T3 not really shifting

[menochar]

Hi there, have been trying to sort out my T3 levels after years of not being listened to by gps etc. Eventually I found a private doctor (through this website) who was prepared to prescribe levothyroxine after years of marginal blood results (TSH high within range, T3 low within range) but symptoms indicative of hypo. After 5 months of taking levo my TSH has plummeted (from 3.8 to 0.28) but my T3 has only marginally gone up. The doctor doesn't want to raise the levo as we don't want my TSH to drop further... any suggestions?

[greygoose]

Get a new doctor? If this one is obsessed with the TSH he's never going to make you well. It just really doesn't matter if your TSH goes any lower. It's the FT3 that is the most important number.

Are your nutrients all optimal?

[pennyannie]

Hello Menochar :

What exactly were your TSH + Free T3 + Free T4 results and ranges ?

Maybe you have a conversion issue -

No thyroid hormone replacement works well until your ferritin, folate, B12 and vitamin D are up and maintained at optimal levels -

Have you any results and ranges of these core strength nutrients ?

[SlowDragon Administrator]

How much levothyroxine are you currently taking

Which brand

How long on current dose

Please add most recent TSH, Ft4 and Ft3 results and ranges

Aiming for Ft4 at least 60-70% through range

retest bloods 6-8 weeks after each increase in dose

ALWAYS test early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test

Exactly what vitamin supplements are you taking

Even if we frequently start on only 50mcg, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or somewhere near full replacement dose (typically 1.6mcg levothyroxine per kilo of your weight per day)

cks.nice.org.uk/topics/hypo...

bnf.nice.org.uk/drugs/levot...

nhs.uk/medicines/levothyrox...

Adults usually start with a dose between 50 micrograms and 100 micrograms taken once a day. This may be increased gradually over a few weeks to between 100 micrograms and 200 micrograms taken once a day.

Some people need a bit less than guidelines, some a bit more

TSH should always be below 2 on levothyroxine

gponline.com/endocrinology-...

Graph showing median TSH in healthy population is 1-1.5

web.archive.org/web/2004060...

Comprehensive list of references for needing LOW TSH on levothyroxine

healthunlocked.com/thyroidu....

onlinelibrary.wiley.com/doi...

If symptoms of hypothyroidism persist despite normalisation of TSH, the dose of levothyroxine can be titrated further to place the TSH in the lower part of the reference range or even slightly below (i.e., TSH: 0.1–2.0 mU/L), but avoiding TSH < 0.1 mU/L. Use of alternate day dosing of different levothyroxine strengths may be needed to achieve this (e.g., 100 mcg for 4 days; 125 mcg for 3 days weekly).

sciencedirect.com/science/a...

The optimal daily dose in overt hypothyroidism is 1·5–1·8 μg per kg of bodyweight, rounded to the nearest 25 μg.

[menochar in reply to SlowDragon]

Hi all, thank you so much for taking the time to read my message and replying. My last set of results were as follows

Magnesium 0.9 0.7 - 1.0 mmol/L

TSH 0.28 0.27 - 4.20 mIU/L

Free T4 19.0 12.0 - 22.0 pmol/L

Free T3 3.9 3.1 - 6.8 pmol/L

This is after being on 75mg levo since october. initially some of my symptoms improved (my hair stopped being frizzy, the aching seemed to ease, sleep was better) but seem to be back to feeling rubbish now. Have t say i was too tight to get the whole raft of tests done, maybe I should again. It's all so confusing. My cortisol levels are always very high, don't know if that can affect things.

My sister is celiac (late onset) and hypo... I have been tested and it came back neg but wondered whether this could be a factor?

Again, many thanks for reading

[SlowDragon Administrator in reply to menochar]

How long ago was this test done

How much levothyroxine were you taking

Which brand of levothyroxine

Get retested including vitamin levels

Request GP run tests for you or test privately