# Optimizing TSH, T4 and T3 numbers on Levothyroxine (Hypo)



## thyroidboardsfan (Apr 10, 2018)

My doc switched me from Armour 90mg to Levothyroxine 100mcg as I didn't do well on the former. I've been on the T4 only Levothyroxine for 8 weeks and here are the latest numbers:

TSH, 3rd Gen. 1.040, Ref: 0.270-4.200 (uIU/mL)

T4, Total 6.37, Ref: 4.50-11.7 (ug/dL)

T3, Total 0.56 (flagged low), Ref: 0.80-2.00 (ng/mL)

I'll be discussing these numbers with my doc this week. Looks like I need to bump up the dosage as I'm still experiencing fatigue symptoms. What are the best TSH, T4 and T3 numbers I should aim for? Is it a good idea to request T3 supplement at this point as my T3 is flagged low or increasing T4 will automatically increase T3 as well?

Thanks.


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## joplin1975 (Jul 21, 2011)

First, your doctor should be testing free t4 and free t3, not total.

You should be aiming between 50% - 75% of the range for free.

Given that you didn't do well on desiccated meds, I would aim for getting your free t4 in a better place first and then making a decision about adding in Cytomel.


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## thyroidboardsfan (Apr 10, 2018)

What should I do when my TSH goes to 0 and still can't get the T4 and T3 numbers to that 50-75% range? My doc switched me from Armour to Levothyroxine because I "maxed out" on Armour dosage with cardiac issue and not getting where the T4 and T3 numbers needed to be.


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## WhatHappened (Nov 12, 2015)

It might be he is judging the wrong labs. There is Total T4 and Total T3 and then Free T4 and Free T3... those numbers are important if you feel you are getting hyper. Were those on your lab results as well?

There are some stickies at the top of the labs forum where there is some background on various labs.

While total T4 is all the T4 in your body, a lot of it basically gets tied up to other proteins. Free T4 and Free T3 is what your body has available to it for other things like your metabolism. So your Total T4 could look "good" but if you have no Free T4 or Free T3 there is no "go juice" in your system and you will feel bad or worse. The reverse is true too. If most of your T4 is not bound to proteins, then you might have too much Free T4 floating around and you go hyper or start sequestering Free T3 as Reverse T3 and you will feel lousy.

Those are the Labs you need to use to dial in your dose. (at least Free T4)


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## Pamzilla13 (Sep 9, 2013)

Do you happen to have your labs from when you were first diagnosed? I ask because hen I was diagnosed hypo my TSH was 0.70 (which is very good) BUT my Free T3 and Free T4 values were at the very bottom of the range.... I take 210mg Armour thyroid and my TSH is in the negative values...Totally suppressed. My Free T3 is now a 3.8 (2.2-4.2) and Free T4 is mid range and I feel a lot better. When I first started taking Armour (15mg) I did experience "hyper-like" side effects, but it did go away...I titrated slowly and had to have patience. Personally I don't think you were taking enough Armour because hypo and hyper symptoms can be kinda the same. Your doc didn't run the right tests (FT4 and FT3 are the right ones). You definetly need a source of T3 because your T3 value is below normal and I can assume that FT3 will be low too...

Do you have labs from when you were on 90mg Armour that you can post?


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