ….I was taking 10mcg —T3 & 12.5mcg —T4.
14-10-23 yearly blood check TSH —2.13 FT 4 — 8.2 FT 3 — 4.3
This resulted in my doc saying I needed to up my T4 to 20mcg.!
I tried doing it slowly but ended up @ 16.5 mcg having horrible headaches, feeling v cold, v.v tired, putting on weight , loosing hair, I became very depressed & I had an on going cold.
3 mth check up 13-02-24. My Doc had left practise.!
TSH— 2.58 FT4 8+
Due to excessive cold and tiredness ( also I’d had a fall, as I was sooo tired.)
New Doc started to look to other blood tests..
04-04-24 only TSH result…2.98.
17 -05-24 I ask doc to let me go back to what I was originally taking 10mcg —T3 & 12.5mcg —T4, yes.
The most recent lot of NHS Bloods were done 2;40 pm ! No choice.
NHS Blood test. 23-05-24.
Vit B 12….. 993ng/ L [>178]
Iron /Ferritin….. 78ng/ ml [13 - 150]
Calcium adjusted level …. 3.37 mol/l [ 2.2 - 2.6]
TSH level. … 1.59miu/ L [ 0.27 - 4.2]
Magnesium level…… 0.96 mmo/l [ 0.7 - 1]
My yearly NHS thyroid check up is now due.
I’m to see another new doctor about arranging this test, what should I be asking to have tested?
Would memory problems be thyroid related?
Many thanks for reading all this.
Tea7Light.
Written by
Tea7light
To view profiles and participate in discussions please or .
Taking any dose of T3, even an inadequate dose, will significantly reduce TSH
14-10-23 yearly blood check
TSH —2.13
FT 4 — 8.2
FT 3 — 4.3
please add ranges
Was test early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
T3 ….day before test split T3 as 2 or 3 smaller doses spread through the day, with last dose approximately 8-12 hours before test
On dose
10mcg —T3 & 12.5mcg —T4.
That’s a very low dose of T3 and Levo
Which brand of Levo
Which brand of T3
my doc saying I needed to up my T4 to 20mcg.!
(you presumably mean 25mcg)
I tried doing it slowly but ended up @ 16.5 mcg having horrible headaches, feeling v cold, v.v tired, putting on weight , loosing hair, I became very depressed & I had an on going cold.
standard STARTER dose of levothyroxine is 50mcg if under 60……or 25mcg if over 60 years old
Starter doses will almost always make you feel more hypothyroid…..the answer is to increase the dose
Levothyroxine (and/or T3) don’t “top up” your own thyroid output…..they replace it. ESSENTIAL to be on high enough dose
Typically bloods retested 6-8 weeks after each increase
Aiming for Ft4 at least 60-70% on JUST Levo
If on combination of levothyroxine plus small doses of T3 …..then both Ft4 and Ft3 probably at least 50% through range
Thank you Slow Dragon for all this information, and your time. Sorry it’s so long.
14-10- 23 test done 11:30 am, so not ideal , but I took T3 after the blood test.
I have T3 am as it keeps me awake if I have it pm & T4 ideally about 9 pm.
I have to take phlebotomy appointments when space. In future I will ask. But only drinking water prior to test.
My sister had thyroid cancer.
Brands T4 Mercury T3 Morningside.
Yes 25mcg
I have some working thyroid so I understood it was topped up by the tablets…. Irish logic!
Background.
I was diagnosed by my Doc with thyroid problems, in Eire in 2007 waited 2 yrs for Endo diagnosis. As I knew thyroid wasn't right I researched NDT. Used that for 10 yrs.
My NDT supplier ran out just after I moved to the UK 2015.
It was making the transition from NDT to T4 that some problems happened . I did the gradual T4 rise with regular tested blood tests. But T4 @ 75mcg I had a bad dose of the hives and I found I was very foggy brained. I went back to NDT, but an unreliable source .
Returned to NHS T4, I struggled with this as I had foggy brain too often for about 2 years.
Result an Endo appointment, but I needed NDT to coherently explain my problems!
My original notes to the Endo showed it was a slow brain fog, tiredness, poor sleep & weight gain that I was coping with. We had a long talk about the great value of NDTs compatibility mirroring our own T1,T2, T3 & T4.
The T4/T3 trial combination gradually allowed my conversational skills to return by 2020/21 .
