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How do you know that you are converting well from T4 to T3???
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How do you know that you are converting well from T4 to T3???

How long does it take to determine whether or not a person is converting properly???  If the conversion is met, does the patient still need the Free's Testing (Is it still important).....and lastly. Those who have converted, do you  feel like your old self again or do you have good and bad days????
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798555_tn?1292791151
In a way, this is a complicated question to answer.

People are found to have conversion problems at any given time as in, their first Dx with hypo, or even years down the road.

Generaly if your FT4 is up but FT3 is lower, that would generally be recognized as low converion by some opinions. Then the 'range is rule' doctors might only look at the ranges and disregard ratios of T4 to T3.

And some people just feel better with T3 in the upper part or even over the range - do they have slight Thyroid Hormone Resistance? - no one realy knows, as that is also a very opinionated area of this disease.

So its not a matter of time, its whenever you see it in lab results. But you need to give time to starting on any new med to judge how it or your body is working. You did not say how long you have been on thyroid med, or more specifically, a particular brand.



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Avatar_f_tn
I think it's important to wait until FT4 is approximately midrange before determining a conversion issue (if you started on T4 only meds, as I know you did).  Furthermore, my experience has been that FT3 often lags FT4, i.e. as FT4 comes up, it takes a while for the whole conversion process to ramp up again and for FT3 levels to rise, too.  My FT4 hit a stable level, but four months later, FT3 was still rising.

It is still important to test FT3 and FT4 every time (now, really, you didn't think I was going to say anything else, did you?  LOL).  As Moose said, a conversion issue can arise at any time.  It's also your own personal history and helps to establish the range at which you feel good.  It's something you can look back at , and it will become your goal.

I take T4 only, and I don't feel like I'm 20, but I feel well for too-close to 60!  My hypo symptoms are gone.  Do I still have aches and pains?  Of course.  But I feel pretty "normal" and in some respects feel better than I did a good part of my life (I suspect I was probably borderline for most of my life).  For instance, since being on T4, I can maintain my weight, which is something that NEVER before happened in my life.

How are you feeling?
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929504_tn?1332589534
LazyMoose

I had my TT in Dec and started med's 5weeks later (50mcg), went to 75mcg and then to 88mcg, which is where i am now and i believe that i need to go up a few doses...whether it be due to my weight or how i'm feeling. I'm much better than i was in the beginning..and as i said, i go to the gym daily and have energy in the morning more than i do in the evening...it's like a "running out of gas" feeling and that's besides all of the other healthi issues that i acquired. Thanks for the response, i was curious as to the conversion issue and i am going to the doc on the 28th for my followup and results of my last lab with my NEW endo...LOL


Goolara

I am praying that i am closer to normal range with my last set of labs that i will see on the 28th...and yes, thanks to you...I know the importance of FT3 and FT4 and funny you mention because i told you that my new endo did request to run the FT3 but it was actually the Total T3 (sigh)...but i noticed in time enough to check off the FT3 on the lab slip....so it was tested (I pray)....Anywho...I am feeling better than before but the exhaustion feeling still wears me down and i have to go job searching soon (pray for me)...Thank God that i am able to exercise and sweat the weight off, whereas in the beginning i had no energy to do anything!....Thanks  
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190559_tn?1280615967
This is a question that has come up recently for my daughter.  2 docs have told her that she has a problem converting conventional T4 to usable T3.  I think the reasons for the conversion problem are pretty complicated.  I know that my daughter was recently found to have critically low magnesium and ferritin levels, which I think may affect the conversion process.  To make matters worse, the thyroid specialty doc is all but sure that my daughter has Hashimoto's in addition to Grave's, so this adds to the equation as well.  There is some suspician that she is gluten intolerant, so this could further complicate her ability to properly absorb the key nutrients she needs for her thyroid (and possibly her adrenals) to work properly.  

Whew--that was a mouthful!  Hope you get some good ideas here for questions to ask your doc and find out the answers for your situation.
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649848_tn?1357751184
It's possible that your daughter has a conversion issue.  Do you know what tests they've run?  TSH, FT3, FT4, antibody??

I'm not sure what you mean by "conventional" T4. Is your daughter on thyroid med? If so, what kind(s) and what dose(s).

You said "the thyroid specialty doc is all but sure that my daughter has Hashimoto's in addition to Grave's" -- it's very possible for a person to have both Hashimoto's and Graves; what I have to wonder is why he's "all but sure".  Antibody testing will confirm whether or not she has autoimmune thyroid issues.  She needs to have the following tests run to make sure:  Thyroid Peroxidase antibodies (TPOab), Thyroglobulin antibodies (TGab); these 2 tests will confirm/rule out Hashi's; Thyroid Stimulating Immunoglobulin (TSI) is the test to confirm/rule out Graves.

Do you have a lab report from which you could post her thyroid levels - those being at least, TSH, Free T3 and Free T4?  If possible, please post lab results, along with the reference ranges (these are lab specific, so must come from the actual report).  

Has she had a thyroid ultra sound?  That will also help confirm/rule out Hashi's.  

A good share of the conversion process takes place in the liver, so a lot of doctors assume that if liver function is good, so will be conversion.  That's not the case; I have good liver function, but I'm one who doesn't convert well.  That determination was made, based on comparing results of my FT3 and FT4.

I've never heard that magnesium and ferritin affect the conversion process, but anything is possible. Magnesium is  very calming and does wonders, for some of us, with muscle aches/pains.  Ferritin levels show how much iron is stored in the body; has she been tested for anemia?

I have read quite a bit about selenium being helpful in the conversion process, but I don't think that's been totally proven.  I, personally, take 200 mcg selenium daily because I *do* have Hashi's and the selenium helps to calm things a bit.  

Some people are gluten intolerant; you could try her on a gluten free diet and see if she feels better; then try reintroducing gluten very slowly and see how it affects her. If symptoms come back, most likely she has issues.

It sounds as if your daughter's doctor might be doing some speculating, without running the necessary tests to confirm or rule out specific issues.  

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139126_tn?1255040591
I am exactly 1 year post op for a TT and am finally where I need to be.   I only take synthroid; no combos.  Went from 88 to 50 to 75 to 100 back to 75...That's where I felt good for months.  Then I too started to get that "running out of gas" feeling.   Bumped back up to 88 for about 3 months.   Started to get a little tired again.   Just did another bump back up to 100 and I feel wonderful!   My TSH is low and my FT4 and FT3 levels are where they need to be.  It took a while to get the balance but my FT3 and FT3 finally inched their way up to good levels.    If they had not I would have asked for cytomel.   On another note...I found I do much better by taking 2 50mg of synthroid once a day vs the 100mg tablet.   The 50 mg have no dyes and it turns out I was having some reactions (stomach issues).   Totally went away with the 50 mg.  Hang in there.
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393685_tn?1325870933
You obviously haven't been reading the post Debbie posted on her daughter. This is a very complicated case.

http://www.medhelp.org/posts/Thyroid-Disorders/Psychiatric-complications---thyroid-involvement/show/1250528


Blsdnsvd

I can answer 2 of your questions. Yes - the free testing should be done regularly and thankfully - YES - you can feel your normal slef again when you are optimal.


The conversions of thyroid T4 into direct T3 are almost individualized P2P. As said above the T4 "should" be in the upper half. I however didn't reach my optimal level until both my Frees were in the top of the reference range scale.

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393685_tn?1325870933
On the magnesium and ferritin. If your RBC magnesium is bottomed out then the conversion will not happen. On Ferritin, the iron will block and store hormone.
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