Hi Thank you for all the valuable patient feedback here! My first time posting. WARNING: VERY long and detailed!
Summary: I started on T3 only (Tertroxin) 20 mcg middle of June, slowly built up to 40mcg (which I took around 4.30 am a few times Ct3M), but now as soon as I wake up around 7 am.
It just doesn’t feel like enough - My resting heart rate came up a bit to around 60 when I started but now again 56. Basal temp 36.3 C or so - steady low.
Some days I take half tablet (10 mcg ) around lunchtime but I’m still sluggish. Don’t want to go up too much/too fast as I have had 3 episodes of atrial fibrillation requiring cardio version. (i take anti coagulant apixaban to lower stroke risk)
I'm guessing Rt3 should have cleared by now after 6 weeks and am wondering whether to increase T3 or rather add 1 grain NDT back or do something else. Am trying to go by symptoms rather than retesting too soon.
Details: Diagnosed hypothyroid in August 1994 when starting to miss periods at age 33. TSH then was 4.18 (Range 0.23-4.0). Antibodies were negative. Started levothyroxine 50 mcg. Got pregnant 2 or 3 months later!
Was on Levothyroxine (Oroxine/Eltroxin 100mcg) until about 2007 - but never felt amazing and continually battling weight gain etc.
Saw an integrative general practitioner and requested to go on NDT. I think I started on 1 grain. I remember my adrenal function was very low (all cortisol levels low.) Over the years took some progesterone cream as my “bad” oestrogen was high. Iodine was very low — only excreted 30.4% Took iodine for a few months. Never retested. Increased NDT to about 2 grains and did well with new integrative dr after moving to another town. Dr no 2 not stressed about suppressed TSH, and my T3 was middle of range and T4 upper end of range.
Gradually picked up weight, moved to another state, got older and increased NDT as feeling more and more tired. New integrative GP insisted on cutting back on NDT especially as I had third episode of atrial fibrillation requiring electric cardio version in November 2017 after surgery. Cardiologist not concerned and doesn’t think it was brought on by excess T3, but by stress from operation.
The last year’s results:
26/09/2017 I think I was taking 2.75 grain Naturethroid then
TSH 0.01 mIU/L (0.5 - 5.5)
FREE T4 10 pmol/L (9.00 - 19.00)
FREE T3 4.8 pmol/L (3.10 - 6.00)
27/12/2017 On around 2.6 grain Naturethroid
TSH 0.02 mIU/L (0.5 - 5.5)
FREE T4 9 pmol/L (9.00 - 19.00)
FREE T3 3.9 pmol/L (3.10 - 6.00)
LATEST RESULT 02/05/2018 On 2.5 grain Thyroid S and Thiroyd (mixing both as one was easier to cut in half without crumbling. Naturethroid out of stock) Also some leftover Armour 2.5grains.
TSH 0.03 mIU/L (0.5 - 5.5)
FREE T4 11 pmol/L (9.00 - 19.00)
FREE T3 3.7 pmol/L (3.10 - 6.00)
So endocrinologist wanted to further reduce NDT in spite of T3 and T4 trending lower and my bone density scan showing very good bone for my age (57) Now postmenopausal.
I got GP to prescribe T3 only instead as my Reverse T3 was going up. (But she doesn’t know about dosing)
Reverse T3 on 27/01/2015 was 210 pmol/L (Range 140-540)
Reverse T3 on 02/05/2018 was 417 pmol/L (Range 140-540) So I calculated ratio of Rt3 to T3 as 8.9 (which should be over 20?) According to STTM Rt3 should be under 165 with this range.
I did have quite a few of these causes of high rT3 over last year which probably contributed.
* Chronic inflammation, whatever the cause, has risen RT3 in patients. I guess my iron studies show inflammation and I had a big operation to my gut so I only use half my small intestine now.
* Physical injury, a common cause of increased RT3 (surgery counts?)
* Starvation/severe calorie restriction is known to raise RT3. See this study. I had very low calories for a few months after surgery.
* Cirrhosis of the liver (page 38 here) I don’t have liver cirrhosis - but do have “fatty liver” My liver function tests have been high since surgery in November 2017 (gallbladder removed and SIPS (SADI-S) procedure as I could not lose weight even after lapband in 2006 and gastric sleeve in January 2016.
Liver function 0n 2.5.2018 (I don’t drink)
AST 45 U/L (10-35)
ALT 84 U/L (5-30)
ALP 169 U/L (30-115)
GGT 41 U/L (5-35)
Last Iron studies on 2/5/2018: (?showing inflammation)
Iron 14 umol/L (5-30)
Transferrin 33 umol/L (25-40)
Saturation 21% (10-45)
Ferritin 191 ug/L (30-500)
My ferritin used to be very low like 29 , had iron transfusion end of 2015 when it was around 41-44. Was 147 on 26/09/2017
2/5/2018 25 OH Vit D 86 mol/L (51-150) I believe goal should be over 100. I had strong Vit D injection in March so this is afterwards.
I have lost some weight after surgery so my Type 2 diabetes is in remission but am unable to lose more weight (still have at least 20 kg to go) and am always freezing cold and terrible brain fog. Can’t eat too much fat now, craving carbohydrates especially sugar!
My saliva cortisol levels were all low when I did them in 2010, but when I repeated them on 21 June 2018 just when I commenced T3 only, the morning one is too low, midday one too high and afternoon and evening OK.
Morning: 17.5 mol/L (6-42)
Midday: 15.3 H (2-11)
Afternoon: 7.2 (2-11)
Evening: 4.8 (1-8)
My organic acid test on 18/6/2018 shows too low Vit C, Vit B 2 and B12
Blood test Vit B12 on 2.5.2018 was 661 pmol/L (139-651) I take methylcobalamin and occasional adenocobalamin ( MTHFR heterozygous for both genes 677 and 1298)
Serum folate: 19.6 ug/L (=44.4 nmol/L) (range over 3.8 ug/L)
Homocysteine: 7.8 on 5.2.2018 (7-7.5)
Copper 17.7 (13-25)
Zinc 11.5 (9-19)
Ratio I think copper too high?
I tested negative for coeliac.
I still have my thyroid.
Anyway thank you if you read all the way to here!! I started on T3 only (Tertroxin)20 mcg middle of June , slowly built up to 40mcg which I took around 4.30 am a few times, but now as soon as I wake up around 7 am.
It just feel like enough - My resting heart rate came up a bit when I started but now again 56. Basal temp 36.3 C or so - steady low.
Appreciate your time and help!!
Thank you very much.