I realise compared to others here I’m on a very light dose, but the T3 was the vital link and my brain again functioned properly as it had when on NDT ( I also have a stressful marriage which doesn’t help.)
recent results. On last years test 14- 10 -23. my NHS ranges were
These results suggest you are on inadequate dose levothyroxine
Most people on adequate replacement when on Levo plus small dose T3 will have BOTH Ft4 and Ft3 at least 50-60% through range and TSH likely below range or suppressed (because of taking T3)
if on ONLY levothyroxine…..guidelines suggest 1.6mcg Levo per kilo of your weight per day
Typically dose levothyroxine only needs very small reduction from this when T3 is added
If ONLY on T3 ….then most likely to need between 40mcg - 60mcg T3 per day
ESSENTIAL to maintain OPTIMAL vitamin D, folate, B12 and ferritin
If you have an underactive thyroid (hypothyroidism), treatment may be delayed until this problem is treated. This is because having an underactive thyroid can lead to an increased cholesterol level, and treating hypothyroidism may cause your cholesterol level to decrease, without the need for statins. Statins are also more likely to cause muscle damage in people with an underactive thyroid.
I tried last year to increase T4 up to 25mcg. Not good, I became v.cold, v . tired and foggy brain increased. I couldn’t sleep properly. So after 7 months I asked to be allowed to return to T4 @ 12.5 mcg. & T3 @ 10mcg.
I can cope on this, but feel somethings are slipping.
Having been on NDT I know how I like to feel, it really was so natural and easy.
Proportions of T4 to T3 approx 50-60 % ….would this be near the ratio 4:5 Endo put me on?
Vit B 12. 993ng/L[>178]
folate 14.3ng/ml [>2.9]
Ferritin level 78ng/ml [13– 150]
No Vit D, unless another name?
Are these OPTIMAL doses?
I have asked several times for my Cholesterol to be tested, it was omitted, so I will ask again.
I tried last year to increase T4 up to 25mcg. Not good, I became v.cold, v . tired and foggy brain increased. I couldn’t sleep properly. So after 7 months I asked to be allowed to return to T4 @ 12.5 mcg
You should have retested after 6-8 weeks after each increase
And results almost certainly would show ready for next increase to 50mcg daily
I did have a retests but we could only get the TSH results those were
13-02-24. ~~2.58 [0.27–4.20 min/L.]
04-04-24 ~~2.98
Back to my usual combination of T4 / T3.
But STILL no further breakdown of these individual elements :- T3 & T4 after Doc had been asking for 6 months ….Only TSH. {She did take it further but No joy. It needs another appeal to the head of Endocrinology !}
23-05-24 ~~1.59
On this old combination I lost the tiredness, gradually I felt warm, and the brain fogs lifted . Also I can sleep MUCH better & I didn’t have awful headaches on waking.
When on adequate dose Levo plus T3 you would expect TSH to be well below 1, almost always below range and often suppressed
Thousands of U.K. thyroid patients have to test privately to make progress
Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
T3 ….day before test split T3 as 2 or 3 smaller doses spread through the day, with last dose approximately 8-12 hours before test
Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins
Can I quote you “ just testing TSH is totally inadequate” I will see if my new doc will PUSH this point with our local Senior Endocrinologist……
Though I think there was a group Europe & USA meeting of Endocrinologists and they agreed TSH was the answer, forgetting the 1000’s who have thyroid problems and rely on thyroid supplements.!!
If your taking any replacement thyroid hormones it’s essential to test Ft4 and Ft3, but ESPECIALLY if taking any dose of T3 as TSH will be significantly lowered
If ONLY on levothyroxine you need to test Ft4 to see if taking high enough dose
Essential to always test Ft3
Unfortunately on NHS its very rare these days to get Ft3 tested and increasingly rare to even get Ft4 tested
My new young doc. ……reads notes and my complaints and is now armed with 2 patients both needing T3 T4 results. Has booked me in early next Wed for a thyroid blood test then the discussion will go further!! Seems all my letters to the previous Doc are NOT lost.
Thank you for educating me & giving me confidence to keep trucking. Those labs have to change their tune…..TSH only…..!!!
I am not a T3 expert, so leave others to comment on that.
However, I have noticed that your calcium levels are elevated.
