can someone help me understand my analysis? (and how to adjust my levo doses?)

[hendb]

Hello there!

I hope someone will have the time to help me, because im quite lost. I'll try to make it the shortest possible.

the 5th of december 2017, I was taking levothyrox 50 for 6 weeks (or more) and here were my results

TSH : 0,52 (lab range 0,18 - 4)

Free T3 : 4,2 ( laboratory range 4 - 8,3)

Free T4 : 14,5 ( lab range 8- 24)

ferritine : 51 (lab range 13-150)

vit D : 46

I then added levothryrox to 75

and here are my results after 8 weeks (3thd of february 2018)

TSH : 0,89 (lab range 0,18 - 4)

Free T3 : 4 ( laboratory range 4- 8,3)

Free T4 : 14,2 ( lab range 8- 24)

ferritine : 25 (lab range 13-150)

vit d : 71 (lab range 30- 70)

ac anti tpo : 10 ( inf < 50)

My feelings :

my energy levels are way better. Im not feeling cold anymore. my mood are better.

In the meantime I also notice that my metabolism is very low. I struggle to loose pounds. I do a lot of water retention. Im gaining weight for no reason.

What should I do?

Try to add t3? add t4?

ps : Last time i tried to add t3 (liothironine) i had a HUGHE Headache starting day 3. so i stoped it.

[shaws Administrator]

I am sorry you aren't feeling well. It has taken years, I believe, before we are finally diagnosed as being hypothyroid so it takes time to gradually feel better. That's when we reach an optimal dose which makes us feel well.

Unfortunately we are taking tablets which don't react like a paracetamol for a headache and have to gradually increase doses.

Unfortunately, doctors are fixated with the TSH alone and when it reaches a number they feel happy with they don't increase the dose.

Are you self-medicating?

I doubt your doctor would increase your dose of levo due to the TSH but your T3 is very low so dose of levo isn't yet optimum. What amount of T3 did you add to T4 which made you feel awful. Maybe adding more levo would help. I think it took me about 4 or 5 years to, finally, get to a dose/hormones that made me well.

Your ferritin is low but have you had B12 tested?

[hendb in reply to shaws]

thank you SO much @shaws for answering me. Your words are full of compassion and they are warmhearting to me (im french so apoligize for my wordings).

I am self medicating indeed.

what worries me the most is that at the very begining (back in 2013) i was just slightly hypo. My TSH was around 3 and I was trying to conceive. My endo told me everything was fine but I had to explain to him that a TSH has to be around 1 (or under) when TTC. so I begged him to prescribe me levo. he prescribed me levo 25 (he told me I was saying stupid things and told me "ok just so you are happy")

2 months after I was pregnant finally after several years of miscarriages etc.

That is how i started taking levo.

since that i've been taking it episodically. sometimes I stopped taking it. sometimes I felt so tired so I went back to it. but I never felt fine, energic etc...

Now when I see my results with levo 75 (wich is a hughe dose) im worryied.

Regarding t3, i just added 6,25...and after 3 days i started having impressive headaches.

I also tryed one grain of NDT nature thryoid, and after 3 days i started having nausea and diarhea.

I don't know what i am supposed to do now. because as you said, i'll never find an endo who will understand all this

[shaws Administrator in reply to hendb]

If you are self-medicating don't worry. Your dose of 75mcg is small. Even though your TSH is low and some doctors would be worried and not increase your dose, the fact that the only Active Thyroid Hormone i.e. T3 is so very low that your body cannot function normally. This could be due to the fact that you aren't taking thyroid hormones daily. We know we are on an optimum dose when we feel well with no clinical symptoms. We cannot do this quickly but very gradually.

Levothyroxine is T4 alone. It has to convert to T3, so your dose of T4 is not high enough to increase your T3.

Once we are diagnosed as hypothyroid, we must take thyroid hormones for life. Thyroid hormones drive everything in our body (i.e. metabolism) and we have millions of T3 receptor cells. I shall give you a link with clinical symptoms and if we are on an optimum dose symptoms should resolve.

thyroiduk.org.uk/tuk/about_...

