Got Free T4, T3 test results. What is the next step?

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Hello everyone,

I’m currently on 75 mcg of generic synrhroid (levo) and my TSH is at .07 way lower than where I should b (1-2). Doctor said that my my dosage was too high.  She also ordered extra lab tests which I’m having a hard time interpreting because all my Dr does is either increase or decrease my Meds. She already saw my results below and only asked what dosage I was on? Shouldn’t she know that? I’m not sure  what questions I should ask my Dr.  now or how I should interpret these results other than what I found online- change my diet and exercise. Is that all I need to do here? Thanks 

So it’s as follows: 


TPO AB 369 IU/mL (me) <=35 IU/mL (standard)


2.0 ng/dL (me) 0.8 - 1.7 ng/dL (Std)

T3, TOTAL 137 ng/dL (me) 50 - 170 ng/dL (std)

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  • Posted

    Emi, how are you feeling?

    Yes, your fictitious should know what size you’re on. Perhaps your dose was on a different computer screen than your test results so she just asked (?)

    Right off, your antibodies are very high. This tells you that your immune system is actively triggered. Any chance you had your antibodies tested before the meds? What were they? If you have antibody tests prior to starting meds, you can identify or rule out the meds as a trigger.

    Next, notice that your T4 is a tad above normal range and your T3 is roughly midrange. Your medication is T4 only, so your going to get the T4 sort of high-ish in order to get the T3 in the midrange.  Most people feel best when both numbers are midrange or higher.

    How long have you been on this dose? If it’s less than three months, it’s likely your mumbers will still increase a bit, in which case, you’ll need to lower your fosafe a tad.  If it’s been a while, I’d say this is probably as good as your numbers are going to get. As, you can’t increase your dose any more because your T4 will be too high. It’s ok if it’s a tad above normal range.

    Keep in mind yheee are normal ratios of T4/T3. Since you’re only taking T4, your ratios will not be normal. This incorrect ratio can result in thyroid symptoms. So you can see how it would be extremely difficult to get the perfect dose. You raise your dose. Cause you have dympypms associated with low T3 and you get high T4. So you wind up with both hypo and hyper symptoms at the same time. Constantly changing the dose cannot solve this problem, as it is inherent in the medication that your ratios will be out of whack.  This often results in anxiety, hair loss and other symptoms.

    Meanwhile, the belief is that TSH levels are determined by T3 values: as your T3 increases, your pituitary gets a signal and reduces TSH production. This is one reason T4 only is a preferred mode of treatment. Also it is believed that T4 only is less likely to cause heart palpitations. However, you can see from your results that your TSH is decreasing more proportionally to your T4 levels than your T3 levels. 

    For some people, the TSH tends to zero out before the medications are effective, as yours is approaching. This is unhealthy, as it tells you that your pituitary thinks you are hypothyroid, so the pituitary responds by slowing TSH production. Since we only look at thyroid numbers, we really don’t know what sort of effects the slowing of the pituitary’s TSH production has on the rest of the endocrine system. It is very likely that slowing the pituitary’s TSH production also affects other pituitary functions. This would result in other areas of your endocrine (hormonal) system being affected, which of course, is undesirable. 

    Again, I’d say your numbers are probably in the sweet spot now. If you lower to 50, it will likely your T3 will be towards the bottom range or below, which often feels like crap. You could try alternating, 50 one day and 75 the next. But my experience is that’s a flippin’ roller coaster that really confuses your body. 

    Since the side effects of this medication include autoimmune disease such as fibromialgya and arthritis, as well as bone density loss and other horrible side effects, it’s undesireable to have your dosage too high. The side effects are proportional to dose- higher dose means increased side effects.

    You really have to consider how you’re feeling on the medication.

    I had similar lab work as you on the Levo: at best, T4 in the high end, T3 towards the midrange, TSH very low or undetectable.  Not so good was T3 in the low range, TSH still low and T4 in the midrange. In the US and my TSH numbers didn’t much ever show once they were below 1, so I’ve long suspected our labs use a less sensitive TSH  test than what you’ve got in England. The really good endocrinologists and experienced docs were familiar with the TSH going to zero and treated base for on symptoms and thyroxin levels, essentially ignoring the TSH. The less experienced doctors freaked out when the TSH was low.

    In the end, I tried to get the dose right for over two years and was unsuccessful in actually treating my symptoms with this medication. I wound up far worse off due to the side effects of levothyroxin, which will take years, if I ever recover from them. I have severe advanced thyroid disease and feel better without the meds, using only diet and supplements.

