Blood results on T4/T3

[Mhaire]

Please could someone comment on my daughter’s recent blood results?

She is 17 years old and was diagnosed with hypothyroidism and chronic fatigue syndrome two years ago. I always thought that her hypo could be causing the fatigue and she certainly experiences brain fog.

The fatigue has been so debilitating that the consultant added in a dose of 2.5mcg liothyronine to her 75 levothyroxine in July. At first, she thought it gave her a boost but this didn't last. Blood results below:

TSH 1.9 (0.27-4.2)

T3 4.2 (3.1-6.8)

T4 13 (12-22)

Thyroglobulin Abs 15.5 (0-115)

Thyroid peroxidase antibodies 12.8 (0-34)

CRP 0.204 (<3)

Vitamin D 34.2 (>50 sufficient)

Ferritin 65.90 (30-169)

Active B12 >150 (>37.5)

Folate -sample error

Before introducing liothyronine, her T4 was 17.1 (12-22), T3 6.2 (3.1-6.8)and TSH 3.7 (0.27-4.2) in March 24 but her fatigue was severe, as well as other symptoms.

Her vitamin D has been low on and off over two years. I have put her on 2000 better you Vit D spray. Is this sufficient? Would anyone know?

I am a little worried about her being on T3 so young. Endo wants to raise liothyronine to 5mcg but I'm nervous about this, as he talks about cardiovascular and osteoporosis risk. For context, I am on T3 only myself.

Would appreciate any thoughts or advice.

[TiggerMe Ambassador]

Gosh they are horribly low!

Free T4 (fT4) 13 pmol/L (12 - 22) 10.0%

Free T3 (fT3) 4.2 pmol/L (3.1 - 6.8) 29.7%

Quite a turn around from... Before introducing liothyronine, her T4 was 17.1 (12-22), T3 6.2 (3.1-6.8)and TSH 3.7 (0.27-4.2)

It looks like her conversion was pretty good on Levo, it comes down to does she feel better or worse now, whether to raise her T4 dose or T3, both fT4 and fT3 are unlikely to cause any heart or bone issues if kept within range as you are just replacing these hormones to bring them up to a more natural level

Vit D, no 2000 isn't going to be much help, this is a great calculator to tell you what is needed, you are looking to acheive 100-150nmol/L, also worth adding magnesium as this is necessary for Vit D uptake

grassrootshealth.net/projec...

I'd suggest a good loading dose for a few weeks to get things moving in the right direction

[Mhaire in reply to TiggerMe]

Thank you for this. I've been very concerned as she does not seem well and is very symptomatic. Her fatigue and brain fog has become much worse over the last few weeks. Her colour is poor and she has some hair loss at the temples, for the first time.

I think I will contact her doctor to discuss the T3 in the circumstances. The Vitamin D calculator is excellent. I will have a look at this.

It is so good to get your advice and perspective.

[pennyannie]

Hello Mhaire :

Did your daughter feel any better / different between these 2 sets of blood tests ?

Once on T4 thyroid hormone replacement it is suggested that the TSH be kept under 2 - and many feel best when the TSH under 1 and towards the bottom of its range -

We generally feel best when the T4 is up in the top quadrant of its range at around 80% with the T3 tracking just behind at around 70% through its range.

On first glance on paper her previous results ' show a good high T3 ' but

her T4 is at just around 51% with her T3 at around 84% -

Were any antibodies run at this point in time or a scan suggested ?

She must have been feeling some internal pressure -

as she hadn't enough T4 circulating in her blood stream to maintain such a high T3 and the T3/T4 results inverted with a TSH reading at 3.70 - shouting out for more T4 thyroid hormone replacement.

The second set of blood tests after taking a small dose of T3 along with the 75 mcg T4 - has impacted all her results and all have lowered - TSH - T3 & T4 : with her TSH back down at 1.90 and her T3 at around 30% with her T4 at around 10% and still inverted.

I think I would follow up with thyroid scan if this has never happened as something is clearly not right - maybe check for Graves Disease antibodies ?

Just for reference - I now aim to maintain ferritin at around 100 - folate around 20 - active B12 125 ( serum B12 500++ ) and vitamin D up at around 125 for optimal conversion of T4 thyroid hormone replacement.

Her vitamin D level immediately jumps out as needing action.