You must get a blood test for thyroid antibodies if you haven't had them tested. The commonest form of hypothyroidism is that antibodies are present in the body.

In the UK once we are diagnosed as hypothyroid, we do not pay for any more medications as it is classed as a 'very serious condition' if untreated.

I suggest you begin your routine again and levothyroxine has to be taken first thing with one full glass of water on getting up and waiting one hour before eating. Food interferes with the uptake of thyroid hormones.

Some prefer a bedtime dose, in that case you'd last have eaten about 2.5 to 3 hours previously so stomach is empty.

When you have blood tests, these have to be at the very earliest, fasting (you can drink water) and allow a gap of 24 hours between last dose and test and take afterwards.

We must have thyroid hormones at optimum as heart and brain need the most T3.

If we feel that a thyroid hormone is causing more problems, it could be the fillers/binders in it that we are sensitive to. So we take one anti-histamine tablet before taking Thyroid Hormones and if we don't have a reaction, we have to change the make of levothyroxine or liothyronine (T3).

[hendb]

Thanks a lot shaws, you are very kind.

I do take Levothyrox every morning on an empty stomach. I started taking levo back in september 2017. (after a break of few months).

My condition didnt really improve yet. even though i am much less fatigued.

I do not understand why my t4 levels do not get higher? despite the increase in levo (from 50 to 75)

t3 are still very low, unchanged actually.

I hesitate between : increasing levo to 75 + 12,5 = 87,5

or adding t4/T3,

I have dithyron (wich contains 50 T4 and 12,5 T3).

> that would equal 50 T4 + (12,5x3) T3 : 87,5

Is it right?

Would'nt the 12,5 t3 added be too much?

ps : My antibodies are : anti tpo : 10 ( inf < 50). I heard they had to be close to 0.

What is your opinionon mine?

[shaws Administrator in reply to hendb]

I am not medically qualified but 25mcg of T3 is equal - in its effect to 100mcg of levo.

I would add 1/4 tablet of T3 to your T4. Take notice if your symptoms are improving or not and in a couple of weeks you can then add another 1/4 tablet of T3. How 'we feel' is a good indicater of our dose of thyroid hormones.

Research has shown that a 3:1 (T4/T3) combination suits many people. If your pulse/temp goes a bit higher, reduce slightly next day your dose.

Your antibodies are below 50 so you don't have hashimoto's (i.e. Autoimmune Thyroid Disease).

[Clutter in reply to hendb]

Hendb,

Your FT3 is bottom of range so 12.5mcg T3 in Dithyron won't be too much. I would try it.

Ferritin is low in range. It is optimal halfway through range. You can raise ferritin by supplementing iron with 1,000mg vitamin C to aid absorption and minimise constipation. Take iron 4 hours away from thyroid medication.

Thyroid peroxidase antibodies are negative for autoimmune thyroiditis (Hashimoto's) because they are <50. Most people have some thyroid antibodies.

[hendb in reply to Clutter]

ok thanks for the advice, i thought T3 should be added very gradually.

according to you i could switch from levo 75 to Dithyron (wich equal to approximately 100 t4)

If i do so how long will it take me to see positive effects? (as t3 has quicker action than t4)

[Clutter in reply to hendb]

Hendb,

You can reduce Levothyroxine to 37.5mcg and halve the Dithyron tablet to see how you tolerate the 6.25mcg T3 before increasing to full tablet if you want to.

Dithyron has 50mcg T4 and 12.5mcg T3 which is equivalent to 87.5mcg T4.

Some people feel improvement within days of adding T3, for others it takes longer. I felt improvement in brain fog, mental clarity and mood within a weeks but it was months before I felt improvement in physical symptoms.

[hendb]

from what I know 1mcg T3 = 3,5 mcg T4

so if I add 6,25 mcg T3,it would equal 21,8 T4

You think i should add it to my actual 75 levo? (it would suit the 3:1 ratio)

PS : In the US some doctors (like cristianson) says that if one has nodules, he has hashimoto. I have nodules. They also say that optimal antibodies should be around zero :/