Your thoughts please!
TSH 0.36 (0.4-4.5)
T4 10.4 (8-21)
T3 3.9 (2.5-6.5)
Under range for vit d and folic acid
Recent bloods: Your thoughts please! TSH 0.36 (... - Thyroid UK
Recent bloods
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Joanneconnor
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Hi! Can you tell us more about your story? Diagnosis? Medication? Dose and how long? Symptoms? And any other information would be great!
Previous posts may help ... 😊
Including the details is likely much more effective if someone is looking for answers. 
Many people read this site on an app on their smart phone. Unfortunately lots of posts where responders have to ask for labs and details.
So are you saying you cannot click onto to the OP and read previous posts when using an App ?
I'm saying that when asking for advice, it's the standard and common practice to include qualifying details when posting so that readers have complete information. You've probably seen many posts where someone says, "post your labs and details or we can't help you". Expecting readers to dig for the details isn't efficient and isn't the norm. It's not expected that people have time for that.
Some people are on apps, on their phones with their tiny little screens. If you've ever been on an smart phone, you've probably experienced trying to navigate a the tiny screen, trying to read on a tiny screen, trying to hit tiny forward and backward buttons, a mini keyboard, overly sensitive auto correct spell check, etc. Plus you need to be on a network for the fastest internet and also so you don't eat up your data plan allowance if not connected to a network. You probably know what I mean?
Having been on the Forum for almost 7 years I am more than happy to look through previous posts - especially when you know someone is unwell Nothing is the 'norm' when you are struggling. We do sometimes ask members to complete their Bios to make responding easier. Have you completed yours ?
I do use a Smart Phone 
ShootingStars
Same here Marz though I don't always remember to look and I'm on my iPhone but I always check when something obvious is missing. Sometimes as well past questions can help a lot
😊😊
Just wanted an opinion really are they too low, background is hashi's for 14 years 2 pregnancys 1 bad one good, big digestive problems which I now eat auto immune paleo diet, keeps swelling at bay, have had high cortisol, fixed that now normal, have some oedema, results on thyroid s but recently changed to Thiroyd 4 weeks ago
Hi Joanneconnor. Thank you for some details. What was the date of that above lab range? You've only been on Thiroyd for 4 weeks, and you'll be running bloods again in two more weeks at the standard 6 weeks point?
This is a very interesting case. Your TSH is nicely optimal, but your T3 and T4 are not even close. If these are Free tests, your levels are quite low. You don't have any other potentially hypo symptoms aside from oedema? First, what kind of T3 and T4 tests these? Are they Total or Free? I'm hoping they are Free, which are the right tests and give the right information about your levels.
Based on your above labs and your lack of hypo symptoms, I'd be reluctant to want to increase your dose by much, if any at all. I explain why below. Your TSH is already slightly below range in the above lab result, but your actual thyroid hormones are not anywhere near what is classically in the "optimal" part of the range. If this lab result is FT4 and not Total T4, then your FT4 is too low at 10.4. Optimal range is over half of the lab range, and would be above 14.5 but not over 3/4. Optimal is between 14.5 and 17.75. If the next lab result is FT3, yours is too low, too, at 3.9. Optimal FT3 is close to, but not above 3/4 range. Half range is 4.5 and 3/4 range is 5.5. The "optimal" target number is 5.5. That all being said, optimal range varies per person. If you don't have any other hypo symptoms aside from some oedema, then the above ranges might ok for you. If you have other hypo symptoms, they weren't mentioned. Oedema can be from thyroid antibodies or from being hypo, or both, or something completely independent.
It would probably take a lot of T4 to get you to optimal and it might be a bad ride getting there and might not be where you want to live. The potential problem with adding additional T4 and/or T3 to try to increase your FT3 and FT4 levels up towards optimal is that doing will likely give you much too suppressed TSH. Even just adding 12.5 mcg T4 count suppress your already borderline low TSH.
The big question is: why are you not absorbing T4 and then in turn not able to create enough T3? Also, since you are already 4 weeks out on your new medication, why not wait two more weeks to get labs and see what your bloods are, and go from there?
Results suggest you could increase your dose.
Totally agree! The TSH is irrelevant when you are on thyroid hormone replacement. Doesn't matter how low it goes, as long as it doesn't go high. The TSH is not a reliable test, and having a low TSH doesn't mean you've over-medicated. You need an increase in dose.
