Hi Guys, Need Advice

[Dinjo]

Hi Guys,

I have been suffering with an under active Thyroid for about 1 and a half years.

I am 35 years old Male and 5.8 in height.

I was originally taking Levo when diagnosed but i went up from 13.5 stone to 14.5 stone within a period of 3-4 months. I also felt like rubbish on levo, no energy, pilling on the Weight while exercising 3 times a week and playing local footy once a week.

I also pay alot of money per month for fresh and healthy foods that are portioned.

I then changed to Nature Thyriod, started off with 1 grain and gradually upped my dose to 2 grains per day.

I felt alot better on these tablets and have been on them the last 6 months.

Still my weight to this day is increasing and i am now at my heaviest at 16 Stone.

It is soul destroying, exercising 3 times at least a week eating less than 1500cals a day an not a pound lost, only gained!.

I got my TSH, T4 & T3 results back today please see below :

Your Thyroxine Stimulating Hormone (TSH) test results has been returned as NORMAL Your results

TSH - 2.06 mIU/L ---- Normal range

0.27 - 4.2 mIU/L= Looks ok

T4 - 15.70 pmol/L ----- Normal range 2 - 22 pmol/L = Looks ok

T3 - 7.00 pmol/L Normal range 3.1 - 6.8 pmol/L = Slight over but nurse says this is fine.

I am at my wits end, i do admit i feel a lot better altho always wake up with a dry throat but can deal with it. I have gained 2 - 3 stone since i was diagnosed with an under-active Thyriod. I am an active guy.

Has anyone experienced this ? Should i get more tests ? Is it even my Thyroid ?

Any advice or help much appropriated.

Many Thanks

[greygoose]

What time of day did you do that test? And, did you take your NDT before the test? Or how much time did you leave?

[Dinjo]

Hi Grey goose, I asked this question before I took my blood sample and the nurse told me to take my medication as normal to see if it was working.

I took 1 grain of Nature Thriod at 6PM the night before and another 1 grain at 8am and got my bloods taken at 12pm

Thanks

Dinjo

[Clutter in reply to Dinjo]

Dinjo,

T3 peaks in the blood for up to 6 hours after the last dose so your FT3 level is elevated because of the NDT dose you took. Leave 8-12 hours between last dose and blood draw in future.

I think you are probably under medicated. Most people taking NDT will have TSH <1.0 or even <0.1 which is suppressed, and aim to have FT3 in the upper third of range. FT4 isn't very important when taking NDT.

[Dinjo in reply to Clutter]

Many thanks for that. So should i increase my NDT by half a grain ? And then test again in 6-8 weeks ?

Again thanks for your help with.

[Clutter in reply to Dinjo]

Dinjo,

Yes, I would.

[Dinjo in reply to Dinjo]

Also when you say have your T3 in the upper bracket, what number would you aim for ?

[Clutter in reply to Dinjo]

Dinjo,

5.5 - 6.8.

[Dinjo in reply to Clutter]

Would you advise me to get a more advanced test the next time, like RFT3 and RFT4 antibodies etc or is that really needed ? Thanks again

[Clutter in reply to Dinjo]

Dinjo,

TSH, FT4 and FT3 are fine for most of us. It's not essential to have rT3 tested. I've never had it done. There is no rT4.

If you don't know whether thyroid antibodies are positive for autoimmune thyroiditis (Hashimoto's) it is worth having thyroid peroxidase and thyroglobulin antibodies tested to confirm or exclude it. You'd only need to order it once unless you want to monitor thyroid antibody levels.

[Dinjo in reply to Clutter]

Thanks !

[dang]

Hey Dinjo just want to make a note that others might have missed. Exercise uses up precious T3 until you're optimally medicated (you still seem slightly under medicated considering your tests reflect a "spike" since you took your NDT before bloods). T3 is needed for metabolizing, and losing weight. Many hypo people find they put on weight when exercising, and only once they have sufficient FT3 levels do they finally lose weight. I personally had to stop exercising for a number of months, and just focus on diet and healthy eating, in this time I lost 50 lbs (over the course of just under a year).

Another thing, although I don't think you're in the "danger zone" yet: low carb/low calorie diets are really bad for hypos. The problem is that the body uses glucose from carbs to convert T4 to T3, and the more we lower carbs the worse the body is able to convert, and the more hypo we become (this is actually a natural feedback loop so that our ancestors didn't starve, when intake was low the body would slow down to keep our ancestors alive during times of famine). There's

even a point of calorie restriction where the body switches from using carbs to using ketones as energy, at this point the thyroid really goes out of whack. I'm not saying to eat a lot of carbs, just don't over do the calorie restrictions, the metabolism doesn't really bounce back well, and people are actually capable of making themselves hypo through calorie restriction.

I believe that once you're optimally medicated, and along with healthy dietary decisions (which you already seem to be doing) you should be able to start shifting the weight. Maybe try in the meantime to limit the exercise and see if that helps.

All the best!

