Doctor says I am hypo and hyper at the same time

[Blossom13]

Hello there, I have just been to see my doctor and got some blood results. I will also post my previous results:

10/04/18 (was taking 50mcg T4 & 20mcg T3)

FT4 - 17.4 (9.0 - 25.0)

TSH - 0.08 (0.50 - 5.00)

FT3 - 6.3 (3.5 - 6.5)

27/07/18 (was taking 50mcg T4 & 35mcg T3)

FT4 - 8.6 (9.0 - 25.0)

TSH - 0.01 (0.50 - 5.00)

FT3 - 6.4 (3.5 - 6.5)

He said these latest results show I'm hyper (TSH) and hypo (FT4) at the same time.

The last 2 weeks he asked me to drop my T4 to 25mcg and my T3 to 30mcg which I did and progressively got worse, so I've gone back up to 50mcg T4 again and keeping the T3 at 30mcg.

I would be grateful for anyone's thoughts. It's the 2nd time I've tried to reduce my T4 with bad consequences. Can anyone shed any light on what might be happening and whether the amendment in dose should be the T4 or T3?

All of my vitamins etc are fine and had a saliva cortisol test which showed high night and mornings which I am working on with adaptogens.

Thank you.

[Hidden]

Your T3 is not out of range and taking T3 will drop T4 sometimes to below range.Your TSh will be suppressed as it is, when on T3. You results looked fine before reduction and normal for the medication you are on. Whether it is the right dose for yourself can be best assessed by how well you feel and your pulse.

[Blossom13 in reply to Hidden]

Thank you for responding. I did feel fairly good on 50mcg T4 and 35mcg T3, but the only downside was that I was 'trembly'. I think my doctor thought I was overmedicated which is why he suggested the reduction in T4. It seems so hard to get the right amounts of T4 & T3 right.

[shaws]

The TSH is not from the thyroid gland it is from the Pituitary Gland and so many doctors make the assumption that a very low TSH is 'hyper'. It might well be if patient is diagnosed hyperthyroid inititally but not if they are 'hypo'. Considering that the blood tests were invented for the use of levothyroxine alone (i.e. T4) when we add in T3 or take NDT the results cannot correlate and it is 'how the patient feels' on particular doses which is the best way to judge. This is an excerpt from the following link:

TSH is not a thyroid hormone and is not an appropriate guide to thyroid replacement therapy. The hypothalamic-pituitary secretion of TSH did not evolve to tell physicians what dose of levothyroxine a person should swallow every day. A low or suppressed TSH on replacement therapy is not the same thing as a low TSH in primary hyperthyroidism. If you have central hypothyroidism, the TSH will necessarily be low or completely suppressed on T4/T3 therapy; your physician must treat you according to symptoms and the free T4/free T3 levels.

hormonerestoration.com/

[Blossom13 in reply to shaws]

Thank you for your response. That makes sense and I feel better hearing that. As my FT3 seems fine, but now my FT4 is a problem, do you think I should just go back to my original dosing of 50mcg T4 and 20mcg T3? How do I get my FT4 back up?

[shaws in reply to Blossom13]

Blood tests are only that 'tests' and if we had a blood test every couple of hours there would probably be changes.

I think I would go back to the previous dose but you may have the problem of getting prescription altered. I would drop a line to GP stating you feel worse and have gone back to your original dose - on advice from a NHS Help Line for dysfunctions of the thyroid gland. You can tell him blood tests are for T4 alone and when T3 is added TSH will be suppressed but that it isn't harmful as it is from the pituitary gland.

One of our Advisers only took a blood test for the initial diagnosis and thereafter it was all about 'how the patient felt' on particular doses which were increased slowly every 2 week until symptoms were relieved. Neither would he prescribe levothyroxine but only NDT or T3 only.

[greygoose]

Your doctor is an absolute idiot! What a stupid thing to say. Just having a low TSH does not make you hyper. As Hidden says, when taking T3 your TSH is going to be very low. And, if he thinks that your FT4 shows that you're hypo, why did he lower the dose? What's more, should not have decreased levo and T3 at the same time. It's one or the other. He doesn't have the slightest idea of what he's doing, so you need to be very careful with him, or he will make you ill.

There was no need to touch your dose at all, if you felt well on it. And if it made you feel bad to drop your levo, then it's obvious you shouldn't do it. There's nothing wrong with a suppressed TSH when you're taking T3. It's suppressed because you don't need it. So, how do you feel on 50 mcg T4 and 30 mcg T3? If you're feeling well on it, refuse to reduce your dose again just on the basis of a low TSH. Because there is no medical reason to do so.

[Blossom13 in reply to greygoose]

Thank you for responding greygoose. Yes, I said that very thing to him today about the TSH being suppressed when taking T3. Unfortunately, I'm not quick with the answers as I'm trying to process all of the information I'm learning and I get stampeded unfortunately. My question now, it how to get that FT4 back up quickly. Do you think just taking it back to the original dose should do it? Also, my best results in April were when I was not 20mcg T3 and not 30cmg T3. Do I need to reduce T3 slowly over a couple of weeks? Thank you for your feedback, I'm very grateful.

[greygoose in reply to Blossom13]

Nothing hormonal can be done quickly. All you can do is add back the 25 mcg that was taken away, and see how you feel. Retest in six weeks.

I have no idea why you felt better on 20 mcg T3 than 35 mcg, because the results are about the same. You could try reducing your T3 to 20 again, and see what happens, but only by 5 mcg every two weeks. It's all trial and error, with hormones. We cannot know how we're going to feel in advance. Only when we get there.

[DotLeeds]

How did you feel on 50 T4 with 20 T3? Your blood test in April looked good. Why the increase in T3?

[Blossom13 in reply to DotLeeds]

Hello and thank you for your response. I think it was raised because I was still feeling 'fatigue'. Looking back, it may have been that my adrenal situation, vitamins etc were not as good, but were on the mend. Do you think it's ok to drop back to 20mcg T3 from 30mcg T3 immediately, or do you think the dose needs to be dropped over a couple of weeks?

[DotLeeds]

Always change thyroid medication gradually, try to leave 2 weeks between each step. I am currently keeping my T3 stable at 20mcg and adjusting T4 to find which dose works best for me. Now on 75mcg Mon/Weds/Fri and 100 on other days.

[Hidden]

It looks like you are shacky but feel otherwise well on dose before reduction. It probably needs a tiny reduction but it is all going to be trial and error and can take quite a while to get right. You might want to try 20mg of t3 one day and 30 the next. Don't worry about your Low t4 that is the effect of hormone replacement and not an indicator of your health.You really do need your ferretin, vit D, folate and B12 tested then post your results. These alleffect the way your body makes use of the hormones. Also take your pulse every day and maybe if you could let me know what it is today. It is a much better indicator of appropriate dose than blood tests in my experiance and can help with clarity. If you heart is racing when you are feeling shacky then you definaltley need to reduce a little.

[Blossom13 in reply to Hidden]

Hello mandyjane, thanks again. I just took my pulse now and it was 85. I will need to get updated test done for ferretin, vit D, folate and B12 as you said, although I am very religious about these particular supplements. I think your idea of alternating the T3 dose is a good idea. It heartens me to read your comment about not worrying about the FT4 as I left the doctor's office disheartened.

[Hidden in reply to Blossom13]

Your pulse is good so you have the dose about right just needs a slight tweek. You dont really want to go over 100 pulse wise or less than 65 unless you are super fit.