T3 elevated but still symptomatic

My recent serum free T4 was 20.6 (11.00-23.00) and my TSH was 0.05 (0.35-5.50).

As the lab had refused to test T3 I went back with a new GP request, and have just got the results: 7.4 (3.5-6.5) with a note that it's slightly elevated.......

So before I return to my GP could someone please explain why, if I seem to have reached the Holy Grail, do I feel so awful (and don't mention weight gain .....) and what else might be going on? Accepting that I'm a few years older, I feel the worst I have felt since initially improving when adding T3 x 20 about 4 yrs ago, to my very long term T4.

Any pointers would be appreciated. (I would add that, as I've mentioned before, I've only ever been defined as hypo, although a scan showed that an "autoimmune reaction has destroyed your thyroid" so may be Hashimotos?) might there be absorption problems, or adrenal issues?

[Hennerton]

Have you had all the usual suspects checked, that you have probably read about on this site, i e, iron, ferritin, B12, folate and Vit D? If these are low and they often are with thyroid problems, they may be causing your symptoms. What are they exactly? Do you feel over medicated? Have you taken your basal temperature? First thing in the morning, before moving? It should be 36.5 or more but not over 37.2. If the latter, you may be taking too much medication and if it is under 36.5, your medication may not be reaching a cellular level and so you may still feel hypo. What dose are you on? Sorry, so many questions but answers will help other people to comment.

[Hidden]

Hi. Thank you for your response, it's much appreciated.

I am currently on 125 of T4, and 20 of T3 (but admit to taking 40 this last two weeks to see if I would feel any better). For both blood tests I didn't take my meds the night before so at the point of the bloods being taken I had been about 35 hrs post-last dose.

I have been taking my basal temp over the last few weeks. My lowest temp was 36.02, and the highest has been 36.58. It was always under 36.5 before I upped T3 from 20 to 40, and since then has been between 36.45-36.58 except Tuesday when it was 36.22. So based on your bench mark of 37.2 it doesn't appear I am over-medicating.

I had a private VitD3 test which came back as 112.1 nmol/L, interpreted as adequate @ >50. I know there are some views that it could usefully be improved a little.

My serum B12 was 679 ng/L (190-900), so not bad but again, as the Japanese lab range starts at 500, could it be improved upon?

There isn't anything on my results that I can interpret as iron, ferritin or folate. My Red Blood Cell count is low-ish at 4.32 (4.20-5.4010), as is haemoglobin 127 (120-160), packed cell volume 38.2 (37.00-47.00) and Mean Corpuscular volume 88.4 (82.00-102.00). Also the eosinophil count is 0.1 (0.1-0.7010) - might indicate a cortisol problem/Cushings? The packed cell volume this time was 38.2 (37.00-47.00) so low, but even lower in September at 36.5. Also my red blood count was below range in Sept at 4.19 (4.20-5.4-10). Do these figures indicate a possible iron deficiency?

Apologies for throwing the figures at you, but given that my thyroid results appear to shout "normal and healthy", I need to go well-armed to my GP appt; so any view you might have, is welcome.

[shaws Administrator]

All I can say is that the more I reduced T4 and raised the T3, the better I became. Of course, that wont be the case for many members.

[Hidden in reply to shaws]

Thanks Shaws. That is good to know. More grist to the mill, for my GP appt.

[Hidden]

I suspect you might have some degree of resistance to the thyroid medication at a cellular level. Have you done any reading around RT3 - reverse T3?

Alternatively it may be as simple as you needing NDT, not synthetic replacements. My OH didn't really start to improve until she began taking Armour (self sourced, endo useless as many of them are).

[Hidden]

Thanks LilyMay. I'll get off and do some more reading around RT3 to see if I can learn some more / remind myself. Yes, I'm very much thinking about going down the NDT route, and glad to hear your OH is doing better.

[Clutter]

Your FT3 indicates a tad over medicated. Have you considered lowering the T4 to 112.5mcg daily now that you've increased your T3 to 40mcg? I definitely do better on T4+T3 combi than T4 or T3 monotherapy, currently taking 100mcg T4 + 30mcg T3. I find as I become more active I need more T3 else palpitations and exhausation wipe me out.

Your vits look ok, similar to mine after repairing deficiencies, but I still supplement vitD 5,000iu daily and B12 1,000mcg daily to maintain levels.

A full iron panel might be in order. Low iron can cause pain, fatigue and general unwellness.

[Hidden in reply to Clutter]

Thank you for all the suggestions Clutter. As you and Shaws say, altering the proportions might be better. Yes I definitely need the full iron. Am going to try the India lab and have as much tested as I can afford lol, once I've sorted out who I can get to take my bloods.

[Hidden]

I was going to mention rT3 too. I had mine checked through Genova so might be worth looking into. Also NDT might be worth looking at. We're all so different