Calcium adjusted level …. 3.37 mol/l [ 2.2 - 2.6]
Are you supplementing with Vitamin D3? And if so, are you taking Vitamin D3 AND Vitamin K2 as well? Vitamin K2 will ensure that the calcium from your diet gets directed into your bones and does not stay in the blood vessels. Taking Vitamin D3 without adequate Vit K2 can lead to hypercalcaemia.
Higher calcium can also be caused when your kidneys are not working as they should be. Have these been checked recently?
Hi Tina-Maria, wondered if you know how many mg or mcg an adequate dose of vitamin K2 is please? Do you think it depends on the amount of vitamin D or calcium supplements you are taking? Also wonder if you know if there is an upper daily K2 limit that shouldn’t be exceeded?
Thanks for your information, I do randomly take a calcium tablet with vit D. No Vit K.
Your info is good to know my mother had osteoporosis .
Sorry for delay. I was trying to get into my medical records.
I checked the very extensive bloods I had done earlier this year to find out if kidney check included, there was a renal test. Dr said it was all normal this was 21-05-24.
Yes, taking a Vitamin K2 supplement with your Vitamin D3 is very important. There are many supplements out there these days that have a combination of Vit D3 with K2 already, so it is easier. Make sure you take some magnesium with your Vit D3 +K2 as well, as this will help with the absorption and effectiveness of the Vit D3.
Glad that your kidneys were okay, so that's reassuring. What dose of Vit D3 are you taking?
Has your doctor specifically recommended that you take a calcium supplement? Do you eat yoghurt, cheese etc., and beans, green leafy veggies? Most people, if they eat a varied diet, have an adequate calcium intake - unless they are excluding certain foods such as dairy from their diet.
2.5 mcg Vit D is a very low dose (100IU), especially if you are deficient. The daily recommended allowance is 600IU, but even this might not help you to raise your level significantly if your Vitamin D is low. Most people are supplementing with much higher doses. Doses of up to 4000IUs per day are considered safe. This could perhaps explain your raised calcium levels, as you are taking calcium, but have far too low levels of Vit D3 and K2 to direct the calcium to your bones.
I take VitaminD3 (3000IU) with 100mcg K2 from Nutravita, available on Amazon. There are other products as well, if you want to try a different brand/dose. I always look, that there are no fillers or other unnecessary stuff in there. If you really want to take calcium as well, I would take it in a separate supplement and away from the Vit D.
thank you for a very extensive reply. Lots to think on . You know your onions!😊
I don’t like taking supplements, I try to eat organically and a varied vegetarian diet, with fish…Too often Supplements come from varied sources & are unknown quantities or a good one stops!.
Outdoor work and regular exercise should be enough, but we do age!
I don't think any of us are really keen to have to take supplements, but sadly it is a necessity, if you want to feel well, as many of us have issues with absorption of nutrients, even if we do eat a healthy diet. 😢
I completely agree, that there are huge amounts of supplements out there with dubious quality and it is difficult to separate the wheat from the chaff! 😉 But persistence will pay off in the end and the supplements people recommend here have been tried by many and found to be useful, so at least we can be sure to spend our money effectively and wisely. 😉
She must also know if taking calcium and taking vitamin D together vitamin D can also raise calcium , I'm wondering why she's taking calcium?Was her calcium low at one point?
Her calcium is now mid range, she need to know her base line calcium before she took the calcium supplement and to keep an eye on it to much calcium is not a good thing👍
Thank you Birkie, I was taking it as osteporosis runs in my family. I was told by my Endocrinologist that being on T3 /T4 I was at risk of this problem. You advice is sound & sensible.
I have primary hyperparathyroidism and my endocrinologist put my on high loading doses of vit D in the hope it would decrease my parathyroid hormone, instead it raised my calcium even further 🤦♀️ giving me some awful symptoms 🤮 I have ostiopeania borderline osteoporosis according to my gp after DEXA scan grey zone...what ever that term means 🤷♀️
There is a lot of conflicting information out there and it is difficult to sieve through it all. Many women are concerned about osteoporosis, especially after menopause and when there is a family history of it, and a very common general advice is taking enough calcium for prevention.
