Your dose of levo isn't too high and your T4 result will be low as you have added T3 into the mix. It would be better if your doctor did FT4 and FT3 instead of T3 and T4.
If we took our blood tests at different times the results would be different also.
Free Triiodothyronine Has A Distinct Circadian Rhythm That Is Delayed But Parallels Thyrotrophin Levels
and this is an extract:
Dr Jacob Teitlebaum notes that the new study shows that TSH and Free T3 and Free T4 levels fluctuate during the day. Surprisingly, TSH levels start to rise around 9pm, hitting bottom again around 9am. T3 levels follow a similar pattern following TSH levels by around 90 minutes (as would be expected if the TSH stimulates T3 release from the thyroid). T4 variability was not associated with TSH variability.
This means that thyroid hormone levels are highest at night while we sleep - NOT while we're awake, and even though TSH regulates T4 over the long term (days to weeks), TSH variability during the day mostly seems to play a role in fine tuning T3 levels during the day, having little to no effect on T4 variations during the day. This suggests that fine-tuning the timing of giving T3 is more important than T4.
Forget blood tests which should only be used as a guide. The most important thing is how the patient feels. If not too good an increase is due. If feeling it's too much a lower dose is required.
Read the first and second questions on this link:-
I'm sorry if I overloaded you. Our hormone levels change throughout the day and if you had five blood tests a day the results would most probably be slightly different. Yours is a very small difference.The most important thing is that we are beginning to feel better.
Our blood tests should be as early as possible and fast (you can drink water) and the previous day's dose should be your last until the blood test. Take it after the test. Always get a copy of blood tests for your own records.
"I am not a medical professional and this information is not intended to be a substitute for medical guidance from your own doctor. Please check with your personal physician before applying any of these suggestions
The only reason I can think of is that your T4 is not converting as much into FT3 because of the increase. OR if T4 always turns into either FT3 or Reverse T3 and Reverse T3 blocks FT3, your T4 could be forming more reverse T3. Did you have a problem with conversion before tweaking your dose?
T3 is used up by physical activity (Many members report being physically active one day and finding that they crash the next day due to this). As Shaws says, the drop in your FT3 reading is not very big and could be caused by practically anything. The important thing is how you feel, and the general message that you can take more medication without going over the limits for FT4 or FT3.
I am not a medical professional and this information is not intended to be a substitute for medical guidance from your own doctor. Please check with your personal physician before applying any of these suggestions.
Would it make a difference if I'd taken my t3 3 hours earlier for the last dose the day before and the blood test was an hour later, so that would've been a 4 hr difference????
I'm really worried again now.
I thought an increase in levo was the way to go this time, but someone on a fb group has said my results indicate RT3!!!
I questioned how they came to that conclusion and the reply was because my ft4 was raising faster than ft3!!!
I don't know how they saw that ad I said my ft4 was the same as it was on the blood test 6 weeks previously so it hasn't raised at all.
Pkease xan you get back to me.
I was feeling a tiny bit better but all this yesterday has got me really churned up.
Rose, the time difference probably is why FT3 is lower. T3 dose will be pretty much out of your serum after 6 hours. If you left 24 hours between last dose and blood draw your 3.7 can be extrapolated +20% which means your normal circulating FT3 will be around 4.4.
You've said you feel a little better so the T3 has been helping, whatever the FT3 result is saying, and how you feel is more important than blood results.
The FB comment about rT3 doesn't make sense to me as your FT4 is very low.
I am not a medical professional and this information is not intended to be a substitute for medical guidance from your own doctor. Please check with your personal physician before applying any of these suggestions.
So do you think things aren't as bad as the fb people are saying then?
I was feeling slightly better. My horrible head feelings had virtually gone. The jelly legs had gone. The cold clammy sweats had gone.
My sleep is still bad. Hard getting off to sleep and never feeling tired even if I haven't slept at all.
Still getting the banging heart in the evenings. And hot flushes.
What do you think about my saliva cortisol results??
High,low high,high......
