Hi there... I received a few months ago some blood tests I arranged privately as I had a gut feeling something was off with my thyroid but kept getting dismissed by my GP, who said there were no issues with my thyroid at all. From what I can gather, my TSH and FT4 are within optimal ranges (I'm not going by this lab's optimal ranges, obviously!) but my FT3 is low... and obviously my antibodies are quite high which is indicative of hashimotos. I am relatively new to all of this and have just been doing my own research to the best of my ability. From what I understand I have an FT4 to FT3 conversion issue. In your opinion, does this require pharmaceutical medication or is it possible to rectify this issue with supplements alone? My D3 is very low at 33 nmol and I am supplementing with high dose vitamin D, robiotics, Selenium, zinc, iron, B12, etc now in the hopes of improving my conversion, but I don't know if it will translate to an increase on FT3 over time? I had ibs like symptoms previously but they have all vanished with supplementation, thankfully. Does anybody have any insight, please? I'm new to all of this, so please bear with me... Thank you in advance for your help!
Suspected hashimotos : Hi there... I received a... - Thyroid UK
Suspected hashimotos
I am no expert, far from it. But what are your actual symptoms indicative of hypothyroidism? People with healthy thyroid glands have mid-range FTs, with FT3 just slightly lower than FT4, and a TSH below 2. Your anti-TPO-levels are slightly out of range, but not much. I know it is often said that ”once you test positive for thyroid antibodies, you have Hashimoto’s”. But I have read that some people with highish anti-TPO levels never develop actual hypothyroidism, and antibodies can normalise without causing any harm.
If I were you, I would wait and see. Few doctors would put you on thyroid hormone as long as your TSH is well in range and your FT4 is mid-range. You have neither overt hypothyroidism (TSH above 10, FTs below range), nor subclinical hypothyroidism (TSH between 5 and 10, FTs in range). With your current lab results, you are considered euthyroid (anti-TPOs above range alone are not enough to be diagnosed with hypothyroidism).
As far as I know, T4 to T3 conversion problems occur in people on Levothyroxine, not in euthyroid people.
Taking thyroid hormone is not something I would recommend unless necessary. And there is no medication that will increase T4 to T3 conversion. Correcting nutritional deficiences, however, can.
My advice would be to wait, retest in a few months, and see if your TSH has gone up along with your antibodies and your FTs down.
Thank you so much for your response! You have given me a lot of hope, as I really would much rather not have a longterm issue with my thyroid. I was also hoping that with supplementation the antibodies would drop, so hopefully in a few months I will see some improvement there. My main concern was the low FT3, but like you say, perhaps supplements and improving my gut health will help rectify this. I am very reluctant to go on thyroid hormones unless necessary, so I really appreciate your insight into my results. I will definitely retest in a few months and see if there has been some improvement. Thank you!
Apologies, I just realised I didn't address my symptoms... I have had all the classic hypothyroid symptoms... chronic fatigue, low mood, hair loss, brittle nails, ibs like symptoms, weight gain and difficulty losing weight...
I have just one more question, if you don't mind... You were saying that my FT3 levls should be just below FT4. What level should my FT3 be at do you think, in order to be considered fully functioning? From my research I have found that standard lab ranges are too wide and therefore my FT3 levels fall short of the optimal range. I have seen mention of FT4 to FT3 ratio, but it is something I haven't properly understood. Again, many thanks for your help!
There is no level that is ideal for everyone, but people with a healthy thyroid gland will have FTs above midrange and FT3 is said to be just below T4. So your FT3 levels could be a little low for you, although I find it surprising that you would have symptoms of full-blown hypothyroidism with those lab results. You will need to keep an eye on the antibody levels and retest in a few months.
Thank you! Yes, I was surprised to see that my FT3 was the only thing that was on the low side apart from my antibody levels as my symptoms matched hypothyroidism so much. I'd be thrilled if this is normal and nothing to worry about. Since supplementing my symptoms seem to have vastly improved so perhaps that is all I need! Many thanks for taking the time to reply and for all your insight!
it's a bit of a generalisation to say that fT4 'should be' slightly higher than fT3 in healthy people, or even that levels 'should be' mid range. See image below for an idea of how much variation there can be between individuals ...taken from here :
thyroidpatients.ca/2022/06/...
It is certainly true that fT4 and fT3 are usually pretty close together in people without thyroid disease , but some do naturally have T3 a little bit higher than T4, and some have T4 a little higher than T3 .
The levels of both T4/T3 in healthy people can be anywhere from quite low to quite high in the range. ( but they are usually pretty close together... ie. an fT3 at the top end of the range and an fT4 at the bottom would be a clue there is a problem , and TSH over about 3 is also a pretty big clue).
So your current TSH / fT4 / fT3 results could easily be those of a healthy person , but your symptoms are suggesting a problem , and so is the raised TPOab .. so you should definitely keep an eye on thyroid blood levels going forward. If TSH is gradually rising and fT4 falling , then that is something to point out to GP .
Thyroid hormone levels and TSH tend to stay within a narrow individual band in healthy people, but most of us don't know what that band is for us as individuals (because we never test when we feel healthy) ... so if for example your personal 'normal' setpoint was TSH less than 1 and fT4 around 75 % then yes your current results could explain your symptoms . (but no one will prescribe you levo with those results ,even with evidence of raised TPOab they would need to see evidence it was getting consistently worse, at least for TSH to go over range , or more rarely for fT4 to go under range)
Take thyroid blood tests at same time of day so you get a proper comparison ... TSH is naturally highest middle of the night / very early morning.... falling to it's lowest around 1-3pm, then gradually rising again .
Thank you, that is very insightful and interesting information! I had no idea there could be such individual variation in levels... I did have thyroid bloods done last year, so perhaps I could request a copy from my GP to determine how much has changed between then and now. It might give me a better idea if there is something awry or if this is all in my head! One again, thank you for taking the time to respond and share your knowledge. It's much appreciated!
Welcome aboard
You are doing exactly the right thing in correcting your low vits and mins which all help the thyroid work as well as possible, have you checked your iron levels before supplementing as too much is a bad thing and if taken with other supplements it will block their uptake? Ideally your Vit D would also contain K2 for bone health, B12 is better backed up with a good B complex, folate is another one that is very often low... what does robiotics contain? Or is it just missing a P?
You are right that your thyroid is under attack and it may help to try gluten and or dairy free to see if this helps to lower the attack as the body can be further confused by these
Many thanks for your help! Yes, my GP had told me my iron levels were low. My vitamin D does also contain K2 and I forgot to mention that I am also supplementing with magnesium and am taking a B complex. Sorry, it should have read probiotics and not robiotics! I have been 2 months gluten free now and I feel so much better as a result.
well done on working on improving low vitamin levels
Retest thyroid levels again in 8-10 weeks after adding last vitamin supplement
Also get coeliac blood test BEFORE trailing gluten free diet
Thank you!! I will most definitely get my thyroid levels checked again in a few months. Hopefully the FT3 will be within range thanks to all the supplements! Unfortunately, I have gone gluten free already and my gut has healed so much. I should have gotten the coeliac blood test first, I know now, but I didn't realise at the time. Many thanks!
Test Results In
T3 levels never change / got worse on levo
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