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New Thyroid test results..pls help me with the dose.

Hi,

I got my thyroid function test today and I need an advise about optimal t4 dosing.

I stopped taking levo.3 months ago because it was making me very sick.

After stopping my t4,i felt much better.And I also learnt through this forum that I was under dosed with my thyroid medication and also since the doctor never told me anything about the importance of having good levels of vit.D,VitB 12, ferritin and even cortisol,I suffered a lot on thyroid medication.

Now that I know my levels of thyroid,ferritin,b12,I want to give t4 a try again.

Pls advise me what dose t4 should I start with.The doctor advised me to take 50mcg 5 days a week.But I know that it would be too low to increase my ft4 levels and due to low ACTH and other nutrients I would not be able to convert t4 to t3 easily.

Date:25/1/2016

TSH 6.93 ulU/ml. (Euthyroid 0.25-5/hyperthyroid :<0.15/hypothyroid >7

Free T4 8.84 Pmol/L (9-25)

Free T3. 4.33 Pmol/L (4-8.3)

Ferritin. 64 ng/mL. (6-159)

Folate 15.3 ng/ml (4.8-20)

Vitamin B12. 360 pmol/L (156.1-698)

ACTH. 6.35 pg/mL (7.2-63.3)

Pls also advise what should I do with my low ACTH levels?

I was taking methycobalmine injections 1000mcg 2 months ago.Since my B12 is still low,pls advise how much should i take daily to raise my levels to 900-1000

Also how much iron should I take daily and how long?

Vitamin D was 49 last year.As per doctor's advise I take 5000IU once a week to maintain the same level.But I know that I need to supplement more as it is not enough.So pls tell me how much to take and for how long?

Should i take vit.K2 along with vit D supps?

I have seen some improvement in my CBC report and I think this could be due to adding vit.B12,selenium and zinc supplements.

21 Replies
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Sal1234

Thank you for posting your blood tests. I am not good at blood tests so probably tomorrow you will get some responses about the one's I haven't referred to.

However, for the ones below, I will say regarding your thyroid hormones that your TSH is too high both Free T4 and Free T3 are too low.

I am not medically qualified but I would start on 50mcg of levo every day for six weeks, you should then get a blood test to see how your body is accepting T4/T3. You said previously you didn't feel well on levo and stopped it.

If this should happen again within the six weeks, you might have to switch or add T3 to your levothyroxine. Many find adding T3 makes them feel better.

You can take sublingual methylcobalamin B12 tablets you can start with 5,000 for a while and then reduce to 1,000 (or you can buy 1,000 and take 3 or 4 until you feel your levels have improved).

"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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Thank you very much for such a prompt response. :)

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Hisa1234

I'm personal very sceptical about adding T4 as it can increase rt3, this was my experience with it. Give the t4 a go as some people get better on it but I believe T3 is a superior treatment. Google Dr Mercola and Dr Lowe discuss the thyroid on utube.

Dr Lowe has T3 resistance himself, his father and 2 brothers committed suicide because of the depression associated with low T3/T3 resistance/slow metabolism/low body temp, as he was a Dr and a researcher (he died of a head injury not sure how it happened) with help from his pers in the medical system got to the bottom of his problem and spent the next 25 researching and documenting trials of T3, if you haven't seen it, ist fascinating and a no BS aprouch to fixing you and fixing you for the rest of your life.

Regards Angus1

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Dear Angus1

Thank you for your time and reply.

I agree that t3 or t3+t4 is much more effective than t4 therapy.But since my endo is not aware of rt3,the only option for me to find out if i have conversion issues is through optimally dosing with t4 first and also raising my thyroid essential vitamin levels.If after all that i still see low ft3,i will get my answer that is i have conversion issues.

I have 0% help from my doctor.I am trying to find out what is going on with my body and thats why I started with t4 again but with a higher dose of 50mcg.

Now that I know my ft4 and ft3,i will can compare results and tell if my t3 is increasing or not.

I was taking only 25mcg before because on 50mcg my tsh went low i.e0.04.The dr freaked out and without checking my ft3 and ft4 levels she reduced my dose inorder to increase my tsh.When i asked why are u increasing it because I feel ok.She laughed and said"do you want to kill yourself? Your tsh is too low and we must change your dose."