     I share my experience in the hopes of saving you from the same. This medication doesn’t work for many people. You need to ASK YOURSELF, does it seem like it’s working for you or not? Are your symptoms improving enough to risk the known side effects of this medication? Since you’ve been on the medication, do you feel like your health is getting better, worse or the same? Are you prepared that there may not be a medication that works for you? If you go off this medication, what will you do to treat your thyroid disease? There are other medications out there. Do you feel you should try a different medication? If so, what is a reasonable amount if time to try these medications?

    These are important questions to think about. I know it’s overwhelming and it’s probably all you can do to think about today. But given your experience so far on this medication, what do you realistically think you’ll feel like tomorrow, and the next day, and in a month or a year from now? I’m not asking what you’re hoping for, I’m asking what you realistically feel this medication can do, given your experience thus far. 

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    • Posted

      Hi Catherine,

      Thank you for your informational response. I feel like you’ve explained it way better than my doctor did. It feels like pulling teeth to get an explanation of what is going on from her (it’s Kaiser m- sometimes I feel like they just want to push us through). January is month 4 since I got diagnosed. I feel way better than pre-levo in terms of energy but the weight gain, hair loss, memory issues persist and I wonder if that is just what I have to live with or if it will stabilize. I got a response from my Dr and sure enough she said to take 50 & 75 mcg interchangeably until the next blood test next month.  December was the first month she ordered a full blood panel. I’m not sure if this panel will continue. I hope it does.  I also read up that taking selenium is recommended but I’m not sure if I should stick with what the doctor ordered or if I should try homeopathic r medies in addition to levo. Any  recommendations? 

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    • Posted

      Hi Emi, you’re welcome. You’re Kiaser? Are you in California?

      To clarify, your antibodies are very high.  This is at the core of your problem. Your body is attacking your thyroid tissue. Taking thyroid medication is really only to treat symptoms. You’ll be better off if you focus your efforts on getting your body and immune system healthy. Otherwise, you’re on an endless path of ever increasing medication and worsening thyroid disease.

      The belief is that thyroid medication does two things: 1) treats symptoms, 2) prevents the advancement of thyroid disease by taking the stress off your thyroid. The natural thyroid medications actually do these fairly well. However the synthetics are less effective because they have a different chemical structure. As with all synthetic hormones, you can generally expect more side effects than with a “bioidentical” product.

      Here’s a crash course. “Bioidentical” essentially means from an animal source and not synthetic. It does not mean that it’s exactly like human. For thyroid medication there is no truly identical product available. My mother went untreated for most of her life because the medications were worse than the disease. Also, there is no differentiation between chemical names of natural and synthetic thyroxins (levothyroxin is T4 and trithrioiodine is T3). I’ve found this confusing and misleading. The natural is labeled NDT Levo... tri... For synthetic hormones, companies have both generic and brand names of synthetics that are diffeeent from the natural name. If it’s an estrogen, progesterone or testosterone replacement, they have kitchy names like Testoast or Progest, or Estroven- got brand and generic names. This differentiates from natural. With thyroxin, they call even the synthetic stuff by the same chemical name. This is due to powerful drug lobbying.

      Crash course in history of thyroid meds: natural dedicated thyroid (NDT) has been around forever. The stuff that’s prescribed us manufactured from pig thyroid glands and is tested to assure it is within acceptable ranges for both T4 and T3. The ratios of T4/T3 are different in pigs than humans, as pigs have much more T3.

      There are many other thyroxins (besides T3 and T4) in the body, all essentially forms of an amino acid with iodine molecules attached. The body converts as needed between the different thyroxins. T4 is converted to T3 in many cells of the body (liver and gut are extremely important) .  T3 is converted to rT3  (reverse T3), which then bonds up excess T3 to keep T3 levels from getting too high in the body. T3 and T4 are considered the most important of all the thyroxins. T3 is like 20 times more active than T4 and works with adrenaline for fast acting bursts of energy, it only lasts about 4 hours in the body. T4 lasts about two weeks in the body, but is nowhere near as active. They work together to help keep energy levels stable.

      Synthroid (levothyroxin) is T4 only and has been around now for about 70 years, well before the FDA. It was grandfathered into the existing system. They were forced by the FDA to apply for approval, which was granted the year after they applied. A rubber stamp since it normally takes a decade or so to go through this process. Generic drugs are based on efficacy comparison with brand names. Efficacy is demonstrated during the FDA process. There were some articles  in the NYT specifically about synthroid. You can do a search.

      Labeling of thyroid medications allows +/- 10% variation from the labeled side. This means if you’re taking a dose of 100, you could be getting any amount between 90 and 110. When you get a new prescription it’s from a different lot or batch, manufactured. So between prescriptions, you can have as much as a 20% diffence in dose.

      I’m telling you this because it’s really important to understand and know what you’re taking! I know you’re exhausted and just want to get on with life, but you’ll save yourself a lot of grief by doing the research. It’s really good to know what you’re working with. 

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    • Posted

      Looks like my post is held back fir moderation. I tried to click to send you a pm but there’s some funk and I can’t get to the private message page. 

      If you’d like to send me a hello pm, I should be able to respond and I’ll send you the note privately.

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    • Posted

      Yes, well try the alternating days and see what you think. I liked the idea when I initially tried it because it gave me a sense of being able to better control my fusing.  But in the end I felt like alternating just made my system more unstable. I should also mention that after 2+ years messing with the Levo, I found it did more damage than good. Sounds like you’re getting some relief, so that’s good. But still continue to work with diet and supplements 

      Here’s what I found to be most helpful:  you’ll want good quality multivitamins and minerals, a gluten free Paleo diet, essential amino acid supplements. I’ve expanded on these below.

      Yes, selenium is recommended. Some people find they get substantial relief from selenium. Magnesium deficiency and diabetes have very similar symptoms as thyroid disease. Calcium is required as well.

      There are many supplements out there specifically for thyroid- herbal blends, etc. Most offer temporary relief, then stop working.

      There are also OTC non prescription glandular (dessicated thyroid) that can be used in place of prescriptions. My mother uses ThyroGold. It is a dessicated thyroid from cows (bovine). It has lower T3 than you get in porcine (pig) NDT. So it has fewer side effects. Docs are hesitant to prescribe NDTs primarily because the high T3 can cause heart palpitations. Sadly, the Levo also causes heart palpitations.  Unfortunately insurance doesn’t pay for the OTCs.

      With thyroid disease, your easiest approach is to use good quality multivitamin and multimineral supplements. D, B,C copper, zinc and many others are required for proper thyroid function. Coblimated Bs can be helpful in B (6 and 12) absorption, so I always buy coblimated. Calcium is extremely important. Boron, a trace mineral often forgotten, is extremely important in thyroid function, and is rarely mentioned. 

      Because thyroid disease is autoimmune in nature, you’ll want to address this through diet and lifestyle. Autoimmune disease is generally caused by chemical and radiation exposure, but can also be triggered by allergens and microbial or viral infections.

      A strict glutenfree diet is really helpful. It refuced the load on your immune system. Also ditch sugar, and dairy except for yogurt and hard cheeses (if you must have dairy) It takes a lot of work, but makes a huge difference. Also getting enough protein and nutrients is important, so in addition to gluten free, a Paleo style diet gives you the highest nutrition for your calories and reduces chemical consumption. 

      The one thing I’ve found hands down most helpful is an essential amino acid supplement. These are really amazing! They’ve been incredibly helpful in managing my thyroid disease.

      Amino acids are found in the protein you eat. Your body uses amino  for everything from making muscle tissue and hormones to catalyzing chemical reactions in the body.  Some amino acids can only be obtained from the food you eat. These are called essential amino acids. Your body uses these for functions and also converts them into other amino acids as needed. If you aren’t getting the essential amino acids, your body cannot function. 

      Thyroxin is made from a tyrosine molecule with iodine attached. Tyrosine is obtained from proteins you eat or can be manufactured by the body by converting phenylalanine.  Other amino acids are very important in producing thyroxin as they act as catalysts in thyroxin production.

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    • Posted

      Hi Catherine, I got your posts. Thank you for the info. I do ha e Kaiser from Northern CA. I’ve heard of this alternative called Armour and I wonder if it’s a better suit for what I’m going through. I want to ask my doctor but I think we’re doing a wait and see approach given I’m on my 5th month of levo. I think she will hesitate rolleyes
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    • Posted

      I’m also in NorCal. You can see by my screen name where I am. I suspect you’re also near me.

      Yes, Armour is definitely better. It is a natural dessicated thyroid (NDT) made from freeze dried pig thyroid gland. It is higher in T3/T4 ratio than is normal for humans. However, Levo has no T3, so is WAY lower ratio than humans. Still at least the NDT is natural, so doesn’t have near the side effects of levo.

      Docs don’t like to prescribe it because a lot of docs aren’t trained in NDT. The other reason they don’t like NDT, is the belief that the high T3 causes heart palpitations- but so does low thyroid and levothyroxin, as well as imbalanced T3/T4 ratios. For me, the palpitations and anxiety were way worse with the Levo than anything else. 

      Truly the best is an OTC called ThyroGold. It’s natural and has better T3/T4 ratios. Plus you aren’t held captive by the millions of trips to the doc and obsessing on thyroid blood levels. This works best of the the thyroxin treatments. 

      I couldn’t handle the thyroxin. I got fed up and now use amino acids. I’m still slightly hypo, but I feel tons better than on the medication.

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