Son still not great, help with blood results again please.

[tired22]

Hello again,

Looking for some help with blood results again, please.

My son (27yrs) managed his half marathon on 1st October then had a good October and November. But December and January have been diabolical. He is exhausted all the time, is managing to work (hard physical job) but spends the rest of the time in bed, sleeping or just vegging, no exercise since mid December, has sugar cravings, all this then affects his mood.

He is taking Levothyroxine 100mcg and Liothyronine(T3) 20mcg (10mcg twice daily)

11/1/18 TSH 0.42 (0.27-4.2)

Free Thyroxine 14 (12-22)

Free T3 5.64 (3.1-6.8)

30/1/18 Vitamin D 81.1nmol/l (=32.4ng/ml) - has been taking 5000 units daily for 3 months, until end December then alternate days.

Also taking vitamin K2 100mcg, Magnesium Malate 116.7mg, Super B complex (igennus -vit B+C) 1 tablet- all once daily separate from all thyroid meds.

Just got the Viamin D results today so he will be taking 5000units daily again or should it be more? He is a big lad 6 ft 3 and 75-80kg.

He has a GP appointment on Friday 9th. I think he needs more medication but which one. Any advice you can offer would be great.

[Clutter]

Tired22,

TSH is low-normal, FT4 is low in range which is to be expected as your son is taking 20mcg T3, and FT3 is in the upper range. There is a little scope to increase dose. Increasing Levothyroxine will raise FT4 and FT3. Increasing Liothyronine will increase FT3 only.

Read Treatment Options in thyroiduk.org.uk/tuk/about_...

VitD is replete >75 and 100-150 is optimal so it won't hurt to continue 5,000iu daily for a month and then reduce to 5,000iu alternate days and retest late April/May. VitD should be taken 4 hours away from T4 and T3.

[tired22 in reply to Clutter]

Thanks Clutter.

What about the other supplements, are they good doses? I've been reading about Magnesium and wonder if its enough?

[Clutter in reply to tired22]

Tired22,

I think you can take up to 375mg magnesium daily. Make sure your son takes it 4-6 hours away from Levothyroxine. I think 100mcg K2 is enough.

[tired22 in reply to Clutter]

Thanks

[SeasideSusie Remembering]

Sugar cravings can be adrenals. Might be worth getting a saliva adrenal stress test with Regenerus or Genova, it tests both cortisol and DHEA (both needed for proper interpretation).

Regenerus thyroiduk.org/tuk/testing/r... (results direct to you)

Genova thyroiduk.org/tuk/testing/g... (results go to ThyroidUK who send on to you)

Interpreting results drmyhill.co.uk/wiki/Adrenal...

I also take Levo plus self sourced T3. I find that I need my FT4 to be over half way through range, I don't do well with it low in range. It's all about tweaking to find the doses that suit us best. Might no be so easy when under an endo though.

[tired22 in reply to SeasideSusie]

Thanks Seaside Susie, will consider the adrenal test, have been wondering about it. Hope the GP (a new one, the other one who was really helpful has moved on unfortunately) will increase the Levo on Friday. As clutter suggested he will increase Vit D again, i dont understand why after 2/3 mths of 5000units it hasnt come up any more, and we had a sunny week in Cyprus in October which should have helped. Have you any thoughts on that please?

[SeasideSusie Remembering in reply to tired22]

Winter sun here in the UK isn't strong enough for us to make Vit D ourselves, it doesn't contain enough UVB radiation from October through to end March so we will be drawing on our stored Vit D during these months and if we normally supplement then we often need to increase the dose during the winter. So reducing dose in December wasn't a good idea. Best times to test would be November and then again in April and adjust dose if necessary.

Similarly winter sun in Cyprus isn't strong enough either - from vitdco.com/pages/sunsense

"Southern Spain or Portugal, Malta, Cyprus and Crete are the most southerly destinations in Europe. They provide a very pleasant climate in winter but for two or three months the sun has too little strength to provide much if any vitamin D. In October and possibly the first week or two of November and in the last week or so of February and in March the sun will be beneficial in these southern parts of Europe, but only in the middle of the day. However it is generally warm in winter in these southern locations and so you can wear shorts and a short-sleeved shirt or an off the shoulder dress and enjoy the weak winter sun for an hour or so midday."

As you went in October it may have been good enough but getting close to the time when the sun is weaker, maybe just not good enough to top up your son's store.

I need to take 2000iu in the summer months to maintain my optimal level and I have doubled it for the winter months.

Maybe your son isn't taking enough magnesium. Magnesium helps D3 to work. Normal dose of supplements tend to be 350-400mg. Is your son using Biocare Magnesium Malate? If so each capsule contains 116.7mg of magnesium and it says to take 3 capsules daily.

[tired22 in reply to SeasideSusie]

Thanks Seaside Susie. I just followed the advice 5000 for 8 wks and then lower it, but i should have thought about the time of year. It is all so difficult and my son doesn't engage much, just depends on my advice. You're right about the Magnesium, also my fault and its the one he takes least consistently. He takes all other supplements at tea time and the magnesium at bedtime,(but he forgets) so better take them all at tea time i think.

Thanks so much for your help.

[marsaday]

The winter is a hard time for all humans because sunlight is decreased and so cortisol production drops.

He maybe needs to not stress the body too much with exercise, but if he enjoys it i suppose it is hard to cut back.

He probably needs more T4. It would be nice to see his Ft4 around 17-20.

Try taking the T4 at bedtime and see if this improves cortisol production. It is much more natural to take T4 at bedtime and T3 in the daytime.

He also needs to carry out his own experiments with the T3 to see if it is actually needed in these amounts. This means dropping some T3 on a day and see how he reacts.

I would also look at taking the T3 in 5mcg amounts 4 x per day if he is going to stick on the 20 T3.

Because he is male it is likely he will do better on more T4 and less T3 because he converts well. His Ft3 is good, but is it high because he is supplementing or does he have good T3 levels before T3 usage?

Again he needs to experiment to see if a specific T4 amount with some T3 is better for him.

I am also 80kg's and very active. I take 125 T4 and a little T3. I generally use 3mcg T3 but sometimes 6.25mcg. I find too much T3 makes makes things not work as well. Is this because my body has a good level of T3 and so only needs a top up ? Or does the higher T3 use up cortisol too quickly and so leave me in deficit and so feel tired ? I don't know the answers exactly but these are possible reasons why too much T3 works against my system.

Many people jump onto T3 mixed with T4 in a far too high a dose. The docs will prescribe it in x amount, but they really have no idea what they are doing. Dr Blanchard has a great book out and it approaches thyroid management from a different angle.

He feels big doses of T3 are 1mcg amounts and if he could he would have the manufacturers make it in 0.1mcg amounts. He also says a ratio of approx 98:2 T4:T3 works best. So this means for every 100 T4 amount you would consume only 2mcg T3.

So your son needs to see what a 1/8th size tablet is like = 2.5mcg. Plus he also wants to try 125 T4 as well.

We are all different, but finding the right T4/T3 mix is a big part of the puzzle. I have found my mix and it took time, but you can do it. I also find dose timing to be equally important and if i don't bedtime dose my T4 i feel much worse the next day.

[tired22 in reply to marsaday]

hi Marsaday, thanks for your reply. What a lot to take in. But pleased to hear you are taking these amounts and managing to exercise, it gives us hope. I will show all this to my son and try to get him to take more ownership of the problem. What is the name of Dr. Blanchard's book?

[marsaday in reply to tired22]

amazon.co.uk/dp/B009BVWOVM/...

This is the link to the book on amazon.

[tired22 in reply to marsaday]

Thanks. Just some clarification after reading your profile. My son and I think he should probably change to taking his thyroid meds at bedtime, if he does would that be best to be T3 and T4? and when would you suggest for his second dose of T3?

[marsaday in reply to tired22]

T4 at bed. T3 in the morning or daytime.

It is important to understand he must make timing changes himself that is the only way to find out what suits his body.

So he could also try some t3 at bedtime for example. Don’t just follow what I or others say. Work things through yourselves and that way you have a better chance of getting balanced.

You need to look for small signs of improvement over time plus negative effects are also helpful to you as they provide evidence the body is not happy.

[Greybeard]

Hi, I do wonder if your son is just working harder than his thyroid hormone level can support,

My thinking is this, we know that hard physical exercise depleats t3 rapidly. We know what his t3 level is good when he has his blood tests but we have no way of knowing what his level is at the end of a day of hard physical work. It could be and probably is a lot lower, perhaps towards the bottom or below range.

We know that a healthy system is good at keeping t3 at an appropriate level but your son by definition doesn't have a healthy system.

Does your son improve on his rest days, presuming he is resting and not exerting him self in other ways?

I know this is all supposition but I think it needs discussing with him.

[tired22 in reply to Greybeard]

Thanks Greybeard63. I see what you mean and it is unfortunate he has a physical job and wants to run, but its where we are and we're trying to help him do it all if possible. The problem is we have never in 2/3 years got it balanced, we have come close but... He usually improves after a few rest days, if he has been really exhausted. But this last spell has been 2 months. How quickly would the T3 deplete?

[Greybeard in reply to tired22]

I'm really not sure how quickly t3 is depleated just that it does. Some people believe that dosing three times a day instead of twice helps keep hormone levels more stable. I'm not saying take more hormone but split it into three doses instead of two, this of course makes taking it on an empty stomach more problematic.

We are trying to replace a health hormone control mechanism that makes adjustments on a continuous basis by popping pills a couple of times a day. It's never going to be perfect to my mind, at different times of the day you are either over or under medicated. All we can do is find the best balance for us, running may be the compromise your son makes