I was very ignorant before joing HU.But now I am not going to listen to the drs and just see how I feel ....ie i will keep an eye on my symptoms,keep doing my research to find out why my body is reacting in certain way and what i need to do in order to get rid of my symptoms.

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Ok... I am in a similar predicament but have a GP doctor who is basically letting me treat myself, it has been a long road leading up to this both my GP's, endo and phycologist said there is nothing more we can do and you are going to have to live your life like this the best you can, I said there is many things that I know I can try, eg thyroid, sex hormones and LDN. I reminded my GP last visit of his comment and he was a little embarrest. Its funny my GP is a little scared of me as I can shoot him down quite easily with his shocking knowledge of the human endocrine system and human health but I keep in mind I need him on my side. also last visit he said I need you to do a blood test, I said what would you like to test and he said TSH and T4 I had to explain what the readings would be without doing the blood test ie both low or unreadable as I'm taking T3 at a dose of 90mcg's two times a day. I said if you would like to test something test T3 , RT3 or FT3 , waited until I had completed that T3 cycle and got the blood test done so he wouldn't panic at the high levels, I am on Wison's Protocol T3 sustained release, Dr Dennis Wilson protocol is well documented in his patient and doctor manual I highly recommend reading it. You can order T3 instant release on line if your Doctors won't help you or Doctor shop until one will, personally I wouldn't waist time with endo's as by the time you get an appointment a month can go by and for me it was disappointing once I saw them.

Note

Anything with t4 will convert to rt3 especially if you are stressed and most of us are as it's effecting our quality of life, our bodies are going into conserve ie rt3 mode, not productivity ie t3 mode.

I have just received Paul Robinsons books on thyroid and circadian rhythm so in the next week or so will have learnt more.

I'm sure many people know more than me about thyroid/ the human body but I can assure you the more you know the more in reach this treatment will be.

All this info means a lot to me as its my life and all I want is to be able to function like a normal human being, I think I'm a lot closer to normal functionality and good health.

Good luck

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Your words are very encouraging and i really appreciate all your help and info you gave me.

I have collected online sources to buy t3 online and i plan to add t3 in future.I just want to be sure if i need t3+t4 or t3 only is the right medication for me and thats why Iam going to wait a little till I get my next ft3 and ft4 blood tests.

Thanks again dear. I wish you and all a speedy recovery and a long happy life. Xxx

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sa1234,

Your high TSH reflects the absence of thyroid hormone replacement.

50 mcg Levothyroxine is a good starting dose but I would take it every day (so 350mcg a week.) It is important to take your pill on an empty stomach with a glass of water, 1 hour before food, 2 hours before supplements and 4 hours before calcium, iron or vit D supplements.

Your thyroid hormone levels will need testing after six weeks and given your history you will probably require a dose raise. Organise your test for first thing in the morning whilst fasting (only water) to get the highest TSH possible reading (so prescribed more meds.)

Keep supplementing B12 as you are looking for levels of at least 500.

Are you injecting ? Otherwise sublingual Methylcobalamin is the activated bioavailable form of vitamin B12 so thought to be utilised easier as it has one less step of conversion to make. High folate will exacerbate a B12 deficiency.

High dosed Vit D supplements should be taken with Vit K2. Others will advise on dosage (or post as a new question.)

Ferritin needs to be half way through range as can cause negative reactions like palpitations and anxiety in someone starting thyroid hormone replacement.

Have you addressed any gut issues such as Candida or low stomach acid ? (Very common in hypothyroidism and will inhibit nutrients).

Also adequate cortisol is required for someone to tolerate thyroid hormone replacement as it helps receive the T3 into the cells where it is active (giving you energy & well being). High/low cortisol will interfere with the HPA axis effecting good thyroid function.

I think you are right to retry Levo with the necessary optimal requirements as it works easily for many and for some with only absolutely optimal fundamentals in place and no flexibility.

As Angus had said there is a further small subset of people who may have a DI02 genetic polymorphism that will always inhibit conversion of T4-T3. I have this and have found adding T3 to my T4 to be my answer. There is an easy DI02 test available (link below).

Supplementing selenium will help T4-T3 conversion and hopefully raise your T3 levels.

You are looking for a TSH of around 1.00 and T4 & T3 in mid to upper third of range.

Many on the forum advocate higher test results but I have found with a healthy life style and optimal nutrients & supplements I am doing well on mid range T3 & T4 levels.

