Should I push for a dose increase?

[Jenny23]

Hello lovely, helpful people on here.

I haven’t posted for quite a while, as I have thought that I feel sort-of ok, but I’m wondering if I should settle for that? I still struggle with brain fog (but nothing like as bad as it was), anxiety attacks and depression, although I seem to cope with them better than I did. I guess I just still don’t feel like I am the best I could be.

I’m currently on 175 mcg T4 and 20 mcgs T3 daily ( my endo, whilst a diabetes specialist, is happy to continue to prescribe T3 - thank god! However, both he and my GP are concerned about low TSH despite me trying to suggest that perhaps it’s not that important)

I supplement, thanks to advice on here, with selenium, D3, B group multi, magnesium, zinc, calcium, Vit C and iron, following all the advice for timings of supplements versus meds. Have also been gluten-free for a year - anti thyroidperoxidase abs have halved since last year.

most recent results from Blue Horizon below:

Ferritin 101 (13-150)

TSH 0.01 (0.27-4.2)

TT4 55.3 (66-181)

FT4 12.7 (12-22)

FT3 3.5 (3.1-6.8)

Vit D 55 (insufficient 25-50)

Vit B12 582 (consider educing dose >569)

Serum folate 23.4 (8.83-60.8)

Any comments/suggestions most welcome. Thank you in advance, and as ever, thank you for everyone’s wonderful support on this site.

[shaws]

Tell them that the blood tests which are used, are for the use of levothyroxine alone.

If T3 is added into the mix or we take NDT, bloods will not correlate. It should be upon how the patient 'feels' on a particular dose, i.e. if we have hyper sensations it is a bit too high. If symptomatic too low (T3).

Maybe this will help your doctor and endo to understand somewhat in the following link and give them a copy. It was sent to the Scottish Parliament in the Lorraine Cleaver's case of before them at present:-

parliament.scot/S5_PublicPe...

[SeasideSusie Remembering]

Jenny23

You have quite a long way to go with

Vit D: 55 - recommended by Vit D Council to be 100-150nmol/L

Folate should be at least half way through range, so that's 35+

B12 - you don't give a unit of measurement but you might want to consider what Sally Pacholok says in her book "Could it be B12"

"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".

"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."

Are you taking calcium because you've been tested and it's low?

Do you take K2-MK7 as one of D3's cofactors? It's important as it directs calcium to bones and teeth and away from arterties and soft tissues where it can be deposited and cause problems.

You don't have much TT4 and FT4 considering you're taking 175mcg Levo.

Considering you're taking 20mcg T3 your FT3 is very low in range.

As you have Hashi's, do you have gut issues and it's affecfing the absorption of your thyroid meds?

In SlowDragon 's reply near the bottom of this thread, she has given some links regarding gut issues which may be worth you checking out

healthunlocked.com/thyroidu...

[SlowDragon Administrator]

Do you always have the same brand of Levothyroxine? And which brand on T3?

Did you do this test as early in morning and fasting and no Levo for 24 hours before and no T3 for 12 hours before?

As SeasideSusie says, your results seem very low for relatively high dose T4 plus T3

Do you have low stomach acid or poor absorption ?

[hipolion]

I read somewhere in the forum that a too high dose of t3 in combination with levo, may reduce ft4 and FT3 default, and the patient may feel hypothyroidism symptoms in this way. I don't know if 20mcg T3 is a high dose for you or not. You split your T3 dose or not?

[greygoose in reply to hipolion]

may reduce ft4 and FT3 default

Sorry, but what does that mean? If you take any T3 your T4 is going to be lower in range than it would if your took T4 only. But that's because you don't need as much T4 anymore, and the body only hangs on to what it needs. How much effect that has on your FT3 level depends on how well you convert. And, given that most people add in T3 because they don't convert very well, the effect would probably be negligeable. If the patient still has hypo symptoms, it would be because the dose of T3 isn't quite high enough.

20 mcg is not a high dose of T3. And splitting isn't necessary for everyone. Especially not on just 20 mcg. I take 68.75 mcg T3 and 25 mcg levo. This is, obviously, a high dose. Although I know people who take a lot higher. But, I do not suffer from the effect you are talking about - at least, I think you're talking about - above. I think, what we have here is an absorption problem of some kind.

[hipolion in reply to greygoose]

So this is true, T4 is going to be lower in range if some one taking T3. Very interesting. For example, after I added some T3 in the mix(10mcg and 125levo) my ft4 level droped (18 to 14) but I not fell optimal yet. Maybe I need more T3 but I need to split, if I take the whole dose(with my levo) it makes me anxious. Thank you.

[greygoose in reply to hipolion]

You're welcome.

[Jenny23]

Shaws - thank you for the link. I will show it to GP and endo.

SeasideSusie - thank you. I will try and get my Vit D levels up. I currently use the mouth spray recommended o here that has all the co-factors necessary. I assume I can just increase the use?

I supplement with calcium as I had a bone scan that indicated some think g in my spine and of course, the medics are all concerned about low TSH correlated to osteoporosis 🙄 Folate increase - not sure if I can increase the dose there?

SlowDragon - test is always first thing, fasting, no meds since previous day. My endo said that he was “pleased” with my T3 levels, as “it normally leaves the body very quickly and the fact that you still show some in your system after not taking any for 24 hours is a good thing.” REALLY???

I’m not awar that I have any gut issues. Used to get IBS years ago but not since I lost a considerable amount of weight.

Thank you for your responses 😊