I was low for years and I was fine but my T3 kept creeping up hense it went over range, but it doesn't matter in symptoms so much for me I haven't got a clue how to get to optimal and should I feel different, I just want to try get rid of some oedema 😕
Yes, the oedema is a tricky one. Are your other nutrients optimal? You say you have low vit D and folate. Are you supplementing them? NDT is not easy to optimise if your nutrients are deficient.
I think you might want to look to your gut. Are you gluten-free?
Have you tried termeric for the oedema?
Yes supplementing now, yes I am in auto immune paleo diet although I haven't been too strict as kids been off school, I try to eat gluten free mostly, I found my triggers are yeast, cows milk, tap water so I avoid them
Yes I eat turmeric too
Gluten-free won't help unless it's absolutely 100%. Of course, it may not work at all, it doesn't work for everyone. But, it's worth giving a fair trial.
I tried it for a few months, and ate gluten free products and I started to swell even more I just looked puffy, I don't think it worked for me 😕
Well, I'm not surprised gluten-free products didn't work for you! That's not the aim of the game. Gluten-free products often contain other things that are pretty awful, to replace the gluten. They are processed foods, and hypos are advised to avoid processed foods and cook everything from scratch. Processed foods contain soy, and artificial sweeteners, and loads of E numbers. They're really best avoided.
Yes I did find that out I try eat AIP now when I can
I agree with Marz. Once you are established on ndt (thiroid) your tsh and ft4 are likely to be low or even below range. How you feel and ft3 are more important, most people feel better when their ft3 gets above 5.0. Personally I would be wary of letting it go above the top of its range, so you have a way to go yet.
Are you aware when on NDT or any form of T3 then results are read differently. Your TSH should be suppressed , FT4 can fall but FT3 should be high in the range. First think my Endo explained to me when I restarted NDT. the first time around I was just told satisfactorily! So your FT3 should be much higher and is the only accurate reading which is why you can't not tell if your have a conversion problem as the FT4 falls so nothing to compare. However you have mentioned Vit D and Folic Acid are very low so this is where your problem lies.
Your thyroid works better if Vit D, B12, folate and ferritin are optimal, not just in range so you need to be looking at the Fab Four and supplementing. (See SeasideSusie's posts for saying what values need to be and advice on how to do it. Given time to get these optimal your conversion rate will inprove and some of your thyroid symptoms will be helped as well so a win win solution. Took me about five months but very well worth the effort. Once supplementing though you have to continue but you may be able to find a maintenance dose to keep your levels up there.
I've just read through all your previous posts and they are all saying the same things, dose too low and suggestions on what to do ytobcorrect them. I'm suspecting you haven't changed anything orcif so not by enough. Have you any recent results of any testing you have had done and what you have done to try and address the problem as it doesn't seem to be working.
Have a look at the Thyroid Uk site as well as they have loads of good info and it may be through not fault of your own that you are doing something that hinders absorption. Doctors haven't a clue how important vitamins etc are orcthat food and other medications taken at the wrong time can be counter productive so have a good read through and ask questions if you don't understand
These tested dated January, my doc doesn't test every 6 weeks I have to ask for them about every 3 months!! All free ts yes.. last year my tsh was suppressed T4 was 14 and T3 was 6.8 I was taking 3 thyroid s. He told me to take 2 thyroid s and 1/2levo every other dayto bring down T3, about 6 months later my Tsh went up to15 so he told me to take another 1/2 Levo and this is the results. I don't get a lot of symptoms I'm lucky I just need to get optimal to see if I can get rid of the odema as its really painful, it doesn't change on a daily basis it's always there ☹️
Hello Joanne, have you had a full blood count test recently? I wonder if you have, and if it shows your albumin result. Lab tests on line show the importance of albumin.
Before I was offered a trial of Levo by my Gp, I too suffered mightily from oedema. The endo I saw at that time said I should double the diuretics I was taking. They didn't make any difference to the oedema, and I didn't double the dosage. But I did check my full blood test results, saw that my albumin level was borderline very low., and increased the protein in my diet. I found this helped to shift some of the awful oedema, and I recognised my need to ensure I ate sufficient protein.
The trial of Levo began the process of resolving other symptoms, and continued helping the oedema.