What the advice doesn't say is that additional calcium is generally not necessary, when you have a good, varied diet with plenty of calcium (unless you really have very low levels), or that you need to take Vitamin D3 and K2 as well, for the calcium to be absorbed into the bones, where it can prevent osteoporosis, by actually strengthening the bone structure. If your calcium levels are very low, your body can release calcium from your bones (called osteopenia), which in severe cases can lead to osteoporosis. This can also happen with very high levels of Vitamin D3 (above 10,000IU per day), especially when taken without Vit K2, and can lead to kidney damage.
The general advice also does not say that you should measure your actual calcium level before supplementing, which we know is essential, hence it is very difficult to make the right decision, with only having part of the information. Many things in our body are very interconnected, so taking too much of one supplement and not balancing it out with something else can soon lead to imbalances, which over time and can lead to problems.
Many doctors and specialists don't understand this tho🤦♀️ my calcium has been very high due to primary hyperparathyroidism in my case when the parathyroid goes overactive it dumps parathyroid hormone into the blood stream and the calcium does the same, it leaches it from my bones and dumps calcium into the blood causing bad symptoms especially kidney stones which I've had and passed plenty my last kidney function was appalling 😣
Now with my calcium at mid range 2.36 adjusted from 2.41 my gp wants me on high vit D dose, which I know will raise my calcium even further, it as in the past when I've taken it, gps and specialists just seem to throw anything at us today and hope it sticks🤷♀️
Also my parathyroid specialist told me vitamin D should only be given in large doses if the calcium is very low [ this being with a raised parathyroid is known as secondary hyperparathyroidism] my calcium is not low🤦♀️
Are you taking Vitamin K2 with your Vitamin D3? The Vitamin K2 is actually directing your calcium from the blood into your bones. High levels of Vitamin D will only cause calcium levels to rise with excess doses of Vit D3 (>10,000 IU) and only when calcium levels are low. This is to keep the blood levels of calcium within a physiological range, as we need calcium for different purposes other than bones (e.g. muscle function, heary rhythm, enzyme function, nerve function etc.). It is still not good to take Vitamin D3 even in moderate doses without Vitamin K2.
Also my parathyroid specialist told me vitamin D should only be given in large doses if the calcium is very low
Well, yes that would release the calcium from your bones in response to the low level, but that would lead to osteopenia or osteoporosis in the long term - surely not a desirable effect?!🫣
So if your GP wants you on a higher dose of Vitamin D3, you should take some Vitamin K2 (between 100 and 200 mcg) with it as well, so you direct the calcium to your bones and prevent the calcium from being released from your bones, should your levels go below your physiological levels.
I have attached an article for you regarding the benefit of Vitamin K2 in calcium disorders.
To my knowledge, there is no upper safe limit for Vitamin K, as it has a low potential for toxicity, either when you are ingesting it through food or by supplementation. The only caution is, that you need to speak to your doctor, if you are on anticoagulant (blood thinning) medication (such as warfarin or clopidogrel), as Vitamin K is involved in the clotting cascade and can block the action of these medicines.
The reason to take vitamin D with K2 is, that you would need a lot more Vitamin D on its own to achieve the same Vitamin D level, than taking it with Vitamin K2. And the Vit K2 directs the calcium from your diet to your bones and will not cause hypercalcaemia (high calcium levels in your blood). The NHS even states, that taking 1000mcg of Vitamin K or less is unlikely to cause any harm.
I don't think there is a hard and fast rule on how much Vitamin K2 you need to take. However, in general there are recommendations which suggest around 100 mcg Vit K2 for doses up to 2500IU of Vit D3 and 200 mcg of Vit K2 for doses greater than 2500IU per day.
It all depends on your own blood levels of Vitamin D and where you start from. For example, my Vit D level was 65 nmol/l around 2 years ago. I have supplemented with 3000IU Vit D3 and 100 mcg Vit K2 (plus Mg) since then. My Vit D levels in Sep this year were 125 nmol/l. Doses of up to 4000IU Vit D3 per day are generally classed as safe, important thing is to test your levels so you can get a feel, if you need to adjust your intake either up or down. Hope this will help?
Pleased you mentioned it, that calcium level is really high 🤦♀️ pth calcium, vit d should definitely be done ..[pth in EDTA tube] along with magnesium 👍
In my experience thyroid probs affect memory and ability to think, big time! You mentioned taking NDT, was there a dose of NDT that got you well?A lot of people feel well when their TSH is just below 1. Also I've been told to aim for a T3 of 6 by my thyroid doctor. Hope you get your blood tests and feel better soon.
