Optimizing T3 - latest blood results

[GraceB]

I started T3 7 weeks ago taking 12.5 T3 along 100mcg T4. Before that I was on 150mcg T4. My previous results are in the post under this link but pasted the most relevant for convenience. healthunlocked.com/thyroidu...

In my previous post, I've got many valuable comments and suggestions that I decreased the T4 dose too much and perhaps too fast and that's why I was feeling worse. However, as I was on that dosing for several weeks I decided to continue up to 7 weeks to check hormones levels and then decide what next.

So here are my latest blood results and I would appreciate advice on how to adjust my T4 and T3 dosing.

TSH 1.60 0.27 - 4.20 mIU/L - previously 0.12 (0.35-5)

T4 Total 78.9 64.5 - 142.0 nmol/L

Free T4 13.49 12 - 22 pmol/L - previously 17 (9-19)

Free T3 3.71 3.1 - 6.8 pmol/L - previously 4.3 (2.6-5.7)

Anti-Thyroidperoxidase abs H 41.1 <34 kIU/L

Anti-Thyroglobulin Abs 23 <115 kU/L

CRP 0.30 <5.0 mg/L

Ferritin 80.7 20 - 150 ug/L

Vitamin B12 703 Deficient <140 pmol/L - Insufficient 140 - 250, Consider reducing dose >725

Serum Folate 33.44 8.83 - 60.8 nmol/L

[Saggyuk]

Hiya - Did take the blood tests 24 hours fasting like many on Levo? If so and when taking T3, I think this can skew T3 results a little especially if a bad converter as my T3 drops faster so would normally only leave it 12 hours max. However, you are only on a small dose at the mo and mostly on T4 still and I am on T3 only so just maybe something to bear in mind in the future especially if you start to favour T3 over T4.

There's certainly room for an increase in your dose going by your TSH and T4 levels but your T3 levels are still barely in range so I would simply add another 12.5mcg of T3 and retest in a couple of months maybe if you are a bad converter or you've felt better with the added T3. Or you could add 25mcg T4 instead if this is what you'd prefer?

How do you feel, any improvements or symptoms?

[GraceB in reply to Saggyuk]

Thanks Saggyuk. I'm taking levo together with T3 and yes it was fasting test and last levo and T3 tablets were taken 24 hours before the test.

Previously I was on 150mcg levo but each dose increase was making me really sick for weeks and still have hypo symptoms.

Adding 12.5 T3 I reduced my levo to 100mcg. Didn't have much issues with adding T3, my frequent headaches/migraines disappeared with the first dose of T3. However, I became a bit nervy but that has improved now. Also became very tired and sleepy, low energy, unable to do much physical effort and having this strange popping in my right ear but this is probably associated with decreasing T4.

Don't you think I should increase both? Increasing T3 may bring T4 even further down. Or even if both need to be increased it should be done one at the time?

If I increase T3 to 25, should I split the dose 12.5 in the morning and 12.5 in the evening?

Apologies for bombarding you with all these questions but not sure what to do next. Many thanks for your advice.

[Saggyuk in reply to GraceB]

Hiya Grace.

I think adding 25mcg T4 and 12.5mcg together would be far too much in one go, I can't normally do much more than 10mcg T3 at a time without it causing issues. As much as it sounds a little amount T3 is very powerful. To give you a clue, I have no thyroid function at all, and my whole dose is 30mcg T3 and 25mcg of T4 - so this is my full dose and all I get. I did used to take a little more T3 but my requirements decreased hugely after going GF.

THe other problem with adding both at the same time is that you wont have a clue which might be causing any side effects you get and which is making you feel better. I think there is only room for a little improvement and that might be all you need.

I've just had a read a couple of your past posts and can see you've been a bit sensitive to dose changes so also not a good idea because of this. I'm assuming you're trying to try more t3 in order to see if resolves your ongoing issues so I think you should add only 12.5 max and then retest in a couple of months. Considering everything, you might even be best to just add 6.75 and then another 6.75 in two months if your blood tests show room for more movement. If they don't, then you would need to consider swapping rather than just adding.

Your T4 levels may increase this way anyway as by adding T3 directly, you wont be needing to convert as much T4 into T3 and might leave a little more behind so I wouldn't worry about that until the next test.

Just because I read some of the difficulties you mentioned with weight gain and energy levels etc and the food you were eating, I have a hunch that it might actually be your diet at fault. I can't imagine from a brief look of your daily intake that you would be getting enough calories and energy from your diet to support an energetic lifestyle. While lowering calorie intake in the short term can cause your metabolism to rise and weight loss as your body will use more Adrenalin for energy instead but in the long term a low calorie diet may unfortunately have the opposite effect and cause your body to go into starvation mode and conserve energy and store fat faster than normal and make exercising very difficult. I think you might also be missing one or two important smaller minerals and things that aren't often tested for. This is just my personal opinion but my mum has the same problem.

You should use a website called cronometer which tracks your whole diet and is free of charge. A woman requires 2000 calories a day to function properly and the website will ask if you want to reduce this but if you really have to, I would not put it lower than 1750 and certainly not less than 1500 as this will very likely have a bad effect on metabolism although I think you should keep it at 2000 at first to get a good idea of what you're not get getting in comparison to normal requirements. They have a food database that contains all the food you might eat so just find the closest, select the amount and add it to your list for the day. They have used a few food directories from a few different countries in which they have physically tested each item to see what it contains down to the tiniest mineral but there are some custom made options so always choose the options which have USDA, NCCDB or CRDB listed as these will always contain all nutrients. Just plug in everything you eat each day down to every pinch of salt, dash of balsamic vinegar, water and supplements. It takes a while the first few days to set it up but then becomes really quick as you can copy previous days into the next and amend where necessary once you have all the foods/supplements/drinks you normally eat.

You can even plug in the exercise you do so it will take this into account in regards to whether you're getting enough calories etc. It flags up anything missing or not right and you only have to do it for a few weeks to get a good idea.

Even if you don't want to concern yourself with calorie intake, I think this would be a good thing to do to check for any deficiencies as I'm sure you're missing a few key things in your diet.

Either way, I hope you start to feel better