1st Endo visit

[Trewoof]

Hi, would appreciate your comments/advice....

I'm seeing an Endo on Thursday because I was diagnosed with auto immune rheumatoid arthritis and thyroiditus a few months ago.

Theses are my latest bloods

TSH. 0.01. (0- 5)

Free T4. 31.5. (9-28)

Free T3 5.5. (0-7.7)

B12. 1328ng (200-900)

Folate 17.2 ug/L. (3-12)

Potassium was just above top range. 5.6 nmol/L

Creatinine was a bit low at 52 umol/L

Neutrophil blood count raised 9.42 10*9/L. (2- 7.5)

Lymphocyte count 0.5 10*9L. (1.5 - 4)

Others seemed normal

My Tsh has been suppressed for some time. I have not been able to get T3 tested until now but this seems ok? T4 has been this high for a while.

When I lower my dose (150) I feel awful, really tired.

I'm guessing (?!) Endo will say no no too high, reduce your dose so I'm planning my response is its a lot to do with how I feel.

A, I right in thinking that not all T4 is converting to T3?

Could adding T3 to Levo help?

I take supplements- B12, Vit D, beta carotene, Vit C, Calcium, Vit E, Vit B1,2,3,6 , Folic acid, Zinc,, Selenium, Iron.

I'm also on steroids, Hydroxchloroquinine, Methotrexate for rheomotoid.

[Clutter]

Trewoof, Not all T4 is supposed to convert to T3. Some converts to rT3 which is a protection against too much T3 being converted and circulating.

FT4 may sometimes be slightly over range when TSH is suppressed on Levothyroxine and it shouldn't be considered a problem as long as FT3 is within range. Read Dr. A. Toft's comments about dose and thyroid levels thyroiduk.org.uk/tuk/about_...

Your FT3 is just shy of the top 75% of range considered 'ideal' by many thyroid sites so you don't appear to have a conversion issue. You can certainly ask whether T3 to added to a slightly reduced dose of T4 to see would improve your fatigue.

It can be helpful to take a list of medications, supplements and doses in case your endo asks about them. Endos aren't renowned for their knowledge of nutrition and vitamins/minerals so don't be downcast if the endo thinks they're unimportant.

Raised neutrophils are common in people with autoimmune diseases. Your B12 and folate are above range so you could reduce your supplements. You won't OD as excess is excreted in urine but you are peeing away expensive supplements. Calcium shouldn't be take unless you have had a blood test and are deficient.

I hope consultation goes well and is helpful.

[helvella Administrator Thyroid UK in reply to Clutter]

Not only does some T4 get converted into rT3, but some gets glucoronidated or sulphated! Both of which can remove T4 from being available.

[Trewoof in reply to Clutter]

Thanks clutter, I have prepared a list of supplements so I will take that with me. I hadn't realised Calcium shouldn't be taken. I might get that tested.

I may try reducing Levo if he suggests it provided he retests T3 and listens to how I feel!

Thanks for advice.

[Clutter in reply to Trewoof]

Trewoof, Resist reducing Levothyroxine unless some Liothyronine (T3) is prescribed in addition otherwise you will feel undermedicated.