Thyroid UK
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Please help with increasing T3 dose!

Hi, I'm looking for some advice...I have been diagnosed with Hashimotos for 3 or so years now and have been on a tiny dose of 50/25mcg thyroxine. I also had a diagnosis of CFS for the last 6 years. For the last 2 years I have been pretty much housebound and have to spend almost all my time lying down. At the end of November I saw a functional medicine doctor who is sure all my symptoms are due to the Hashimotos not being treated properly (high RT3) and consequently low adrenal output.

My results as of 30th Nov were:

TSH 7.79 (0.4-4)

FT4 14.2 (11.5-22.7)

FT3 3.8 (2.8-6.5)

RT3 0.35 (0.14-0.54)

FT3:RT3 10.9 (>20)

The doctor stopped the Thyroxine and started me on 5mcg slow-release T3. I went more hypo on this dose (worsening fatigue and muscle pain and further drop in basal temp). After 2 weeks we increased to 10mcg and I picked up a little, probably back to how I was on thyroxine. After a further 2 and half weeks we increased to 15mcg (last Wednesday). The following day I started to feel a lot worse fatigue and muscle pain wise and I have splitting headache 24 hours a day. I don't really have any hyper symptoms, although my heart is beating a bit harder (as in I am aware of it most of the time). My basal temp is stable and my heart rate and BP have increased a tiny bit, but not a lot. I added in steroid cream on Monday but still feeling terrible. I'm presuming this is because my adrenals can't keep up.

I don't know whether I should stick it out on this dose for a while longer or drop back down to 10mcg for a few weeks before trying to increase again. Any advice would be much appreciated as I'm new to this! And sorry for the long post!

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I'm not sure this functional doctor knows all that much about thyroid - none of them appear to. Your problem was not the rT3, which was well in-range, but your high TSH and low Frees. You were totally under-medicated on levo. That's why you didn't feel well. You were still on a less than starter dose, and your doctor should have increased it a long, long time ago.

There was absolutely no justification for putting you onto T3 only. What he should have done was increase your levo for six weeks, then retested to see how you were doing on that. Then, T3 could have been added to your levo. Some people just don't do well on T3 only, and need the T4. I think, if I were you, I'd go back to the 10 mcg T3, and add in 50 mcg levo. Hold for six weeks, and then retest.

As you have Hashi's, are you gluten-free and taking selenium? This helps to lower antibodies. And, has anybody ever tested your vit D, vit B12, folate and ferritin? If not, it would be a good idea to ask for them to be done. :)

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Thank you for your response. Sorry I should have said, when we have increased t4 in the past even to 50mcg I would get shaky and have a rapid heartbeat, whilst seeing no improvement in fatigue, muscle pain, cold hands and feet, hair loss etc. I have had all those things tested and are normal. I take selenium and am gluten, soy and dairy free.

From what my doctor said and from what I have read it was the low ft3, ft4 and the ft3:rt3 ratio which is the problem. Apparently the ratio should be at the very minimum 20 in health....

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Forget the ratio! This makes me so mad! Ratios are for healthy people, not hypos. In fact, forget the rT3 altogether. Waste of money doing the test. As I said before, I really don't think that doctor fully understands hypo treatment. We see so many people on here that have consulted functional medicine doctors, and they just don't seem to know much about thyroid.

What was important was that you were under-medicated. And, if raising levo gave you problems, he probably should have investigated your adrenals before doing anything else. A 24 hour saliva cortisol test.

As for 'normal', there's no such thing. Who said they are normal? I think it would be a good idea to post the results for your nutrient testing on here, and let's see if they're optimal. Because they probably aren't! :)

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It is possible that you find dose increases difficult because the foundations are not in place - and they are B12 - Folate - Ferritin - VitD. Please post results with ranges 😊

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You were extremely under medicated on Levo

Almost certainly have terrible levels of vitamin D, folate, ferritin and B12

These must be tested and supplemented if too low in order to be able to tolerate Levo or T3

Typical post with low vitamins due to under medication and detailed advice on supplements

healthunlocked.com/thyroidu...

Private tests are available

thyroiduk.org.uk/tuk/testin...

Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have money off offers.

All thyroid tests should be done as early as possible in morning and fasting and don't take Levo in the 24 hours prior to test, delay and take straight after. This gives highest TSH, lowest FT4 and most consistent results

With Hashimoto's you almost certainly need to to be strictly gluten free

Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels

Low vitamin levels affect Thyroid hormone working

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

But don't be surprised that GP or endo never mention gut, gluten or low vitamins. Hashimoto's is very poorly understood

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

Ask GP for coeliac blood test first

thyroidpharmacist.com/artic...

thyroidpharmacist.com/artic...

amymyersmd.com/2017/02/3-im...

chriskresser.com/the-gluten...

scdlifestyle.com/2014/08/th...

drknews.com/changing-your-d...

thyroidpharmacist.com/artic...

Suggest you get vitamins tested urgently and try strictly gluten free diet

Vitamin C supplements help adrenals as does plenty of salt

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Thank you for your replies.

Vit D3 104.8 (50-150)

B12: Recent Genova ONE organic acids test, doesn't give values but I'm right at the top of green where it says 'need for supplementation'

Folate: Same as for B12

Serum iron 17.9 (11-29)

I have been on a high quality multi for a while now with active b-vits, strict gluten free for 2 years (was negative for celiac prior to this), strict dairy/soy free for a year. Follow a paleo diet so lots of fruit and veg. I know I have low stomach acid, so we have been supplementing with betaine HCl and digestive enzymes.

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