NEW BLOODS - getting there, but need advice on a few things please!

[FallingInReverse]

TOP LINE SUMMARY:

Changes: Last 9 weeks, added 12.5 Levo to land on 75 Levo/10 T3 regiment.

Symptoms: ON AVERAGE improving, feel more stable/less volatile, but still low overall.

Results: Free Ts and Vit D did AMAZING in my recent bloods!

ALL OBSERVATIONS WELCOMED PLEASE! SPECIFICALLY LOOKING FOR:

1) confirmation on my Levo/T3 course of action (planning to increase T4 by another 12.5 to 87.5 and no change on T3). Also FT3 is now way higher than FT4, is that ok?

Also, almost forgot! I have ALWAYS taken all my Ts sub-lingual. Have been pondering a switch to swallowing them. Should I just start doing that… or treat it like a dose change and make no other changes when I do?

2) Input on B12 and Folate – both solid, but I don’t know enough about them to know if I need more.

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DETAILED UPDATE:

Most recent post (Jan’24): healthunlocked.com/thyroidu...

Meds since Jan 17th:

🔸ADDED 12.5 Levo to a total of 75 mcg, NO CHANGES to 2.5 T3 morning, 2.5 T3 noon, 5 T3 bedtime.

🔸Vit D – loading dose of 25,000 a day for 7 days, then settled on 7500 D daily. Taken with 400 K that I then reduced to 200 K. (it worked!)

🔸Increased Iron intake – In January I ATE 100-150%+ of the daily requirement of iron. About 18-25 mgs day. It was ridiculously hard to eat that much, not overeat in the process, and keep a balanced diet doing that. Every meal had to be very iron rich. So in February I switched to one Three Arrows every third day. (About 2 a week). This reflects my conservative approach to find out how well I absorb. (Not very well apparently, as you’ll see below!)

🔸Other misc: Daily glucosamine/chondroitin (no changes), recently stopped taking a daily over-the-counter seasonal allergy pill (which I had been on since before diagnosis while searching for solutions.)

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NEW BLOODS:

Summary – Free Ts outstanding improvement! Vitamin D… nailed it! Iron – I was super conservative in past months, and no movement.

Test protocol. CONSISTENT FOR ME… Levo 24 hours but I did my last split of T3 at 1 pm (18 hours before). I wanted apples-to-apples on T3 results, I’m going to switch next time to forum protocol.

Why I waited a full 9 weeks: I waited 6 weeks after a Feb 8-12 cold/cough with antibiotics; and 4 weeks after a Feb 26 norovirus (2 days, no medicine for it, 100% gone in 2 days). CRP is low, so is ferritin!) so looks like it didn’t interfere (?).

March 27, 2024 Results (compared in parenthesis to January 12, 2024):

🔸TSH <0.008 (0.55-4.78) (keeps dropping)

🔸FT4 1.34 (0.89 – 1.76) 52% (UP from 7% in range, hurray!)

🔸FT3 4.3 (2.3 – 4.2) 105%! (UP from 68% in range, hurray!)

🔸Vit D: 119! (UP from 49…. that grassroots calculator and loading dose TOTALLY WORKED!!!!)

🔸Ferritin 12 (7-271) (it’s been 7, 9 and 13 in past months) Iron 59 (50-170) (it’s been 158, 71 in past months) 19% Saturation (12-50) (just barely but goo enough... was 43, 21 in past months) (Both of these ~no big change TIBC 317 (250-524) UIBC 258 (130-375))

🔸CRP Sensitive 0.3 (0-2.9)

🔸Vit B12 751 (In Jan’24 it was 568; in early Nov’23 it was 800) (211-911)

🔸Folate 18.1 (In Jan’24 was 13.3; in early Nov’23 it was 21.1) (>5.4)

🔸Cortisol 25.3 (a.m. range 5.3 – 22.5) (22.9, 26.5 in past months)

Symptom Summary:

A HORRIBLE AWFUL TERRIBLE brainfogged December, January, February. Dreamlike state with fleeting memory. This symptom defined my life since Dec. FINALLY IN APRIL it’s lifting. Palpitations FINALLY settled after 9 months since starting T3. Involuntary naps/fatigue decreasing. But any exercise/exertion still results in days of recovery. So general hopefulness now in April because fatigue and brain fog is not DEBILITATING anymore. But, in past few weeks some old symptoms have returned (joint aches/frozen lower back) and some rosacea; and I’m more aware of my head/nose congestion. It was one of my early symptoms and it doesn’t seem to get better or worse but I’m not sure and I’m going to pay more attention now. New and infrequent: fibromyalgia-like sensations (cold patches, itches), sudden and excessive sweating (peri/menopause?). Also, I’ve been working harder and longer/later lately, and it sometimes cuts into a good night sleep – which takes days to recover from.

➡️MY COURSE OF ACTION AND QUESTIONS PLEASE:⬅️

🔸Free T4. I think I will bump it up by 12.5 TO 87.50 daily. Does it matter than FT3 is now way higher than FT4?

🔸Free T3. Just over range, but will leave as-is, and I’ll see what happens when I add some T4. Wondering if being over range even by this little has brought back the muscle aches/rosacea. Will keep an eye on. (Also, I have already decided to stop splitting my morning dose.)

Ps-do I switch from Ts sublingual 1) INSTEAD… 2) at the same time??? Or 3) wait?

