I am on Levothyroxine 75mcg per day supplied by NHS and T3 20mcg per day from Roseway Labs. Started taking T3 in January this year. Both taken when I wake in the mornings usually between 7 and 8 am
I had two tests done on Wed. so didn’t have to stop vits etc twice. I stopped everything two weeks before the test. Medichecks done at 7.45 am, my friend who is a phlebotomist took the blood. Then had NHS test done at 9.50 at the drs surgery. Followed all protocols, T4 24 hours before. Split the T3 into two doses, first one in the morning of the day before test and second one that evening. However, the evening dose of T3 ended up being 1 am on the morning of the test due to me knitting, losing track of time, and falling asleep in the chair downstairs. Would this account for the high T3 result on the Medichecks test?
TSH Your value is <0.03 mU/LNormal range 0.35 - 5.50 mU/L
Free T4 Your value is 16.8 pmol/LNormal range 10.5 - 22.7 pmol
I’m confused as to what to do now. The GP ( I’ll call this doctor A) passed a message on to me on Thursday via the reception to say that he has reduced my Levo to 50 mcg in line with guidelines, I’m not sure if he read my notes, or if he knows I’m on T3 now. He did this last year without discussing with me first, we came to an agreement and settled on 75/100 alternate days at that time. I still felt unwell and in September last year my liver function became a problem I had extensive tests and saw a consultant in November, bilirubin over 200 etc. it resolved itself and by Christmas all levels were back to normal. This I felt was a result of not having enough T3 in my system and decided to source T3 privately. Started 2.5 mcg once a day from Roseway Labs and gradually increased slowly up to 15mcg once a day. When the weather changed I gradually began to feel symptoms returning, not sleeping so well, sluggish, tired by mid afternoon, cold, more brain fog, so two weeks ago I increased my T3 to 20mcg per day.
My Medichecks test in May gave T4 at 23 (12-22) so I reduced this from 100/75 alternate days to 75 a day, on good advice from the forum. The GP wasn’t aware of this.
When I had the NHS test in June my T4 had reduced to 17.3 (10.5-21) but the GP I saw at that time (I’ll call this doctor B) still wanted to reduce my Levothyroxine further because of my low TSH. I then decided to tell the GP that I was self medicating on T3 and had already reduced my Levothyroxine to 75.. There was a silence, then he asked about the T3 – dose, name etc. and was ok about this. I said I was keeping a check on my temp, heart rate etc. He explained I would still need NHS tests because I was taking Levo. I felt happy about this. However, it was Dr A who has decided to lower my dose again, Dr B is away apparently.
I’m not sure whether to let Dr A reduce my Levo to 50mcg or to keep it at 75. I lowered my T3 to 17.5mcg this morning.
I made a resolve to see Dr B in future, but when he is away Dr A takes over. There are only three doctors in the surgery. I had issues with the other doctor when I requested a Ferritin test last year. Please can you give me some help with this.
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Watamu
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Hmm... so first thing is to refuse the dose reduction and point out that your fT4 is only mid range at 51.6% and you do not agree to this change
Then your high fT3 result 7 hours after last dose does show that you have rather more than your body can utilize, did you feel any better changing from 15-20mcg T3?
It's actually looking like your fT4 dropped a bit too low and that this is the culprit for the return of symptoms and possibly would have been better to add it a couple of 100mcg doses to the regular 75mcg to bring it back up rather than more T3
I don't understand the liver/ T3 connections as this resolved before adding T3?
It looks like you were on a dose of 5mcg T3 which resulted in 95% so plenty of T3 I'm not sure how you ended up on 20mcg? Do you feel better now than 5 months ago?
Also your folate has halved in this period along with a slight drop in Vit D which ties in with the season change so could do with increase to maintain 100-150nmolL
Looking back at your T4 only results I'm really not sure why you are adding this much T3 if any... it looks like a small increase in T4 would have been a better option to trial but maybe you had already tried this 🤷♀️
Free T4 (fT4) 17.7 pmol/L (10.5 - 21) 68.6%
Free T3 (fT3) 5.6 pmol/L (3.5 - 6.5) 70.0%
T4:T3 Ratio 3.161
These showed good conversion
You say you never felt well on T4 but it may well have been you didn't ever quite have enough of it or were on a brand that didn't suit you?
You cannot convert more T4 than you're actually taking. Good conversion will give you an FT3 slightly lower than the FT4, not slightly higher. So I agree with Sleepman , there is an element of Hashi's here. I think one would have to look at more than just one set of results on T4 only to get an idea of just how well the OP was converting.
I'm not hard to please, I just like to be precise. People on here have brain-fog for the most part, and are not thinking straight. We owe it to them to be strictly accurate, not vague and woolly - not that I'm saying you were vague and woolly but I think it only fair to say when I don't agree. I know from experience that people can come back later with some strange tails of what they've been told, and when you check it out they had totally misunderstood what they'd been told.
