Do I need more T4 or something else?

[Rennixon]

Had an appointment with the endo on Thursday. I have labrynthitis at the moment & so arrived feeling very dizzy, pounding head & was flushed from head to toe. Because it was so hot in there I just got hotter & redder!

The endo immediately started on about why there was no way I was getting NDT. He listened to all o had to say. But he kept referring back to how red I was & that lupus maybe the answer, or (because I have psoriasis) that it could be rheumatoid arthiritis. 

He is testing this & wanted bloods.

When I asked about the levels of T3 he said my TSH was in normal range, but that maybe I would feel better with more T4. ( my dr would not put up the dose as my tsh was normal) so he now wants me to take 125mg of leverthyroxine for six weeks to get my T4 up to about 18 (11.0-23.0) last test Jan this year it was 13.9

So I'm wondering that as my symptoms have been worsening for the last 18-24mths if this will work given that last March my t4was 18.1 ??? Or do I need to ask for t3, or consider NDT

Tests results below

March 2015

T4 18.1 pool/L(11.0-23.0)

TSH 0.21mu/L(0.3-5.5) -below range

FreeT3 4.8pmol/L(4.1-7.9)

Jan 2016

T4 13.9

TSH 2.1

No free T3 as TSH level has gone up?

[Ruthi]

Your TSH has gone up to well above optimal (around 1). 

And I would bet that your free T3, which was only just in range in March 15 is now well below.

[Rennixon in reply to Ruthi]

My thoughts exactly, after getting home & feeling a little better, what he said didn't really make much sense. He's referred me to a rheumatologist & said he would refer me back if they couldn't find anything (tennis ball comes to mind).

I've got an appointment with the GP on Monday & have thought about asking him for T3 to be tested & if he'd consider prescribing it

[shaws Administrator]

Your March 15 T3 is the bottom of the range rather than towards the top - nearer 7 would be better. Jan '16 your TSH is too high. Dr Toft recommends in his Pulse online article:-

The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range – 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance.

But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

This ‘exogenous subclinical hyperthyroidism’ is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l). 

Even while taking the slightly higher dose of levothyroxine a handful of patients continue to complain that a sense of wellbeing has not been restored. A trial of levothyroxine and tri-iodothyronine is not unreasonable. The dose of levothyroxine should be reduced by 50µg daily and tri iodothyronine in a dose of 10µg (half a tablet) daily added.

[Rennixon]

Thank you Shaws, so maybe I should take the extra 25mg of leverthyroxine & see what the test results are in 5-6 weeks ( when the endo has asked for a retest). & see how I go, I think I'll discuss this with the doc on Monday just to test the water re T3/T4 combo.

The results are confusing as my iron & folate levels in March 15 were very low, so the assumption was that I needed to correct these first. But I actually feel worse!

Rx

[shaws Administrator in reply to Rennixon]

Just remember when you reply you have to press the green reply button, otherwise the person's not notified (just as you have done above). I just happened to see your response to me by chance and you might have wondered why I didn't respond to you.

See what your doctors suggests although many wont go against the Endo.

I think you need an increase.

[Rennixon in reply to shaws]

Ooops thank you Shaws