🔸D – I’ve been taking 7500 a day. I’m now slightly over range. I’m inclined to keep at 7500 for the next 6-8 weeks.

🔸B12/Folate…. How high exactly do I want my B12 – we say over 500… but I am at 751. How high for folate. I think we aim for 20, and I am at 18. I have bought Better You B12 spray and Thorne B Complex. Should I start them?

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Notes for my reference:

For iron/ferritin I'm going to increase from one Three Arrows every third day --> to one a day.

Reminder for myself of long list things to consider: cortisol test, Menopause and HRT, LDN (prompted by fatigue and very infrequent fibromyalgia type sensations)

Vitamin long list to consider: magnesium, gluten free as a last resort. Copper? Zinc?

[SlowDragon Administrator]

vitamin D is presumably 119ng/ml

That’s 297nmol

That’s too high.

I would reduce dose. Perhaps 2000iu or 3000iu daily

Yes obviously ferritin is terrible

I would start taking your Levo and T3 by swallowing.

retest first 6-8 weeks later

Perhaps consider reducing T3 by 2.5mcg after next test

[SlowDragon Administrator]

What B vitamins have you been taking until now?

You won’t need separate B12, just vitamin B complex

Looking at your very helpful profile page

Last iron panel, iron etc were pretty good. Just ferritin poor

You need to do full iron panel test again

If iron is good, but ferritin low, you can only increase ferritin by iron rich diet, not supplements

I would try strictly gluten free diet.

May help with improving Ferritin too

Only make one change at a time then wait 6-8 weeks

[FallingInReverse in reply to SlowDragon]

 SlowDragon

Vit B : I’m not and have never taken any B supplements.

That’s why I’m wondering if I need to, since my numbers are I think at a good level.

Should I aim for higher? Should I start the daily Thorne B Complex that I have on on hand now?

Vit D: Yes, that’s ng/ml (ie, range 31-100). I will reduce to 2500 iu daily (the gummies I have are 2500 iu per gummy.)

Sublingual to swallowing: ok, this could be the time to do that!

T3 reduction: I will put this to the top of my list for next change.

I do wonder if the high Vit D or high T3 has prompted the return of my symptom of my face/cheeks feeling flushed/hot.

Anyone else have any thoughts on the whole big picture and/or what you would do next if it were you?

[SlowDragon Administrator in reply to FallingInReverse]

You may find you absorb more thyroid hormones swallowing it …..be interesting to see comparison in 6-8 weeks

I would experiment with taking vitamin B complex 2-3 times a week initially

First time you take it, it can make you feel a bit wired. Best taken after breakfast

Thorne are large capsules. You can open and take powder out. Perhaps initially only take half

……warning it tastes and smells disgusting. Be ready to wash down with lot of water

And it will turn your pee bright yellow

If those results were mine, I would reduce T3 by 2.5mcg now

[J972]

You’ve set the bar terrifyingly high in terms of the exquisite way in which you’ve presented your results! 🫣

I’m sorry, I’m not here to offer any particular insight but I was intrigued by your revelation that you’ve been taking your tablets sub-lingually. Why did you take this approach? Did it take long for the tablets to dissolve? Did it taste gross?

Other than that, I’m thrilled that you appear to be moving in the right direction, well done 👏

[FallingInReverse in reply to J972]

Hi! And thank you : ) I try!

So the sub lingual thing I find so interesting too. Doing so was based on an early wrong approach in thinking that things would be absorbed better and more directly into the bloodstream through the mouth’s membranes.

I did some research about molecule size and membrane thickness and made some slightly misguided conclusions that it was equal or better.

Later I did more research and learned that Levo is actually absorbed EXTREMELY EFFICIENTLY through the digestion process in the small intestines.

So I’ve been shocked that it is obviously working well sublingual! But I definitely should and will switch to swallowing as indicated.

Also - to answer your question - the taste of both my Levo and Cytomel/T3 is very sweet!!! And it dissolves at a nice perfect pace. I am going to miss it actually : )

And yes - to see T4, T3 and D move so much was very exciting, as things have moved slowly or not at all for me. I can’t believe I will consider reducing T3 next time!!

[FallingInReverse]

Thanks as always!!! SlowDragon . Update and for my own future reference.

I think going with the idea in your first post - the one change I'm going to make it swallowing vs sublingual. I'm wavering between that and reducing T3/Lio now.

Current status on notable symptoms/changes - brain fog lifted after a terrible Dec-Mar. And palpitations reduced by it feels like ~90% for the first time since starting Lio 9 months ago.

I haven't had upper range T3 probably in 10 years... and I am correctly or incorrectly attributing how I feel right now to that T3 result.

At the same time - in past week or so I've had the face flushing/warm feeling returning... Is it over-replacement on T3? I don't know. So that gives me pause.

But at this point the fact that the brain fog is not debilitating, and I can think and do my job... all these other physical symptoms are nothing compared to that. I'm afraid to reduce T3 right now esp since the brain fog is gone and my palpitations are better than ever. I still feel sub-par but I dare say better than I have in a long time? But I've felt crap for so long, hard to tell.

Also - I am so intellectually curious about what will happen when I swallow the pills vs taking sub-lingual. After a full 9 weeks+ on steady dose, I have a good controlled background rate to have a good experiment going!!!!!!!!!!!!!!

ps. I've also reduced my D to 2500 iu/100 K a day. I may add the B complex in a few weeks, but might just wait a full 6 weeks anyway.

Off I go!