Yes, pity I didn't check the percentages but... But that tells a different tale. That suggests to me poor conversion. The gap between the FT4 and the FT3 percentage-wise is just too wide. I know you go by ratios but I don't think they tell the full story - not in real life. OK, I'm off now to do some more nit-picking somewhere else.
Sorry your struggling. It is so blooming complicated and slow!
I am so grateful for this forum.
I wonder if your results in autumn last year that TiggerMe looked at showing good conversion were affected by autoimmune system attacking thyroid and releasing T3.(swinging) I had this. Have you any T3 results other than this when on T4 only showing poor T3 results?
Being on only T4 is simpler if you do convert well.
I think it works a bit like this ... 50 mg T4 is about 18 mg of T3. So on 75 levo and 50 odd coming from T3 you would be possibly higher 125 mg ish.
Your bio suggests vit B12 issues. Some need jabs not oral supplements? Has this been looked at. Pernicious anemia forum on here is good. There are 2 types of b12 blood results.
Maths is not my strong point but this sounds like gibberish to me. And we always have to remember the when dealing with real, live hypos, these theoretical formulas always fall down because they don't take into consideration two very important variables: absorption in the gut and conversion rate of the individual. You need what you need, and you can only find that out by trial and error, not by a formula. helvella , what do you think about this?
It doesn't help that you are using "mg" when almost invariably thyroid hormone doses are in micrograms (mcg or ug). It doesn't make an arithmetical difference but can confuse.
And converting a T3 dose back into T4 seems a bizarre way of looking at things. (To my mind. We are all different.)
If you are going to suggest a 3:1 ratio, then take the 75 T4 dose, divide by 3 = 25. And add the 17.5 T3 dose = 42.5. In other words, go forward to the calculated T3 dose.
One little comment is that: yes, taking your T3 later in the day, so that the gap between the dose and blood draw is smaller WILL change the results of the test.
I am struggling a bit with this issue myself at the moment. I realise that in past years I haven't been scrupulous about keeping the gap between my last dose and my blood draw identical.
I have tended to leave a gap at the larger end of that discussed on the forum, 10-11 hours between last T3 and blood draw. Currently my freeT3 is well inside the range, but I've been alerted to the fact if I made the gap smaller, I might not be inside the range. I had an incident at my GP a couple of years ago with a surprise thyroid test added to some others an hour or two after I'd taken the tablet. I had a freeT3 in the region of 20, and needed to do a lot of smoothing over.
Shortly after I began to realise this significance, I started seeing a new private Endo. He told me straight off that he doesn't believe freeT3 tests at all because they are just a function of the gap between the dose and the blood draw, and don't tell you anything objective. I am not sure whether to fully believe this, but I am sympathetic to it.
It's possible if you'd left the gap you intended to leave then this freeT3 test would be a chunk lower. You don't mention how many hours you shaved off your timings. The more it is the more the difference will be, of course.
Hi SilverAvocado, thank you for your input, i did feel that I may have messed up the test but all plans were in p lace and there was no way to change it. The hours between taking the T3 and test were 61/2 . I took T3 at 1.30 am and the test was at 7.50 a.m. In view of the short life of T3 I felt this must have some effect. I will still reduce the T3 by 2.5mcg and see how the next test goes. I'm finding the T3 dosing much easier to deal with than the T4. Thanks
I am 6 years down the T4/T3 combo route, the levo being NHS the T3 private ( like you Roseway tho was originally a private endo), and I regularly get the ‘overmedicated on levo’ spiel, and phone call from poor GP receptionist saying the levo.prescription is being reduced. 3 months ago the GP did this without my consent as TSH 0.02 ( not new as tends to be 0.02-0.04 ish), and since Covid impossible to get to speak to him for at least 3 weeks, so had to go on lower dose from 100 to 75 levo, fortunately can’t touch the 3x5 mcg T3. TSH went up to 0.03, but I saw from private blood test ( filled separate phial at same draw by surgery nurse) that this went with FT4 dipping from 17.2 to 14.9 ( 52 to 29%), whereas FT3 slightly oddly rose from 40 to 46%. So never ‘overmedicated’ if anything under; even with levo.only my TSH was never in range yet FT3 3%… so the ‘conversion’ of T4 and T3 equivalents never made much sense to me.
Incidentally before T3 I had raised bilirubin…turned out to be a blocked bile duct, perhaps yours was too but became unblocked, mine need need procedure!
I would just like to add that a GP is supposed to work with you, and not dictate. There was a recent thread here about the policy, so it may be worth just saying to your GP that this is supposed to be a partnership, not a dictatorship. I hope you get your sweet spot soon and feel better.
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