I offer this as a suggestion that may be worth looking into.
I was diagnosed and for the first year no problem then I got pregnant and I woke up and my legs were someone else's (bottom half)it happened instantly and hasn't changed at all since then over the years gradually the thigh area began to enlarge its non pitting oedema my albumin levels are 41 g/l (35-50) I eat a fair amount of protein but I pile the salt on every meal
your doctor should re test 6/8 weeks after a dosage change to see how you are doing on the new dose, you can ask for it doing, see what your doctor says
Ahhhhhhhhhh cherchez le medicine! He should not have done that. He gave you bad advice. Reducing your Thyroid S by 1/4 grain would probably have been sufficient. You did not need that extra levo. And you did not need that huge decrease in Thyroid S. And, decreasing by such a large amount in one go probably had a negative effect on your body.
Do you need to go by what your doctor says? Because if you're a free agent, if I were you, I would slowly work my way back up to 2.5 grains, and drop the extra levo, and see how you go from there. That would be what I would do, anyway.
No I don't always do what they say, but not having many symptoms to go by I wanted to be optimal, I am on Thiroyd now so I will see what comes back I take 3 grains one day and 2 the following day, I'm not cold anymore and my skin looks healthier, I go back in a few weeks for more bloods and the full MOT on the genome project research so hopefully they might advise me then if I'm taking too much, it does seem more potent though 😀
You can't do that. NDT has to be taken the same amount every day, or you will mess up your metabolism. Why can't your take 2.5 grains a day?
Because they're 60g tablets
60 mg is 1 grain. Just cut one tablet in half and take one whole one and one half one.
Ok
I would have ignored adding any T4 as in theory that should increase FT3 which was already too high. I would have dropped NDT by a quarter then wait for it to settle and see how that pans out. I missed my sweet spot as literature told me to increase by half grains up to 2 then increase in quarters which I did but got up to 3 grains and differ frel I was getting anywhere. I had an imminent Endo appointment so I left it to him. He told me to drop down to 1.75 which I thought was huge but he was right and I had missed my sweet spot because I was going up in too large a jump. I'm still on 1.75 and doing well but I realised being over medicated is very much like being under as symptoms over lap. Now if unsure I always drop down first to make sure I haven't done it again as out of the two being under is easier to live with.
Not getting anywhere with my endo or doctor to try and get to optimal
What do you suggest I do?
Ok I think you have 2 problems. I think you have a conversion problem and also not on the right dose. Also I'm guessing that the top of the range for FT3 is 6.8 which is what you were at when on 3 grains. Having said that the top of my FT3 range is either 5.7 or 5.9, not sure offhand but very different to what I'm thinking yours will be.
Vit D is low as is folate and chances are B12 and ferritin are low as well. These four help your thyroid to work better and being low also suggests you are t converting well. Normally you would compare FT4 with FT3 and FT4 would be high and FT3 low but you can't use that as on NDT and as I've already said only the FT3 is accurate so have a search of Seaside Susie's posts. She had excellent advice at to what levels should be and how to get them there. So as you increase your levels then conversion will slowly be getting better thought it takes months not weeks so I would go Back to 2.5 grains and forget the extra Levo, that was never a good idea and see if you can hold that steady till your next blood test. Get yourself a good pill cutter, I was told to get Pill Mate off Amazon which isn't always perfect but better than others I've tried going back to 2.5 means the first time you have three chances at splitting it so if one isn't down the middle then call the 2 bits one grain, which it was and try again. So when got 2 grain and another one with a good split then take on an empty stomach and don't eat for an hour though you can drink more water. May sure other meds are 2 hours away and thinks like iron, the Pill Vit D are 4 hours away. You will soon work out how to plan your day. Earlier I said you may have been better to reduce your NDT BY quarter of a grain we'll try on the lower dose but if your levels aren't rising quickly then you may have to add in another quarter to feel better but keep an eye out as you may end up over medicated as Vits etc continue to improve. List your symptoms so you have something concrete to watch changes as you work towards wellness. But keep an eye on thingsasthere is a huge gap between the 3 grains you were one and the 2.5 I have suggested but I just want to make sure that you are slightly under medicated than the other way around. Keep posting and updating your progress as probably will need some tweaking along the way. Good luck!
