Latest results have me puzzled … advice?

[Currently taking: 50-mcg Synthroid / 15-mcg Liothyronine]

T4 - 0.75 (0.82-1.77 ng/dL (LOW)

T3 - 107 (71-180 ng/dL

TSH - 0.194 (0.450-4.500) (LOW)

My doctor wants me to stay on the current dosage for 8 more weeks.

I am thinking that lowering the dose of Synthroid and slightly increasing the Liothyronine would be the next step?

Thanks in advance for any help!

[dang]

Do you have results for FT3 and FT4 as well?

Lowering levo and increasing T3 will lower your total t4 even more.

Are you symptomatic?

[Hidden in reply to dang]

Thanks for the reply and sorry for not clarifying, these are Thyroxine (T4) Free, Direct, S and Triiodothyronine (T3). If you look at my earlier post you will see the results from the two previous labs.

What I am hoping to achieve is a higher T3/T4 but a TSH around 1.0 as I seem to feel better when there is an adequate amount of T3 circulating.

As for symptoms, yes. Fatigue and brain fog have returned, although not quite as terrible as I have had in the past.

[dang in reply to Hidden]

You need Free T3 results those are the most important. What you want is FT3 high in the range not total t3. When taking t3 it is common to have low FT4. In fact as you add t3 that will often lower FT4 even if levo dose stays the same. FT3 and FT4 should be tested at the same time.

As long as you're able to convert levo you could add either levo or t3 and that should raise your FT3 and total t3, but again FT3 results are what we really need to go off, since that shows how much t3 is actually in the blood and available for use.

Also as a note, to achieve a higher t3 it is quite likely that your TSH will have to go under 1. It seems you're trying to raise your TSH? Your TSH is irrelevant at this point, and you should not be focusing on raising it (unless you suspect over medication, in which case FT3 and FT4 are still the most relevant results).

[dang in reply to dang]

Soozbee, I think what you're looking to do is actually increase your levo. This would raise your FT4 and FT3. But I wouldn't recommend doing this at all without seeing your FT3 results, since you're taking t3 FT4 results can't be used to gauge your dosage.

[Hidden in reply to dang]

Thanks!!

I have looked back at my labs for over 2 years and realized that they have never tested FT3 - only Total T3!

I will try to get that in my next labs and before I make any changes as you suggest.

I am improved from Synthroid alone but seem to have regressed a bit recently. I am having such trouble with the brain fog right now it's difficult to even reply properly - but this fluctuates throughout the day. It seems to clear up later in the afternoon and I feel more like myself. I take all meds in one dose around 6:00 AM every morning.

[dang in reply to Hidden]

You're welcome I had brain fog and all sort of issues until my t3 dose and levels were just right, then finally it subsided (my FT3 is near the top of the range). Fatigue is a symptom of both over and under medication, so either way it seems you need some sort of adjustment in your dose (likely an increase).

Try to get the FT3 levels tested, if for any reason your doctor won't do it you can order private tests (search the forum for this info as I don't know much about it myself).

[eeng]

It is normal for someone taking T3 to have a low FT4 reading. The TSH isn't very informative either, but the one to watch is your Free T3 level (FT3) which should ideally be in the top third of its range.

[Hidden in reply to eeng]

Thanks for your reply. I agree that T3 needs to be higher but I also thought that the T4 should at least be in range or even slightly higher … it's my understanding that if the TSH level is low my body is assuming I have enough T4 and stops producing. This is where my confusion (and the brain fog) prevents me from understanding what to do next.

[humanbean in reply to Hidden]

As long as you have a Free T3 level which is within range and at the right level to fix your symptoms, Free T4 is optional for some people.

I take T3 only, and my last Free T4 level was about 2 with a reference range of 12 - 22.

Some people on the forum who have been severely hypothyroid for a very long time and who take T3 only have Free T4 levels of zero.

There are some people who feel better with some Free T4 in their systems even if they have plenty of Free T3. But it is a personal thing. Some need Free T4, some don't.

[Hidden in reply to humanbean]

I realized, thanks to a reply from dang (see above) that I am basing all my decisions on T3 lab results vs. FT3 - and have been for years!

I felt quite good when I initially added T3 to my original dose of 75 mcg of Synthroid and even for quite awhile on 50 mcg/ 15mcg Liothyronine. But lately that is not the case.

I am quite discouraged because it is SO challenging to get this under control … it feels like such a moving target.