So I've done as you suggested and increased levo to 100mcgs.
When I put this on fb they said I should decrease it and increase t3 but to be honest they have confused me. So many different things they say... Overmedicated. Undermedicated. Stage 2 Adrenal fatigue.
I respect your opinion and would rather have you guide me if you don't mind??
Have I been stressing unnecessarily!!!!
Thanks so much once again
I really can't tell you how much your advice means.
Rose, I8 hours after last dose means normal circulating FT3 will be around 4.25 which is respectable, not unduly low, although maybe not yet optimal. 100mcg will deliver better FT4 which will in turn improve FT3 and remaining symptoms should improve.
I don't see why the FB people think things are bad when symptoms are improving. As long as symptoms are improving I do think you are stressing unnecessarily about results. Results can be a guide to dosing, and your GP has responded by increasing your dose to improve FT4, but other than that, how you feel is far more relevant.
Hot flushes are usually menopausal symptoms and folic acid may help menopausal flushes.
I'm sorry I don't know enough about cortisol to comment other than I think it is supposed to be high in the morning and low at night. Perhaps you could post a separate question about cortisol.
I am not a medical professional and this information is not intended to be a substitute for medical guidance from your own doctor. Please check with your personal physician before applying any of these suggestions.
You always make me feel better. And ease the worry.
I am 13years post menopause but maybe I can take some folic acid and see if that helps.
Any idea on the banging heart in the evenings?
I can only think it's to do with my slow release beta blocker which is supposed to last 24hrs but it's inferior in its coatings compared to my old one which I used for 8 years.
The old one did last 24hrs but it's no longer made and the inferior one replaced it.
I will post another question about cortisol results.
Rose, have you tried taking an extra half of the Beta blocker to see whether it helps with the evening palps? You might have to experiment to see whether taking 1.5 at once works or a 2nd half tablet dose a couple of hours before the palps start is more effective.
I am not a medical professional and this information is not intended to be a substitute for medical guidance from your own doctor. Please check with your personal physician before applying any of these suggestions.
Rose, I'd trust your doctor, he sounds very on the ball. I actually know very little about beta blockers as I've never taken them. Sounds like you should take the 2nd blocker around 4pm.
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I am not a medical professional and this information is not intended to be a substitute for medical guidance from your own doctor. Please check with your personal physician before applying any of these suggestions.
I have another worry now. I've just thought about the test and the t4 result. When I had the test it would've meant that there was in fact a 34 1/2hr gap from last dose. This is because I was taking it at night, so I didn't take it the night before the test. So my last dose was two night before the test!!!!
What difference would that make???
I've now gone back to taking T4 in the mornings because I thought taking at night was making me restless through the night.
As you know I increased levo to 100mcgs last Thursday.
Im a little concerned because my pulse was 104 last night.
I've also had looser BM.
Do you think it could be the increase??
I tried not to bother you and put this on a couple of fb groups. They said my ft4 should be under 14 when on combo and ft3 in the upper part ( which I know you have said upper part too)
Could you give me your thoughts on this. I've never had it so high. My heart Usually bangs in the evening but my pulse has never been more than 84 at that time.
My pulse is now down to 76 but the beta blocker is working now for avoyt 14 hrs.
Rose, it's possible that the dose increase is responsible. You could go back to 100mcg for a week to see whether pulse & BM remain normal. Then increase to 100/125mcg for a week or two before increasing to 125mcg. Your FT4 was low so I doubt 125mcg will bring it up to 14. Nothing wrong if it did go >14 though.
I am not a medical professional and this information is not intended to be a substitute for medical guidance from your own doctor. Please check with your personal physician before applying any of these suggestions.
Rose, perhaps the cortisone injections have increased heart rate, not Levothyroxine? If you want to ride through it stick with 100mcg + T3. If it's alarming you go back to 75mcg until it calms down and either increase to 75/100mcg alternate days or back to 100mcg.
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I am not a medical professional and this information is not intended to be a substitute for medical guidance from your own doctor. Please check with your personal physician before applying any of these suggestions.
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