Calcium supplements neither cure, not prevent, osteoporosis. That is a false idea spread around by the dairy industry. In fact, they can have the opposite effect and make your bones brittle so that they break easily..
Calcium supplements are a very bad think to take unless you absolutely have to. They are very badly absorbed at the cellular level but instead tend to build up in the arteries and soft tissues, causing problems like kidney stones and heart attacks. And even taking vit K2 with them won't help like it does with calcium from food sources.
So, it's very easy to over-dose - as you've found out! Your serum calcium level is much too high, and that is dangerous.
Other nutrients, like magnesium, are far more important for bones. Did your doctor tell you you need to take magnesium with your vit D? As a general rule, doctors know nothing about nutrients or nutrition and you take advice from them at your own risk. Always, always do your own research before taking anything your doctor recommends! I often wonder how many people they kill with their dietary 'advice'. Certainly I wouldn't have survived long if I hadn't realised I knew more about nutrition than any doctor! I've had some really terrible 'advice'.
As for not liking to take supplements and wanting to rely on a good diet. I'm afraid that when you're hypo it just doesn't work like that. Being hypo can cause low stomach acid which make digesting food and absorbing nutrients difficult. So, even with the best diet in the world you can still have nutritional deficiencies and need supplement of one kind or another.
It's hard going but all you really need to read are the conclusions:
Conclusions
The recommended intake levels (RDA) of Mg were provided by the United States Food and Nutrition Board (Food and Nutrition Board 1997). These values are generally higher in men than women, and in certain situations, such as pregnancy or breastfeeding. More precisely, in the adult man the reference value varies from 400 to 430 mg/day, while in the adult woman the reference value varies from 310 to 320 mg/day. The tolerable upper intake level (UL), in relation to pharmacological contributions or supplementation, is defined for all categories except for the age groups 6–12 months and 1–3 years (for lack of experimental evidence) with a value of 250 mg/day, according to the recommendations of the EFSA document (European Food Safety Authority 2006).
From the various studies carried out since 2009 on the serum concentration of Mg and its relationship with the bone, it has been shown that lower values are related to the presence of osteoporosis, and that about 30–40% of the subjects analyzed (mainly menopausal women) have hypomagnesaemia.
Various dietetic investigations carried out have shown that many people (about 20%) constantly consume lower quantities of Mg than recommended; moreover, in this category, a lower bone mineral density and a higher fracturing risk have been found several times.
Considering the studies published to date on supplementation with Mg, most have used this mineral in the form of citrate, carbonate or oxide, with a dosage varying between 250 and 1800 mg, therefore beyond UL. In all studies there was a benefit both in terms of bone mineral density and fracture risk.
Thank you very much for all this thorough information. Lots to read, research and think on. I have stopped the random calcium tablets, and I do use magnesium oil, don’t know what you think of that?
I do realise we all need extra vitamins and minerals as we no longer get these in our refined diets today.
I can’t lay my hands on the very good book I have on Magnesium and it’s use in the diet.
I did reply to you earlier but I don’t see it. I’ve a lot going on here so I’m going to have to close for the moment, and get back in better times.
Hi, only just seen this reply because you didn't click on the blue 'Reply' button under my comment, so I wasn't notified that you'd replied.
When you are hypo, it's not just that our diets are too refined, it's also that our stomach acid levels tend to be low, so we have difficulty digesting our food and absorbing nutrients.
What do I feel about magnesium oil? I couldn't stand it! The feel of it on my skin. Ugh! So, I have no idea how it works for people, whether or not you can get enough magnesium from it to help.
Sorry I’m not into technology at all. This Ipad is my limit. Magnesium oil I agree it is psychological boost. I don’t mind the seaside salty effect. But it has stopped muscle cramps so I continue with it. I make my own as it’s STUPIDLY expensive these days.
“The Magnesium Miricale” book I have is by Carolyn Dean, M.D., ND. = Exercise daily is the answer……!
To improve your natural magnesium up take for example…..Infact your whole body benefits from that doc recommended 1/2 hr walk, for a start your blood circulates better. But I realise walking is not for all, swimming is another alternative, or yoga……
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
BLOOD TEST RESULTS ON T3 ONLY
Blood test results
Feeling lost! T4-T3 ratio > blood tests results > please advise! 
Blood Test Results
