Advice on latest results

[SLC76]

Hiah, I've just had my latest thyroid blood results back and would be really grateful for your thoughts. I have been alternating taking 125mcg/150mcg Levothyroxine and I am also taking 25mcg T3 every day. These results were taken at 9am in the morning and I did not take my medication until after the bloods were taken, so it was over 24hours since my last dose of T4 and T3.

FREE THYROXINE (T4) - 18.7 (range 12-22)

FREE T3 - 4.4 (range 3.1-6.8)

TSH - 0.09 (range 0.27-4.2)

TPO AB - 530 (range 0-34) *I know this is still really high but for months I was >600 and they do seem to be coming down by 30 each time I have a blood test. I am gluten, soy and dairy free and have also recently decided to become vegan.

Thyroglobulin - 79.1 (range 0-115) Six months ago this was 251, so I am pleased with this result.

I can't understand why my T4 result has come down (although not out of range) when I have been on the same dose of meds and I don't really understand why my T3 result isn't higher by now, but maybe it was because it had been over 24 hours since my last dose? Do I need to be concerned that my TSH is 0.09 or is that fairly normal when taking T3? I have only been taking T3 for a few months. I did go up to 35mcg of T3 but my head went really foggy and felt like it was in a clamp and all my energy went, so I lowered it back down to 25mcg.

I am feeling ok at the moment, my energy dips regularly still and if I do anything very physical then I will go down for a day and have to stay in bed but I think this is possibly more about my adrenals than my thyroid...or maybe it's both but I just cannot exercise there have been small improvements though and I do feel happier in myself since starting the T3.

Your help and advice is as ever, very much appreciated. Thank you.

[SeasideSusie Remembering]

SLC76

When doing thyroid tests, we should leave off Levo for 24 hours but T3 should only be left off for 12 hours, so you have a false low with your FT3 result. Adding 20% will give you a rough estimate of what would normally be circulating in your blood so that would be approx 5.28

Looking at your thread from one month ago you said

" I only started adding T3 two weeks ago. Starting on 5mcg and now I have upped that to 10mcg."

So presumably you went from 10mcg T3 to 25mcg in one dose increase? If so that's too much, with T3 you should increase by 1/4 of a tablet at a time.

Or did you increase by 1/4 tablet and have had 3 increases within the month? Again, too quickly.

How long have you been taking 25mcg T3? You should have been on that dose for 6-8 weeks before retesting. I need a full 8 weeks for my levels to stabilise and feel the full effects of a dose change.

Taking T3 tends to lower, even suppress TSH and can also lower FT4.

[SLC76 in reply to SeasideSusie]

Hi SeasideSusie, thank you again for coming back to me. I increased by 1/4 of a tablet and have had three increases within the month. Feel a bit stupid now after I read back on your advice but my doctor told me to do it that way, even though I questioned it. I have been on that dose for just over 4 weeks now apart from a short blip of increasing it again before very swiftly going back to 25mcg. I will stay on that dose now and not change it until further bloods in a month or so.

I take 25mcg in the morning with my levo and I can't actually cut these capsules in half and I have run out of the 5mcg capsules. When you say every 12 hours, should I be splitting my T3 dose then? Is it not good to take it all at once in the morning with Levo?

One more question (sorry)....if my T3 result is approx 5.28 like you suggest, would that mean my ratio of T3/T4 is good? 5.28/18.7?

I won't worry about the TSH being 0.09 then - thank you for that.

You are so knowledgable, I really appreciate all this help. Last time you made me feel so much better.

[SeasideSusie Remembering in reply to SLC76]

SLC76

When you say every 12 hours, should I be splitting my T3 dose then? Is it not good to take it all at once in the morning with Levo?

I didn't realise you were on capsules.

I take my T3 all in one dose. I tried splitting it but got fed up of timing everything else round it that I started taking it all at once and found no difference in how I felt, other people need to split their dose so it's very individual.

To measure normal circulatingl FT3 level then it's advised to leave no longer than 12 hours between dose of T3 and blood draw, and no less than 6 hours otherwise you'd just measure the dose recently taken (it peaks in the blood 2-6 hours after taking it). When I test I actually split my dose the day before so half in the morning, half in the evening, last dose 12 hours before I know I will do the test. If you can't split your capsule then you'd just have to take it the morning before you test then add 20% to the result.

One more question (sorry)....if my T3 result is approx 5.28 like you suggest, would that mean my ratio of T3/T4 is good? 5.28/18.7?

Once taking a combination of Levo and T3, the ratio isn't anything to do with it. When taking Levo only, we use the ratio to see how well we convert. Once taking T3, we can forget conversion - because we're adding T3 you can't work out how well you're converting any more and have no real need to know.

I would leave it now and retest 6 weeks after you changed back to 25mcg T3, that should then give you a better picture of how things are

[SLC76 in reply to SeasideSusie]

Amazing. Thank you so much Susie.