I'm new here, and would be grateful for advice. I am 20 years hypothyroid, never felt particularly great. About 10 years ago started to experience increased muscle and joint pain, fatigue, pins and needles, brain fog etc I was diagnosed with fibromyalgia ( a diagnosis I am sceptical about). I gave up working about 6 years ago due to ill health. By the beginning of this year felt increasingly unwell. Blood tests showed haemoglobin at bottom end of normal, ferratin at bottom end of normal and small red blood cells so I was prescribed Iron. The resulting improvement was utterly unexpected but very welcome!! I do not believe I have fibro, I am sure the root of my issues lie with my thyroid function. Although I feel better than I did, I certainly don't feel 100%. I paid to have blood tested and my results are as follows:
TSH 0.005 (0.27-4.20)
Free Thyroxine 27 (12.00-22.00)
Total Thyroxine 207.1 (59.00-154)
Free T3 7.15 (3.10-6.80)
Reverse T3 67 (10.0-24.0)
Reverse T3 ratio 6.95 (15.0-75)
B12 167 (140.0-724.0)
Folate 6.34 (2.91-50.00)
Vit D 59 (50.0-200.0)
I take 50mcg Vit d daily and 250mcg Thyroxine
From the reading I have done, I am guessing that my B12 and folate levels may be better if they were higher. The Dr recommended an increase in vit d. My Ferritin level has now increased to 103 (13.00-150.0)
My question is am I taking too much thyroxine? Is that why my rT3 level is so high? I have no symptoms of overactivity, and still experiencing fatigue, brain fog and some muscle and joint pain. Its very frustrating, as I am sure everyone here knows, knowing just where to start
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lindmau
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lindmau My question is am I taking too much thyroxine? Is that why my rT3 level is so high?
The answer to that is 'quite possibly'.
TSH 0.005 (0.27-4.20)
Free Thyroxine 27 (12.00-22.00)
Total Thyroxine 207.1 (59.00-154)
Free T3 7.15 (3.10-6.80)
You probably know from these results that your Total thyroxine is way over range, showing that your dose of levo is too much. The FT4 shows over range as does FT3, again showing dose of levo is too much. These are very much like some of my old results but I wasn't converting well and my FT3 was quite low in it's range.
250mcg Levo is quite a large dose, you might want to reduce it (25mcg to start with) to bring your free Ts down, particularly the FT3 as that's the one that's said should be in range.
As for your rT3 being high, you are making plenty of FT3 so it's not as though you're making rT3 instead of FT3 - maybe there's another reason for the high rT3. A very low calorie diet, or chronic illness can also give a high rT3 level.
I would post these results on the Pernicious Anaemia Society forum here on Health Unlocked for further advice healthunlocked.com/pasoc
It's generally said that folate should be at least half way through it's range and I have read (but not researched so don't have links) that BCSH, UKNEQAS and NICE guidelines recommend:
"In the presence of discordance between test results and strong clinical features of deficiency, treatment should not be delayed to avoid neurological impairment."
And an extract from the book, "Could it be B12?" by Sally M. Pacholok:
"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".
"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."
**
Vit D 59 (50.0-200.0) - 50mcg Vit d daily
50mcg D3 = 2000iu
The recommended level for Vit D is 100-150nmol/L according to the Vit D council. You would be better off supplementing with around 4000iu D3 daily (maybe even 5000iu) until you reach the recommended level then reduce to a maintenance dose, which may be 2000iu daily, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. You can do this with a private fingerprick blood spot test with City Assays vitamindtest.org.uk/
There are important cofactors needed when taking D3
D3 aids absorption of calcium from food and K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems.
D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds.
Magnesium comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds
Thanks very much for such a comprehensive answer! you've given me loads to think about. Thyroid antibodies are in normal range. The reason I take so much thyroxine is persistent hypo symptoms - low body temperature, 4 stone weight gain, debilitating fatigue, memory and concentration problems. However, since taking Iron sooooo much has changed and I am feeling well enough to start really trying to understand this disease. I know that T4 was within range when i started taking Iron, but now 6 months later it is high. The dose of t4 I am taking has not changed so I am guessing that improving my iron levels has changed things?? I suspect that my remaining symptoms may well be tied into B12, and there is a history of pernicious anemia in my family, however so far as all tests carried out by my GP have been within range, no specific test has been done. I am not sure whether to sort out all vits and minerals first to see what effect that has on thyroid function or whether I need to reduce my thyroxine at the same time to see a benefit? I am waiting for results on zinc, magnesium and selenium test. Do you know if rT3 responds quickly to change? I have been following weightwatchers for a couple of months, so eating less but certainly not starving!! I really did feel very unwell before i started taking Iron but that was 6 months ago? Thank you so much for your help, I really appreciate it.
lindmau I certainly found that when my FT4 was over range (mine got up to 30 at one point) I was still having hypo symptoms, which was the reason my GP at the time kept increasing my dose. I believe rT3 can cause hypo symptoms.
Improving your iron will most certainly have helped. Ferritin needs to be above 70 for thyroid hormone to work, and below that level conversion of T4 to T3 wouldn't be happening.
As far as your B12 is concerned, as there is a family history I would check through the signs and symptoms list and then post on the PA forum, they will be able to tell you if all the correct tests have been carried out.
Continuing to take such a high dose of Levo, with possibly it being more effective as your vits and mins improve, will I believe just add more to your rT3 problem. To reduce rT3 you need to reduce Levo and possibly introduce some T3. However, with your FT3 level you don't appear to need T3 at this point. My first thought is to just reduce Levo by 25mcg and see how things go.
I don't know how quickly your rT3 will respond. I added T3 to a reduced dose of Levo, and when I checked a few months later all the right things had happened to FT34 and FT3 but my rT3 was actually higher than before, but I believe that was down to other illness as I have a chronic lung disease which is progressive.
Most of us are low in magnesium so it will be interesting to see your test result. However, Vit D needs magnesium to work so you may need to supplement with some.
Thank you very much. This is all great stuff. I just wish I'd asked all this years ago! Can you recommend any particular brand of vitamins or are they much of a muchness?
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