new here: advice on adding T3 for my Mom

[pjed]

Mom is 89, she had a mild heart attack 6mnths ago. She was hyperthyroid in her 30s and had radioactive iodine treatment. Over last few years she was diagnosed as hypothyroid, despite seeing different endo consultants via NHS they ignore her symptoms which have got so bad, she is on levothyroxine 50micrograms, her last results in

Jan 2018:

TSH 2.52 (0.1-5.0) mU/L

FT4 17(8 - 19)pmol/L

FT3 3.8(2.1 - 6.0)pmol/L

---------------------------

Aug. 2017:

TSH 2.68 (0.1-5.0)

FT4 20 (8-19) (no FT3)

-----------------------------

May2016 :

TSH 2.84 (0.350 - 4.94)mU/L

FT4 16 (9-19)pmol/L

FT3 3(2.6-5.7)pmol/L

Mom has a multi vitamin and we got her onto B12 injections when the first endo refused to help and said it must be something else, so asked GP for B12 which she has.

My question: I realise age is a large factor - is it ok to add a very small amount of T3 to the T4 50micro. or reduce the T4 a little and then add a little T3.Mom is suffering and we need to do something?

I am slow at typing and replying so apologies if I do not respond right away, and thank you to any of you who can suggest if I am understanding what is best to do.

[SlowDragon Administrator]

Better to test her vitamin D, folate and ferritin

As she has B12 injections her folate and ferritin may also be low.

Vitamin D likely low too

Improving these might improve her symptoms

Multivitamins are not usually recommended on here. Especially as most have iodine in and that's not a good idea for most hypothyroid patients

[pjed in reply to SlowDragon]

Thanks for the reply.

Mom takes extra vit D . I will see if she has had recent tests for folate and ferritin.

Why is the iodine not good?

[SlowDragon Administrator in reply to pjed]

As she had RAI presumably she had Graves' disease.

TPO and TG Antibodies may still be present. Some patients find gluten free diet helps, even after RAI

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

chriskresser.com/the-gluten...

Best to retest vitamin D at least once, ideally twice year when supplementing

Iodine best avoided unless specifically been tested and found deficient

drknews.com/iodine-and-hash...

thyroidpharmacist.com/artic...

[pjed in reply to SlowDragon]

Thank you for this, I will read up as soon as possible.

Last records I can see go back to Aug. 2016 for ferritin 106.0 (22 - 2750ng/ml, folate 16.5 (3.1-20.5)ng/ml and vit. D May 2016 - 102.6 so I will speak to the nurse when we next go for the B12 and see about being tested.

My feeling is Mom is not converting to FT3 so will see how the vit. levels are when done.

Very much appreciate your time.

[Aurealis]

Sorry to hear about your Mom’s heart attack. I’m not a doctor, but I think T3 is only used very carefully for people with heart conditions and especially the elderly. Trial and error may not be wise.

Her blood tests seem stable Think you will need to be more specific about her symptoms for anyone to be able to comment

Perhaps you could get a referral to a more sympathetic and experienced endo?

[pjed in reply to Aurealis]

Mom's been discharged from the system after the mild heart attack, the consultant said she didn't need to see him anymore as she was doing fine with only slight damage from the attack.

Generally she was very active and fit before slow progression of symptoms, walking Into town rather than on the bus etc

Muscles have progressively weakened, cold hands and feet, slow gravely voice, tinnitus, balance, very fatigued, can't sleep well, always slim but weight gain which hasn't changed since starting levo some years ago,hair loss,dry skin, the list is endless.

Tried referral twice,same result, just follow in range blood test results and ignore symptoms.

Thank you for your advice

[pjed]

Thank you for your time

[Aurealis]

Really sorry, I can’t be more helpful. That’s the difficulty with hypothyroidism, a lot of the symptoms are vague and the total of everything is needed to be sure. Most symptoms can be caused by other conditions. Tests results are not helpful. She could have other undiagnosed conditions or still be recovering from heart attack

I suppose you’d need a geriatrician with expertise in thyroid and I suspect they’re a very rare occurrence. But you might?

In my experience, introducing T3 is tricky at the best of times, and I don’t think you’d want to inflict that on your Mum without medical back up. What does she think?

I always think that increasing Levo is the first thing to try, but is your mum well enough for that? Have you considered trying one of the recommended private endos on the thyroid U.K. list?

As we get older everything works less efficiently and it’s so complicated when there’s more than one condition.

She’s very fortunate to have you looking out for her.

[pjed in reply to Aurealis]

Mom wants to feel well again and is prepared to try whatever may help so we will discuss all the pros and cons again and just check vit levels as well.

Her FT4 is toward the top end so I wonder if we upped Levo if it might have a reverse effect by making FT4 too high. Then would it produce a better FT3!!

Again really grateful for your thoughts, thank you very much