Dan

[Dinjo in reply to dang]

Dan many thanks for that very informative ! I get what you're saying, thing is I football once a week and need to stay somewhat fit , although I'm pushing on :).

So should I increase my calorie intake back to 2000 per day and maybe only excersize twice a week , and increase my medication by half a grain ?

Again much appreciate your post and time, thanks

[dang in reply to Dinjo]

I don't have a definitive answer to how many calories you need, I'm not informed enough with diet to really give proper advice there. I personally didn't count calories, but instead changed my habits. Stopped eating snacks and ready-made food. Went gluten-free, soy-free, and cut out foods that caused me digestive issues. Started cooking everything from scratch. This worked for me as my habits were really awful before, eating pre-made sandwiches, ordering pizza all the time, etc.

I'm not sure what to say about your medication. You probably need an increase based on your TSH, normally when on NDT (and optimally medicated) TSH becomes suppressed or close to it. I just don't know what to say about your FT3 since you took your dose before the test. I can say when I get tested (I'm on T3/T4 combination) my FT3 is quite close to the top of the range and I leave 24 hours from my last dose. When is your next blood test?

[Dinjo in reply to dang]

Hi Dan, yes i have cut out all the bad stuff myself. I will be getting bloods tested again in 6 to 8 weeks.

When you people say not to take your NDT for 24 hours before blood tests what is this trying do achieve ? How your body works without medication ?

Also the Nurse told me that everything is fine, and my TSH is normal. When you say suppressed or close to 0 what does this achieve ?

Again thanks and sorry for all these question.

Cheers

[dang in reply to Dinjo]

When you take your medication too close to a blood test you're getting false readings as you're seeing the immediate effect of the dose in the bloodstream and not a good indication of what is in the body on average. So when you wait longer you avoid this "spike" and get a better reading.

What is being measured are the levels of free hormone present in your blood, however that hormone needs to be utilized by the body, and while it leaves your blood rather quickly (as is the case with T3) its effects on a cellular level go on for a couple days. So 24 hours or so doesn't really cause much of an issue.

I might have not explained myself properly about TSH. What I mean is that the goal is to achieve a higher FT3 result, and it's unusual to see someone with FT3 as high as yours, yet still having a TSH of 2. Normally once someone is well medicated on NDT TSH just happens to be near 0, this is just something we've seen in general. My experience with T3 is that in order to feel good my TSH is also under the range, and my FT3 is near the top of the range, this is quite common. And likely your results would have indicated a lower FT3 since your TSH is still around 2. If for example you were to get your bloods taken after waiting at least 12 hours from your last dose and your FT3 showed up under halfway in the range then I'd say it's no wonder you're struggling, but since you took your meds soon before bloods I'm trying to work from your TSH instead. TSH takes longer to move up and down, and doesn't spike as quickly as FT4 and FT3 results.

You're welcome! I hope this isn't too confusing since I'm writing it past midnight 🙂

[Dinjo in reply to dang]

Thank you so much, well written and very informative ! I understand it so much better now.

I will take your advice and will up my dosage to 2 and a half grains of NDT per day.

The next blood tests i will do will be at least 12 hours after i take my NDT.

Thank god i came across this forum, people like yourself are so much helpful, hopefully once i get my TSH and FT3 levels optimized i can come back and help other users with similar issues.

Thanks Again.

[dang in reply to Dinjo]

You're very welcome! Yes this forum truly is great, I've learned so much here myself and have been helped numerous times when I didn't know what to do. Would be great if you helped others on this forum from your own experience

Good luck with it all!

[humanbean in reply to Dinjo]

Make sure blood testing is done first thing in the morning - at the very latest by 9am.

TSH has a circadian rhythm. It is at its highest at about 2am and lowest at about 2pm. To get the highest TSH during normal working hours, try and get the first appointment of the day. Since doctors determine dosage by TSH, to reduce the risk of getting meds lowered or to increase the chance of getting meds raised, TSH has to show at the highest possible. If you are self-medicating then this doesn't matter so much, but I still think it is worth doing. People on this forum are used to interpreting results done under the conditions described.

Don't forget to fast overnight and delay breakfast until after the blood draw. Water can and should be drunk freely while fasting - dehydration should be avoided.

If you are taking NDT you need to take your last dose before test 12 hours before.

If you take Levo the gap between last dose and test should be 24 hours.

If you take T3 then the gap is 12 hours.

[Dinjo in reply to humanbean]

Thanks Humanbean

[Dinjo]

Hi Guys,

Didn't know whether to post a new or reply to this so here is an update.

I upped my dose by a half grain for 6 weeks currently on 2.5 grains of NDT.

I have limited my exercise to only once a week during this period.

My weight has not moved.

I left 12 hours this time before last taking NDT and getting my bloods taken at 10AM.

Here are the results :

TSH 1.00 (0.27 - 4.20 mIU/L)

Free T4 16.53 (12 - 22 pmol/L)

Free T3 5.60 (3.1 - 6.8 pmol/L)

Should i increase my dosage by Half a Grain again and test in 6 weeks again ?

Thanks

dinjo