I believe the less hormone replacement I can take the better as I have a genetic makeup that makes excreting excess (unused) hormone very difficult.

ACTH is a hormone released from the pituitary gland but with a high TSH I don't know what this means. Perhaps others will comment.

With a low result I would want my cortisol levels tested (link below) and would ask to be referred for further investigation, although it might right itself (hopefully) when you are optimally medicated.

Flower

This following link explains the importance of vitamins and where they may be obtained. This forum is supported by the charity ThyroidUK. You do not have to join the charity to benefit from this forum but by doing so you will be supporting the charity and also entitled to various discounts when buying supplements, as detailed in the link below.

thyroiduk.org.uk/tuk/treatm...

DI02 genetic testing (cheek swab)

thyroiduk.org.uk/tuk/testin...

Saliva Stress Test (test ref END01)

Four saliva tests that measure the available "active" cortisol (& DHEA) secreted at set times over a 24 hours period. The results will allow you to see any imbalances in the daily circadian pattern so enabling use of correcting supplements to aid your adrenal health. Unfortunately this test is not generally used or recognised by GP's.

thyroiduk.org.uk/tuk/testin...

……………………………………………………………………………………………………………………........................

Disclaimer: 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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Thank you Flower for your response and the info you provided.

You said that the TSH should be 1.But isnt ft3 and ft4 levels are more important than trying to improve tsh only?

Iam a bit confused here because if I just try to keep my tsh around 1 then maybe I still wont be able to get rid of all the symptoms?When I was taking 50mcg daily before my tsh got 0.04 and thats why the dr reduced my dose to bring up my tsh but that gave me more symptoms.I don't know what dose will help me get my tsh to 1....i dont know how to calculate my optimal dose?

Regarding low stomach acid,Im taking a herbal supplement after every meal and also taking vitamin b complex.

Reply

sa1234,

Many members who medicate on Levothyroxine function better when their TSH is around 1.0 but it doesn't suit everybody. Some need their TSH suppressed and others are better slightly higher.

T4 & T3 are equally as important and it is the T3 that needs to be higher in range as this is the hormone that gives you the well being factor.

The ranges that doctors use are too rigid as we are all different but there are certain ranges that need to be adhered to (ie - it is important not to take T3 over range or your TSH really low) in order to prevent osteoporosis and heart problems. Too little or too much thyroid hormone can be destructive so it is a case of finding what med and what dose allows you to function well.

Ideally your T4 & T3 levels will raise as your TSH lowers and you will eventually find your correct dose. This can not be rushed as the body will only tolerate small dose increments at a time and symptoms can lag behind good biochemistry by weeks/months, falsely leading patients to think their meds aren't working.

A TSH of 0.04 is fine if that is what you need to feel well as long as T4 & T3 aren't over range. It is a balance and good iron, cortisol and nutrients will help everything work together.

Have you had your cortisol checked ? It is vital for good thyroid function.

Herbal supplements will be good for healing the guts irritated intestinal lining but low stomach acid will need replacing with Betaine HCL with Pepsin . Do not take if you have stomach ulcers.

Flower

hypothyroidmom.com/cortisol...

……………………………………………………………………………………………………………………

Disclaimer: 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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No,I didnt have my cortisol checked.I will ask the doctor to check that on my next visit.

But until now I will continue with 50mcg t4 daily along with the supplements and I will get my levels tested again after 4-6 weeks and then see if I need to change my dose or not?

Am I right?

Reply

Yes sa1234, but remember cortisol is vital for thyroid meds to work.

If you have been without meds for a while and have high TSH your adrenals may be compromised.

There are sups that target specific adrenal problems and you won't know what your issues are without a saliva test.

However, optimal iron, nutrients & eventually thyroid hormones with help adrenal health.

Also lots of Vit C, fish oil, eating a healthy diet & sleeping well will help adrenal health.

Flower

…………………………………………………………………………………………………

Disclaimer: 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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I have taken prednisone in past but I never saw improvements in my symptoms.It was a course for a couple of months and I was advised by the dr to slowly wean off it.

This was about 12 years ago.I was 22 at that time.The internal med.doctor gave me prednisone for my chronic cough and other respiratory issues.But surprisingly,my chronic cough of so many years went away when I started t4 in 2014.I researched about hypo.symptoms and found out that my respiratory tract issues wwre due to my under active thyroid.So I think I might have been hypoT since a really really long time and I was diagnosed too late.

