Dose advice please

[Emits]

I've been taking 87,5mcg Levothyroxine and still don't feel well. These are my latest results with ft3 for the first time since diagnosis. What would you recommend? Increase levo to 100mcg? Do I need t3 added? I know it's hard to get so if I could feel well on only levo that would be fab.

Tsh * 0.16 mIU/L 0.27 - 4.2

FREE THYROXINE 18.4 pmol/l 12.0 - 22.0

FREE T3 4.1 pmol/L 3.1 -6.1

Free t3 before diagnosis was

3.8 (3.5-6.5)

All my vits are optimal except ferritin which I'm supplementing but was 65 when tested 2 months ago so should be higher now.

[Mary-intussuception]

It doesn't look like you need increase in Levothyroxine to me. Doubt your GP would increase it anyway with these results, more likely to try reducing to 75mcg.

Have you seen GP yet? How long since you last saw Endo?

If it were me then I would want to be seen by Endo asap to address symptoms and investigate/decide what is needed to relieve them.

If it is 12 months or less since you last saw Endo would you consider phoning their secretary and asking to be seen in clinic as you still have symptoms and very unwell despite Levo and TFTs results ok. OR at least request phone call from Endo.

If not ask GP to refer you urgently to Endo. If they refuse then go through all symptoms with GP.

Someone more qualified than I am will probably post some advice soon.

Did your Endo do Short Synacthen Test to check your adrenals before you started Levo?

Hope you get cooperation from GP and get sorted soon.

X🐥

[crimple]

Your t3 is low in Range. And t3 is the active hormone needed by every cell in the body.

Have you had any tests to check for antibodies? What are your levels for vit D , B12, iron, ferritin and folate?

[Emits in reply to crimple]

Yes Tpo came back 40 (less than 60)

The levels for those are optimal.

[Mary-intussuception]

Hi again Emits.

Sorry I forgot to ask if you have tried asking GP or Endo for T3?

If I'm reading your post correctly then you are reluctant to ask ?

If T3 plus 75mcg ( or present ) dose of Levo will be right for you then I would ask and keep asking until you get full care and are feeling better.

All the best.

X🐥

[Emits in reply to Mary-intussuception]

Thank you so much for your reply!

I haven't been seen by a endocrinologist. Just my gp. I haven't asked him for t3 singel this is my first test so I didn't know my levels before now. I'm not reluctant to try t3 it's just that I don't think they will prescribe it. But it sounds like you think I need it, right? Or do you mean that the endo (if I get there)need to do more checks?

No they didn't do any Short Synacthen test.

[Mary-intussuception in reply to Emits]

Hi Emits. Firstly; so sorry to be so long getting back to you. Been busy and tired. I have been looking after some trapped water bird young families in a walled lake. They can't get out to graze naturally so depend on people to throw grass into them and grains. And there are not enough volunteers!

Well, I am not medically qualified and so can only speak from my own personal experience. I'm afraid I couldn't comment on T3 as I only take Levothyroxine 75mcg for my Hypothyroidism (I have Hashimoto's ) . My last TSH was 1.94 and GP is happy with this. Possibly because my Endo (if I remember correctly ) told them my therapeutic level is under 2.

Where I am (South Wales ) for patients already on Levothyroxine they only test TSH. I must try to find my old records and see what my T3 was when Endo tested it but that was almost 6 years ago now!

I noticed from your bloods that your TSH is very low. Your FT4 looks reasonable, more than half way up range. Your FT3 though it may appear 'low' in range has actually improved since diagnosis. I'm not sure of the dates of the two FT3 tests but notice they seem to have been done in different labs with different ranges. So whilst it appears to have gone up by 0.3 it is in effect, more as the first test was only 0.3 above bottom of range. The second test however was 1.00 above bottom and 2.00 below top of range.

I doubt your GP would do anything different on these bloods, don't think mine would. So I would make a list of all symptoms. You say you are still not well, can you give more detail? Any throat, swallowing problems, constipation, digestive problems? Do you check your temperature occassionally, especially first thing? Hair loss etc? Unresolved constipation can cause many problems - it can put pressure on blood vessels/circulation; spine; pelvic organs . Can cause mobilty problems . Bulging when straining can cause Diverticular disease, hernias eg Rectocele,sigmoidcele also Intussuception.

You could see GP with your list as your symptoms need to be addressed.

You could ask for referal to Endocrinologist, GP might refuse but you could try. You could say something like - I'm grateful you found the Hypothyroidism but as I'm still not feeling well I need to find out why. You could ask for an Ultrasound scan of your Thyroid. However I have learned from this forum that many have been diagnosed and treated by GP and not seen an Endo. GP may be unwilling to refer you post- diagnosis and treatment. So if that's the case it's back to asking GP to address the symptoms.

I mentioned I thought you sounded reluctant to ask about prescription for T3 because of possible refusal. Because your TSH is so low I wondered if you might be better on a little less Levo and some T3 if GP will give it. Someone more qualified than I on here may be able to comment on that. Again, you could ask GP if it might help. I'm not sure if asking will result in it being prescribed though.

Hope you succeed in getting your GP to investigate your symptoms and you get on the road to better health very soon.

X 🐥🐦🐔