Good news and bad - advice please

[Jefner]

Haven't posted for a while. Did a full panel again yesterday as I haven't had one done since April. Been on 100 Levo and 15 T3 BUT my nutritionist said (as she has thyroid probs) that she believed the T3 might be driving the awful anxiety I get every day. So, I gave my T3 a miss for just over 4 weeks as a trial, and the results are interesting. If you compare my results in April and May when I was on it, to today's results, being a month off, they are not far off the same, in fact very slightly better off it!!!!

Although it's still low in the range, looking at my calendar since I stopped it I have had a lot more good days where my anxiety hasn't been quite so bad and I have felt well much earlier in the day than usual, with energy, felt brighter in myself, no brainfog, eating better and on several occasions have felt completely normal. Although when I look back at May when I was on T3, I also had several better days even after just losing my Dad!

Good news also is that my antibodies are the lowest they have been in nearly two years and I am wondering if that's the reason I have been having better days although I have gone downhill again since the beginning of the month with more fatigue, anxiety and depression. If you look at my profile where all my results are, they are normally in the high 2 or 3 hundreds. Whether my body is starting to produce a better level of T3 on it's own because my antibodies have come down I don't know. I can't work it out!!

Bad news is my TSH has gone up and it's been quite low for a while now. Does my high TSH indicate that I am overmedicating on the Levo? I have been alternating between 100 and shaving a little off of at around 80.

Not sure what to do now. Results below

***11th July 2017**** - 100 Levo, no T3 since 9th July

CRP 0.10 <5.0

Ferritin 76.6 (20-150)

FT4 17.00 (12-22)

FT3 3.21 (3.1 - 6.8)

TSH 3.56 (0.27 - 4.20)

T4 Total 100.7 (64.5 - 142.0)

Anti Thyroidperoxidase abs 198.5 <34

Anti Thyroidglobulin abs 196 <115

B12 624 Deficient <140

Serum Folate 28.46 (8.83-60.8)

***22nd May 2017**** - 100 Levo, 15 T3

TSH L0.11 (0.27 - 4.20)

T4 15.22 (12-22)

T3 3.16 (3.1-6.8)

***3rd April 2017****

CRP 0.10 <5.0

Ferritin 76 (20-150)

FT4 15.13 (12-22)

FT3 L2.95 (3.1 - 6.8)

TSH L0.13 (0.27 - 4.20)

T4 Total 90.3 (64.5 - 142.0)

Anti Thyroidperoxidase abs 263.6 <34

Anti Thyroidglobulin abs 244 <115

B12 569 Deficient <140

Serum Folate 22.08 (8.83-60.8)

[Clutter]

Jefner,

TSH is rising because you are undermedicated but the higher TSH is stimulating some T3 conversion. You will likely find that the TSH stimulating your thyroid gland will cause antibodies to rise. If you are feeling hypo my advice is to increase Levothyroxine dose or reintroduce T3 until TSH is 0.27 - 1.0 but if you feel well then continue on your current dose.

My condolences to you and you mother on the loss of your father.

[Jefner in reply to Clutter]

Clutter

So I higher TSH means that I am not taking enough Levo? Don't understand because I have been on the same dose of Levo for months, so why has it gone up? It's difficult to know how I really feel because it changes every day and as I said I have had many more better days with less fatigue, anxiety, brain fog etc., but at the moment it's all back but I get those symptoms anyway from anxiety.

Why would a higher TSH make my antibodies rise? I have been on higher doses before and they have also been high until now

[Clutter in reply to Jefner]

Jefner,

15mcg T3 is equivalent to 45mcg Levothyroxine so stopping T3 means you've decreased your combined dose by 45mcg and that's why your TSH has risen.

The higher TSH stimulating your thyroid gland increases Hashi flares after which thyroid antibodies rise. Keeping TSH low or suppressed reduces Hashi flares and antibodies.

[Jefner in reply to Clutter]

Clutter

So what if I increase by Levo by say 25mcg? Plus my antibodies have come down for the first time in 2yrs

[Clutter in reply to Jefner]

Jefner,

Yes, see how you feel with an extra 25mcg.