As I'm an identical twin and my sis has developed diabetes type 1.5 we have been asked by our Endo to take part in genome and DNA research to see why one develops one ailment and one develops another, so should be tested more often now
Thank sounds interesting! Good luck with that as well!
Should I be taking B12 supplement, is there different types my B12 was 375nmol (181-910)
You need sublingual methylcobalamin (B12), 1000 mcg nuggets. And, you need to take a B complex with it.
Hi Joanneconnor,
I don't know if you have read any of my previous posts but I do feel for you.
Judging by your last results, I believe your medication needs to be increased and that your are likely to have B12 deficiency too. If you have heavy periods, or had them prior to pregnancy, you may be anaemic as well. Anaemia actually makes you bleed more and can cause the aching and fatique. So you might need a iron supplement. Being under medicated causes the oedema, sometimes severely especially in the left leg (well it did in my case but I have it in both legs). Also if there are thyroid conditions in the family, then diabetes can also be around, either with yourself and or other members of your family. You say your twin sister has it?
My story is that I was born with a partial non working gland, so been on medication all my life. It is includes B12 deficiency, pernicious anaemia, vitamin D deficiency, border line diabetes and oedema (this came later in life, around my late 30's), fortunately not as severe as it was, but find it so difficult to find shoes and damage to my legs is permanent.
I didn't suffer with oedema, until they started messing me around with my medication, but then my haemoglobin levels started showing signs of borderline type 2 diabetes. I am now on my natural dose of T4 (200 mcg) plus T3(20 mcg) now but my recent tests show that I am slightly under medicated on my T4. I also have B12 jabs every three months.
My late sister had underactive thyroid condition as well but hers developed in her late 20's. She also had Down Syndrome. In our family, we have recently found out besides me, that we have vitamin B12 deficiency too and anaemia. Also several sets of twins. Just to give you peace of mind, my sister passing, was unrelated to the thyroid condition or Down Syndrome, but it was something else.
I think you need to be retested sooner rather than later as I would be concerned about the oedema getting worse. I take a diuretic and in the past, my GP has recommended I double the dose, but the second dose does not work. The salt you consume will make it worse though and sodium too, as it makes us retain fluid. Drinking water or low calorie squash will flush out the system. It is just a pain to take the medication as you need to be near the loo for several hours a day, 
I would suggest you get tested sooner rather than later and let us know how you get on. Just make sure you speak to the Dr about your results rather than getting them from the script a receptionist would read out.
Keep in touch and let us know how you get on. Take care
Just to add to the good advice youve been given, you say your vit D is under range which causes a whole range of symptoms like fatigue, aches & pains. This should have triggered your GP to instigate a loading course of vitamin D3. Has that happened? Very low vitamin D not only makes you feel very poorly but also messes with your ability to absorb calcium. Its important to correct or your bones will weaken.
When taking ndt it usually ends up with a supressed TSH. What is most important is that your thyroid hormones are in range, in the top third & are not over the top of the range. Where they are in the top third of the range is individual. People vary as to where in that range they feel most well. This is why any dose alterations need to be gradual, methodical, not made more often then 6-8 weeks and take note of how you are feeling. When I was finding my optimal dose I kept a little daily diary of what I was taking, including supplements, my temperature & pulse rate first thing in the morning, signs & symptoms. I slotted my periodic blood tests into this. It was useful as it helped me to look back & see how Id responded to the variations in changed doses. Unfortunately the treatment of hypothyroidism is not an exact science so this methodical record approach & gradual changes of thyroid meds are the only way to find out what is optimal for you! As others have said getting other nutrients such as B12 iron etc optimised is also vital. Seaside Suzies posts are most Informative.
As I said at the beginning we are all different& people do vary to what feels right for them. I found for me on a ndt my TSH is supressed (usually 0,02) and my ft4 & ft3 are normally near the top of the range to feel well. My temperature has never returned to within normal ranges, remaining stubbornily a little below but that seems to be me! I found the type of ndt makes a difference so certain ndts do not suit me or work as well. Am not sure why but suspect am affected by certain fillers in the tablets.
I used to see Dr Skinner before his sad passing. His wise words were that doctoring is as much an art as a science.
Nothing is more true than when trying to optimally treat hypothyroidism.
Hope you start to feel much better soon. Keep posting you will get there in the end!
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