Aa
low Free t4 but normal free T3, is this normal?
I was recently having hypo symptoms (I have hashimoto's) and my GP increased my does of Armour from 50mg to 75mg because my free T4 was at 0.7 (low out of range) and my TSH was at 3.5 (which is high for me). After the increase in meds my free T4 hasn't budged but my TSH dropped to 1.4 and my free T3 was mid/low in range. It doesn't seem normal to me that I should have low T4 still. Is that ok, or does it mean my dose is still too low (or something else)? The increased dose did improve my mood and fatigue somewhat but after 3 months my hair has not stopped falling out. The GP thinks that since my TSH is lowered, we should not change anything but my gut says otherwise. Has anyone experienced this?
It would seem to me that in order for this to be the case, all of my T3 has to be coming from the medication and I am not making much T3 from T4.
It would seem to me that in order for this to be the case, all of my T3 has to be coming from the medication and I am not making much T3 from T4.
The likely reason your FT4 did not increase is that when you take thyroid med, the TSH will drop in response. This reduces the stimulation of your thyroid gland and the output of natural thyroid hormone is reduced. Since serum levels of thyroid are the sum of both natural thyroid and thyroid med, as stated in Rec. 10 on p. 13 of the following link, "Only when TSH is no longer stimulating natural thyroid hormone production, or is suppressed, will serum thyroid levels reflect further increases in thyroid medication."
http://www.thyroiduk.org.uk/tuk/TUK_PDFs/diagnosis_and_treatment_of_hypothyroidism_issue_1.pdf
I highly recommend reading at least the first two pages of the link and more if you want to get into the discussion and scientific evidence for all that is recommended. You will note that a good thyroid doctor will treat a hypothyroid patient clinically by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being influenced by resultant TSH levels. In fact, as noted in Rec. 10, page 13 of the link, when taking adequate thyroid med, TSH frequently becomes suppressed below range.
As stated by an excellent thyroid doctor, "in tests done about 24 to 28 hrs after their last daily dose, most people on adequate NDT therapy have a suppressed TSH. They usually have FT4 levels that are 1 to 1.3ng/dL, and free T3 levels that are rather high in the range or even slightly above the range. The higher FT3 level compensates for the lower FT4 levels on NDT. These patients have no symptoms or signs of hyperthyroidism--if such occur the
dose is reduced." Note also the deferral of thyroid med until after blood draw to prevent false high results.
Hopefully you can use this info to persuade your doctor to continue to increase your dosage as needed to relieve symptoms, rather than by TSH. Otherwise you will need to find a doctor that will treat clinically, as described. Also hypo patients are frequently deficient in Vitamin D, B12 and ferritin, so you should ask to be tested and then supplement as needed to optimize. D should be at least 50, B12 in the upper end of its range, adn ferritin should be at least 100.
http://www.thyroiduk.org.uk/tuk/TUK_PDFs/diagnosis_and_treatment_of_hypothyroidism_issue_1.pdf
I highly recommend reading at least the first two pages of the link and more if you want to get into the discussion and scientific evidence for all that is recommended. You will note that a good thyroid doctor will treat a hypothyroid patient clinically by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being influenced by resultant TSH levels. In fact, as noted in Rec. 10, page 13 of the link, when taking adequate thyroid med, TSH frequently becomes suppressed below range.
As stated by an excellent thyroid doctor, "in tests done about 24 to 28 hrs after their last daily dose, most people on adequate NDT therapy have a suppressed TSH. They usually have FT4 levels that are 1 to 1.3ng/dL, and free T3 levels that are rather high in the range or even slightly above the range. The higher FT3 level compensates for the lower FT4 levels on NDT. These patients have no symptoms or signs of hyperthyroidism--if such occur the
dose is reduced." Note also the deferral of thyroid med until after blood draw to prevent false high results.
Hopefully you can use this info to persuade your doctor to continue to increase your dosage as needed to relieve symptoms, rather than by TSH. Otherwise you will need to find a doctor that will treat clinically, as described. Also hypo patients are frequently deficient in Vitamin D, B12 and ferritin, so you should ask to be tested and then supplement as needed to optimize. D should be at least 50, B12 in the upper end of its range, adn ferritin should be at least 100.
1 Comments
Wow, thank you very much for that information! I am on vitamin d as well but have not had my B12 checked. I really appreciate your support.
Have an Answer?
You are reading content posted in the Thyroid Disorders Community
We tapped the CDC for information on what you need to know about radiation exposure
Endocrinologist Mark Lupo, MD, answers 10 questions about thyroid disorders and how to treat them
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.