As you need to take T3 only - could there be a genetic issue here for your daughter

[Mhaire in reply to pennyannie]

Hi Pennyannie, I think my daughter has been much worse since starting the T3 in July. I am T3 only and have the D101 gene. I can't tolerate levothyroxine, unfortunately. My daughter has been struggling with severe fatigue and brain fog, which is why, given my history, her endo thought a T3 trial might help.When she had her previous bloods done in March (pre-addition of Liothyronine). She had a thyroid scan done two years ago and she had small cysts on her thyoid. She has had antibodies done several times over the last few years, which have all been normal range.

I am not sure where to turn anymore, as the GPs defer to the Endo and he has a very minimal approach to testing.

I wonder would she be better stopping T3, increasing T4 and optimising vitamins.

[pennyannie in reply to Mhaire]

Yes - I understand - but I'm just concerned that her T3 reading is much too high compared to her T4 reading - and increasing her T4 will likely push her T3 over the range -

Her T3 was at 84% and for a lot of people that would be too high and causing symptoms -

More T4 will likely convert and take her T3 over the range - possibly causing more symptoms -

Possibly - like yourself, she may do better on T3 only - I read the average person needs around 50 mcg T3 a day - just to function - though you likely know better than me -

just surprised such a small dose of T3 caused such a difference in her T3/T4 readings :

What does the endo suggest - increase T3 and phase out T4 ?

Obviously her low vitamin D isn't helping matters - but I don't think this the main issue :

Can you get another scan - it's been 2 years since her cysts were last monitored and a scan should also show up any other abnormalities ?

[Mhaire in reply to pennyannie]

I am going to speak to her consultant and discuss her results and symptoms. Its a complicated picture though and adding T3 at this age/stage of life is not easy. Your reply has been really informative. Thank you.

[Stourie in reply to pennyannie]

hi pennieannie the high t3 reading is before starting t3. The most recent test her t3 is only at 4.2 so possibly needs more t3. Jo xx

[pennyannie in reply to Stourie]

Yes - as I understand this - and please check me out -

on 75 mcg T4 her T3 was 84% and her T4 was 51% -

and likely with a T3 much too high for most people -

why by adding in a little dose of T3 - 2.50 Liothyronine -

her T3 is now at 30% with her T4 at 10% :

We have no AI component to factor into these results - and I just can't reconcile why and how this addition of a little T3 - would have caused such a dramatic difference in this second set of blood tests -

Do you have any thoughts - am I missing something ??

[Stourie in reply to pennyannie]

Sorry, l was reading the tsh at 3.7 as the t3. My mistake. Jo xx

[Mhaire in reply to Stourie]

Thanks Stourie and Pennyannie. Really helpful input. I'm a little spooked by my daughter's signs and symptoms, as well as confused by her blood results. Somethings not right and although it was far from perfect before, it was a bit more manageable than this. I'm awaiting serum cortisol results, Endo is going to do ACTH and I think I will discuss reverting back to levothyroxine only.

[Litatamon]

With her symptoms I would use an oximeter & check her oxygen saturation, simply to cross it off as an issue.

Check it in the day but also slip it on her finger a couple of times during the night, just to be sure everything is okay. If she is okay with you doing that while she is sleeping.

All the best to you both.

[Mhaire in reply to Litatamon]

Hi there, thanks so much for your reply. Can I ask what you were concerned about in relation to her oxygen sats? Sats at 98 at each reading. Her BP is usually on the low side with HR of 84 ish. HR now 120 and BP 120/70. I know it both can fluctuate during the day, but if there is a pattern to this, I'm really not happy about her staying on T3 at her age, unless we have no other choice.

[Litatamon in reply to Mhaire]

That is good news, great readings on the saturation. The oxygen saturation was checking for sleep issues (apnea, hypoxia). A lot of your daughter's symptoms overlap with sleep issues & I always feel things need to be crossed off. Checking saturation at night is an easy way of making sure it is not an issue.

That 120 on the heart rate seems not normal, unless she was moving around a ton or is suffering from anxiety in that moment. Yes it can fluctuate of course but that HR is on level with moderate exercise. Communicating all this because after I had a thyroidectomy I was not properly medicated with thyroid hormones & I had a HR over a 100 on a regular basis. It went on for so long they wanted me on beta blockers, I refused because I knew I was not balanced & felt, Let's check when I am. Well I am now and my HR is never up like that. So keep an eye on that if it stays raised at any point.

Also want to let you know that adding t3 whether to levothyroxine or in NDT always raised my HR & BP. But at the same time others have zero issues. And it has been an absolute game changer for many. Communicating that to show it is all so individual.

Hope you get some answers soon.