HealthCareMagic is now Ask A Doctor - 24x7 | https://www.askadoctor24x7.com

Suggest Treatment For Low T3 Levels

Posted on Sat, 7 Feb 2015

Question: My mother is 95 years old and recently had a blood test with her thyroid function off. Previously her t4 and free t4 as well as tsh were normal but her t3 was low. The doctor prescribed a low dose of cytomel and we just re took the test --this time her t4 was ok but tsh was low her free t4 was high and her t3 was high. I can under stand the t3 going up but since she has not changed her mgs of synthroid why would the free t4 etc go up

Answered by Dr. Ajish TP (2 hours later)

Brief Answer:
Less T4 is converted to T3

Detailed Answer:
Hi XXXXXX,

Welcome to HCM. I had gone through your question and understand your concerns.

In elderly, during some illness there is a situation called Low T3 syndrome. Here the enzyme converting T4 to T3 (De iodinase) is temporarily less functioning. As a result the T3 will be low and T4, TSH is normal. Another hormone reverse T3 (RT3) will be high. This is because T4 is concerted to RT3 instead of T3.

The treatment of this condition is controversial as this will recover to normal after some time or when the illness settle (if due to illness). T3 is given by some doctors if they feel the patient is having signs or symptoms of hypothyroidism.

When you give T3, the conversion of T4 to T3 is decreased as the need for T3 comes down. So there will be excess free T4 and the excess T3 and T4 suppress TSH. This is the explanation of normal T3, high free T4 and low TSH in your mother's case.

Hope I have answered your question. If you have any further questions I will be happy to help.

Regards
Dr Ajish TP
Consultant Endocrinologist

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Ajish TP (2 hours later)

should my mother stop taking t3

Answered by Dr. Ajish TP (1 hour later)

Brief Answer:
Decrease the dose

Detailed Answer:
Hi XXXXXXX,

Welcome back.

What we commonly do while adding T3 (cytomel) to T4 treatment (synthyroid) is to titrate the dose after seeing the thyroid function reports. In your case we can decrease the Cytomel dose as of now and repeat the test after 1 month to keep the T3 in normal range. If T4 on repeat test is still high we decrease the Synthyroid dose. Discuss about these changes with your doctor.

Regards
Dr Ajish TP

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju

Follow up: Dr. Ajish TP (9 hours later)

Yes that is what we are doing. Thank you.

Answered by Dr. Ajish TP (2 minutes later)

Brief Answer:
Wishing her good health

Detailed Answer:
Hi XXXXXX,

Wishing her good health.

Regards
Dr Ajish TP

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Ajish TP (13 hours later)

GOOD HEALTH TO YOU ALSO

Answered by Dr. Ajish TP (40 minutes later)

Brief Answer:
Do rate the answer

Detailed Answer:
Hi XXXXXX,

Thanks for the wishes.

If you are satisfied with the answer please rate the answer and write a review. Your comments are shown as "follow up question". So if I won'y reply, it will be marked as an un-answered question.

Regards
Dr Ajish TP

Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju