Can I optimize my hormone replacement? - Thyroid UK

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Can I optimize my hormone replacement?

Dalilafng
Dalilafng
12 Replies

Hi to all!

I've been taking T3 (tiromel) alone, 75mcg per day.

My recent labs results are as follow:

TSH 0,053 (0,550-4,780 mUI/L)

Free T3 2,9 (2,3-4,2 pg/mL)

Free T4 0,21 (0,70-1,58 ng/dL)

I wonder if I can optimize this by adding Levo...

Also afraid of this low TSH....

Can someone reasure me before I get back to my Endos apointment? He's not that keen on me taking Tiromel and only goes along because I tell him I feel much beter with that over Levo.

Thank you in advance for the reply!

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SeasideSusie
SeasideSusieAdministrator

Your TSH is that low because you're taking T3 only, that's what it does - lowers TSH.

But I would be more worried about your FT3 result. Considering you're taking 75mcg Tiromel, why is your FT3 only 2.9 (2.3-4.2). Something would appear to be hindering it's absorption.

What are your current nutrient levels:

Vit D

B12

Folate

Ferritin

And are you addressing tyour Hashi's and any gut/absorption problems it can cause? Gut problems will stop nutrients being absorbed, and absorption problems mean that thyroid hormone wont work.

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Dalilafng

I have absorption issues since I have a gastric bypass.... that will always be an issue for me.

My Ferritin is now "aceptable" since I made intravenous iron supplementation recently.

Haven't checked folate this time but checked Zinc.

Vit D 25,7 (30-80 ng/mL)

B12 519 (246-911 pg/mL)

Ferritin 15 (10-291 up/L)

Zinc 10,6 (10,7-22,9 umol/L)

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SeasideSusie
SeasideSusieAdministrator
in reply to Dalilafng

Well your Ferritin is a big problem, it's not acceptable for someone who is hypothyroid. For thyroid hormone to work (that's our own as well as replacement hormone) ferritin needs to be at least 70, preferably half way through range.

Your Vit D needs to b 40-60ng/ml.

How are absorption issues dealt with after a gastric bypass? I think I've read that you need to be on supplements, but does that aim for in range levels (whch seems to satisfy doctors) or can you get them to optimal levels which you need as a hypo patient.

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Dalilafng

Doctors aren't realy aware or prepared for this.... They just ask us to take a multivitamin complex every day but we all know that doesn't give anyone a enough dosage, even worse for someone how will never absorve it properly.

They don't even consider the possibility of helping on reaching the optimal levels. As long as you get to the minimum the rest....

I still take Iron suplement but a pill doesn't help much. From time to time I convince them to give it to me intravenous and that helps a bit.

Now I'm in a point that my thyroid doesn't work, my body doesn't convert and all they do is scare me about the low TSH and the heart conditions it may cause....

They don't even try to interpret the test they order!

Your advice should be on pushing more iron and vit D suplements than rising thyroid hormones intake, right?

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SeasideSusie
SeasideSusieAdministrator
in reply to Dalilafng

Your advice should be on pushing more iron and vit D suplements than rising thyroid hormones intake, right?

My suggestion is to aim for the following levels that we hypos seem to need for thyroid hormone to work properly

Vit D - 40-60ng/ml

B12 - top of range

Folate - at least half way through range

Ferritin - minimum 70

Most people can help raise ferritin by eating liver regularly, maximum 200g per week due to it's high Vit A content, and including lots of iron rich foods in your diet apjcn.nhri.org.tw/server/in... but I don't know how much will be absorbed from food in someone who has had a bypass so continual iron supplementation could well be the answer.

I think it's important that you find a doctor who actually knows how you are supposed to improve your levels to more than the bottom of range, in fact two of yours are below range.

What does your multivitamin contain? Does it contain iron? If so then that stops absorption of the other vitamins/minerals in it.

Do you take your iron supplement well away from your thyroid meds (at least 4 hours).

Do you take your multivitamin at least 2 hours away from thyroid meds? It may even need to be 4 hours depending on what it contains. It's probably a waste of time anyway and you may need to supplement individually with what you actually need at decent doses.

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Dalilafng

Thanks a lot! :D

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thyr01d

Hello Seaside Susie

Does your post mean that if we are taking T3 we still need to have ferritin levels mid-range or above? Mine is always at the bottom of the range but I thought this didn't matter now that I am on prescribed T3 because the body doesn't need to convert. I'd be very grateful if you'd let me know either way.

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SeasideSusie
SeasideSusieAdministrator
in reply to thyr01d

For any thyroid hormone to work properly, ferritin needs to be 70, recommended is half way through range.

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RedApple
RedAppleAdministrator

Dalilafng, How many hours did you leave between your last dose of T3 and that blood draw?

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Dalilafng
Dalilafng
in reply to RedApple

I take it every morning and didn't took it on the day I made the test... so, at least 24h. :)

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RedApple
RedAppleAdministrator
in reply to Dalilafng

That would go some way to explaining why FT3 is quite so low.

But you haven't mentioned anything about how you feel on this regime?

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SlowDragon
SlowDragonAdministrator
in reply to Dalilafng

Last T3 dose should be 12 hours prior to blood draw

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