I do take seven seas cod liver oil but I am confused about which form of vitamin c should i take....ascorbate or ascorbic acid?Its very strange but even if i take 250mg of vit.C in any form,i feel that my brain is shutting down,the blood circulation in my head area siezing and i hear a buzzing sound on my ears.Maybe its due to my low iron bcz i read about the connection between calcium,vit.D,b12,iron and vit.C.

I also heard about vit.B5 500mg for adrenal health...maybe i will add that in later.

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Hydrocortisone suppresses the ACTH feedback loop which would normally stimulate natural cortisol production.

If I was you I would do a saliva cortisol test and if necessary supplement with Thornes Adrenal Cortex or similar.

I had a chronic cough when diagnosed and a hoarse voice. Both disappeared once medicated on Levothyroxine.

High doses of Vit C can be taken in the form of ascorbic acid. If it upsets your tummy, you need to reduce until you reach a tolerated dose.

Calcium ascorbate is gentler on the stomach but contains calcium and if you don't need further calcium it would be unwise to supplement additional amounts.

In a 1,000milligram pill the combination would provide roughly 900 milligrams of ascorbic acid (Vitamin C) with 100 milligrams of calcium.

I take Vitamin C with bioflavonoids to aid absorption. There are research papers advocating the claim but others disputing it.

Flower

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I will get my cortisol tested.

I am doing my research on hypopituitarism and I found out that central hypothyroidism is due to pituitary disorders.

Since my TSH is high not low,so would it be right to say that I have Primary hypothyroidsm?

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Yes. The TSH (thyroid stimulating hormone from the pituitary) increases as it tries to entice a failing thyroid gland to secrete more hormones.

T4 & T3 go down as TSH goes up.

Flower

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TSH is really not relevant in dosing thyroid meds. I would do what Angus says and look at the Dr. Lowe video.

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your thyroid labs are low..i believe you are hypothyroid. Maybe try t3 on its own, not adding levo, if it makes you feel bad. But, most importantly, why are you hypothyroid?

i too have low acth and low cortsiol, it is due to pituitary damage, for me, or so i think. I need further evaluation. low acth will cause low cortisol. You need an mri and further testing, but.. I cannot find out if hypothyroidism can cause low acth..could you google it and check also? I am not feeling too well at the moment.

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Hi faith63,

I am sorry to hear that you are not feeling well.

I don't know why am I hypothyroid and doctors won't help in finding the root cause.I will have my cortisol tested.I am surprised that the doctor asked for LH test and not cortisol :(

I am trying to find the link between hypothyroid and it's effect on pituitary gland.I read on hypothyroidmom somewhere that there were some cases of hypopituitarism who reversed it by treating their thyroid.

Some nutritional deficiencies can also cause this.But I could'nt find any more info on this.

If you have central hypothyroidsm then you can read this.

It's very informative....

goodhormonehealth.com/.../p...

If you cannot open this link then pls place it in google search bar.You will get the options of some website,click on the first one.

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i know i have been to that website, but it says url not found.

You need to push for hashimotos testing..something is wrong and it can be fixed, but not thru mainstream medicine.

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SA1234, I think 50mcg daily would be an appropriate starting dose. Levels should be retested in 6-8 weeks to see whether dose is sufficient or needs raising. Arrange your blood test early in the morning when TSH is highest, and fast (water only) as TSH drops post-prandially. Take Levothyroxine after the blood draw.

Most people are optimally dosed when TSH is just above or below 1.0, FT4 is in the upper range, and FT3 towards the top third of range. Currently you are not adequately replaced so it's unlikely you have high rT3 which is usually caused by unconverted Levothyroxine, or a conversion issue. If you had a conversion issue TSH would be low, FT4 high in range, and FT3 low.

Your pituitary appears to be working well as TSH has risen to 6.93 in response to low FT4 and FT3 and rules out hypopituitarism which presents with low-normal TSH, low FT4 and FT3.

If you are on 3 monthly B12 injections you can supplement methylcobalamin sublingual lozenges, spray or patches to top up when you feel the injection is wearing off.

I would supplement 5,000iu D3 daily until vitD is around 100 then reduce to 5,000iu alternate days to maintain level.

_______________________________________________________________________________________

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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Thank you dear for your reply.It's a relieve to hear that I don't have pituitary issues. xxx

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