Help to tweak my meds please

[Lu-ck]

Results March18 Ft4 16.9(9-24) Tsh 1.37(0.34-5.4) ft3 3.5(3.1-6.8) on Levo 100mcg. Still v symptomatic

May Medi results ft4 12.6(12-22) ft3 5(3.1-6.8) Tsh 0.198 (.27-4.2) on Levo 75mcg +12.5 T3 energy levels picked up and feeling pretty good

TgA 349(0-115) TPO 115(0-34)

Vit all in mid range so supplementing to hopefully get into top range.

Medi Dr recommended I reduce my T3?

Appreciate advice. Thanks

[shaws Administrator]

Blood tests were invented with levothyroxine alone so that's why Medi doctor has pointed out T3. Therefore if adding T3 results will be different, i.e. T3 higher than if on T4 alone. The fact that you're feeling 'pretty good' suggests you're on the right dose.

[Lu-ck in reply to shaws]

Because my T4 was bottom range in last test I wondered if I should up my Levo to 125 mcg and reduce the T3 to quarter tab(6.25) or maybe do alternate days of 12.5/6.25? Dr not happy with Tsh being suppressed!

[SmallBlueThing in reply to Lu-ck]

There are many reports of feeling well when FT3 is in the top third of the range (above 5.6, in your case). Currently on 175 mcg Levo only, my FT3 is middle of the range and TSH below range, like yours, but FT4 is near the top, as per Dr Toft's recommendation. In my case, I think I can improve only by adding T3, and am thinking of dropping to 100 mcg Levo and adding one grain of Thiroyd. This would provide approximately 135 mcg T4 plus 33 mcg T4 equivalent from the T3, so should bring down my FT4 while increasing FT3. I've taken four to five grains of Thiroyd in the past, had a flare and returned to Levo only. If you didn't have any particular sensitivities to Levo, I think you should've ensured you get prescribed the same brand all the time and increased until TSH was below 1.0 and FT4 near the top of the range, and seen where your FT3 was at that point.

[Lu-ck in reply to SmallBlueThing]

Thanks for reply.

I didn’t feel much benefit from the 100 Levo alone and decided to self med with some T3. I see the rationale for increasing the Levo but I’m reluctant to maybe slip back to poor energy levels etc without the T3.

It’s quite complex for those of us setting out on the Hashi journey!!

[shaws Administrator in reply to Lu-ck]

T4 is inactive and it is supposed to convert to sufficient T3. Levothyroxine is T4 alone so if we add T3 or NDT the results don't correlate.

The main thing is 'how we feel' on a particular dose not the test result.

At one time we were only diagnosed on our symptoms, no levo then (only NDT which contained all the thyroid hormones), and doses were increased until symptoms were relieved. What is important if we aren't improving is Free T4 and Free T3 but they rarely test these and in the following link you can see the reason it is helpful if we have them tested, keeping in mind that it is T3 which is needed in our millions of T3 receptor cells and thousands of people have no problem with levothyroxine but most on this forum do have problems either through an insufficient dose or don't convert sufficiently.

thyroiduk.org.uk/tuk/testin...

[Lu-ck in reply to shaws]

Yes, I think I had poor conversion as my T4 was mid range but ft3 only v barely into range and I was quite fatigued.

It’s a pity some Drs don’t treat from symptoms rather than results .

Thanks for ur help

[shaws Administrator in reply to Lu-ck]

I believe doctors have been told to get the TSH to 'somewhere' in the range but have no clue about any symptoms at all but will be willing to give you several prescriptions for the symptoms rather than raising dose of thyroid hormones for TSH to be 1 or lower with FT4 and FT3 in the upper part of the ranges.