T3 above range - does it matter?

[PiggySue]

I take a high dose of Tiromel - 150mg per day. Everything is fine except the blood test results with T3 being over range at 6.2 (2.6 - 5.7). (I reduced prior to the last blood test, and got 3.3). The thing is that when I reduce I get palpitations and exhaustion. Should I worry about the blood test results?

[greygoose]

Did you leave a gap of 12 hours between the last dose of T3 and the blood draw? Some people do need their FT3 over-range, in order to get enough T3 into the cells. Difficult to know if you are one of those people.

[PiggySue in reply to greygoose]

I left more than 12 hours....

[greygoose in reply to PiggySue]

OK, so it's actually higher than that. I think it might be a good idea to try and reduce a little, see what happens.

[PiggySue in reply to greygoose]

But when I try and reduce, the palpitations start again...

[greygoose in reply to PiggySue]

OK But, just out of curiosity, do you take your T3 the way you would levo - on an empty stomach, one hour before food, etc.?

[PiggySue in reply to greygoose]

I have done, and try to take the first dose an hour before food as I take iron with my breakfast. The other doses I am not careful with. Sometimes I take the last dose rather too close to my magnesium when I go to bed..But that is rare (and only if I have forgotten to take the final dose at 8pm, which would mean that I must be feeling good).

[greygoose in reply to PiggySue]

Well, that could be why you have to take such a large dose. Iron should be taken at least four hours away from thyroid hormone. And magnesium is best six hours away.

[PiggySue in reply to greygoose]

But taking T3 an hour before each of those is ok, just not after...I normally take T3 at 12pm, lunchtime, so that is usually four hours after the iron.

[greygoose in reply to PiggySue]

But what about the dose you take first thing? Is that 4 hours before the iron?

[jimh111 in reply to PiggySue]

You need to have the blood taken half way between doses to get a realistic fT3 figure. If you take your liothyronine more than once a day this result will be meaningless, your real fT3 will be much higher. It does seem very strange that your fT3 is only 6.2 on 150 mcg L-T3, either the gap between dose and blood draw is too long or you are not absorbing it (unlikely). It may be that you need these high doses but your fT3 is very low for someone on 150 mcg.

[PiggySue in reply to jimh111]

I take 50mg three times a day. Last dose is usually around 8pm and the blood tests have been around 9 - 9.30am.

[jimh111 in reply to PiggySue]

Oh. I thought 'more than 12 hours' was much longer. i guess a 'real' fT3 figure for your would be around 8.0 which is not that high. It is strange that your fT3 is quite low for someone on 150 mcg. Do you have any gut or kidney problems, or are taking any medications? Tiromel is reasonably good quality and so cheap nobody is going to bother trying to fake it. I suppose some people just eliminate excess T3 more quickly than others.

If you need these doses then so be it, just monitor your pulse and keep a look out for insonmia or a fine hand tremor.

[PiggySue in reply to jimh111]

Pulse is better than it ever was, blood pressure is normal, (was 160/98 when I was 16 yrs old, 170/110 when I was 26yrs old but now around 135/89 now I am 52 and on T3). I am seeing an NHS endo, who has sent me for an echo (I have a heart murmur - which has been there for most, if not all of my life) and I am shortly to have a short synacthen test which she has ordered. She disaproves of me taking T3, and says I should reduce my does, even though I lied to her and said that I was taking 75 -100! (Didn't want her having a heart attack!)

I sleep better than I ever have, although I do very ocassionally find it hard to sleep if I wake in the night, but I am going through the menpause and have 3 teenage children, so there is always something to think about.

No gut or kidney problems (as far as I am aware) and my kidneys have been checked previously to find out why my BP was so high, when I was in my thirties.

I do wonder whether I should get tested for MTHFR (I think that is correct)?

[trelemorele in reply to PiggySue]

I'm taking exactly the same dose as you and have exactly the same blood readings, also like you sleep very well.

Go with what you feel.is good for you 👍😉

[jimh111 in reply to PiggySue]

I find sleep a sensitive marker for thyroid hormone treatment. If I am hypo I get to sleep OK but wake up a number of times and feel tired the following days. If I am hyper it takes a time to get to sleep, I'm too alert at bedtime. As you space out your L-T3 I think you are doing OK. If I were you I would try taking your last dose just before bedtime as we seem to use a lot of T3 during sleep. It will also alert you to any over-treatment as you will not be able to get to sleep if you are on too much. Your case is an enigma but I think you are OK, just try to reduce your dose a touch every month or so (and of course resume it if you start to get hypo). This will ensure you are on the minimum effective dose. I think these large doses do have a long term effect on the heart but so does hypothyroidism and if you are able to exercise that will mitigate any risks.

[PiggySue]

With the short synacthen test, should I take T3 as normal? Or should I miss my morning dose as I would with a thyroid blood test and take it after the tests are finished?