[Jefner in reply to Clutter]

Clutter

Is this what the rest of my life is going to be like, tweaking my meds constantly and being up and down

[Clutter in reply to Jefner]

Jefner,

If you feel good on your current dose don't tweak it. You only need to tweak meds if you don't feel good.

[Jefner in reply to Clutter]

Clutter

That's the problem I am up and down like a yo yo every day so I can't really tell BUT I have noticed my anxiety symptoms lower earlier in the day the last few weeks and I have felt better when that happens but gone downhill again with depression, fatigue, hairloss, anxiety. How long before I notice the difference with the increase if I do that?

[Jefner in reply to Clutter]

Clutter

I wonder whether it might be because I have gone back to taking my Levo in the mornings as I had, for several months taken it at bedtime. About a couple of hours of taking it I have my beta blocker which I know can interfere with Levo. Wonder whether that's why it has gone up?

Could go back to taking it at bedtime but I also take a mag to help me sleep

[Clutter in reply to Jefner]

Jefner,

It will take 7-10 days to absorb the 25mcg dose increase and up to six weeks to feel the full impact of a Levothyroxine dose increase.

TSH has gone up because you stopped taking 15mcg T3.

It's fine taking a beta blocker 2 hours away from Levothyroxine.

Levothyroxine needs to be taken 4-6 hours away from magnesium.

[Jefner in reply to Clutter]

Clutter

thanks hon. Still can't get my head around the fact that if I am undermedicated, why is my T3 around the same as when I was taking it?

[Clutter in reply to Jefner]

Jefner,

Because the higher TSH is flogging your thyroid to produce T3 and convert T4 to T3.

[Jefner in reply to Clutter]

Clutter

Just wondering whether to go back on the T3 again rather than up my Levo. If I do, because I have been off it for just over a month, should I restart at 5mcg and build up again?

[Clutter in reply to Jefner]

Jefner,

Why resume T3 if you feel better off it?

[Jefner in reply to Clutter]

Clutter

To be honest I don't know that I do. I have had more good days since coming off it but have gone downhill again with more depression and fatigue etc but that could be due to the gut dysbiosis or the hrt patch. I just don't know hun. I am up and down like a yo-yo.

As you said if I up the T4 only, then it will drive my antibodies which I am trying to get down. Am pretty sure my thyroid is drying up because when I had an ultrasound a year ago there was pretty much nothing left

[Clutter in reply to Jefner]

Jefner,

Re-read my replies. I haven't said that upping T4 only would drive up antibodies. I said that rising TSH will probably cause antibodies to rise.

Increasing your T4 dose will raise FT4 and FT3 and lower TSH.

[Jefner in reply to Clutter]

Clutter

Sorry hon, brain dead today, still filling in forms since my Dad passed.

My T4 is already quite high, do I really need it any higher. What would you recommend, I need some help with this

[Clutter in reply to Jefner]

Jefner,

We're going around in circles. You have 3 options:

1. Do nothing and hope that TSH >3 won't cause a Hashi flare and raise antibodies.

2. Increase T4 dose by 25mcg and raise FT4 and FT3 and reduce TSH.

3. Resume 10-15mcg T3 and raise FT3 and reduce TSH.

[Jefner in reply to Clutter]

Clutter

Would it be my high TSH that is making me feel very fatigued, low mentally, anxious, and aches and pains today? Do you think my B12 levels are OK?

[Clutter in reply to Jefner]

Jefner,

No, TSH levels don't make you feel anything, it's FT4 and FT3 which count. Low FT3 could cause the symptoms but wouldn't just cause them today.

I think B12 is fine.

[Jefner in reply to Clutter]

Clutter

As my T4 levels from my latest test are quite high anyway, will adding more make it go even higher?

[Clutter in reply to Jefner]

Jefner,

FT4 17 is half way through range. It isn't high. Increasing Levothyroxine dose will raise FT4 and FT3.

[Jefner in reply to Clutter]

Clutter

And hopefully reduce my TSH to a better level again

[Clutter in reply to Jefner]

Jefner,

TSH rises because FT4 and FT3 are too low so raising FT4 and FT3 will reduce TSH.

[Jefner in reply to Clutter]

Clutter

thank you xx