If on combination treatment

[Clara9]

My results are 75% in range for both ft3 and ft4. I still don't feel well. What can I do? Where do you need your levels when on combination treatment?

[SeasideSusie Remembering]

Clara9

I am on Levo and T3 and find that I need both my Ft4 and FT3 at around 75% through range.

Looking at your recent post

B12 is in a perfect place

Ferritin is good at 77 (13-148) but it might be a good idea to have an iron panel to see if everything else is where it should be - that's TIBC (total iron binding capacity) or Transferrin, Saturation % and Serum iron

What are your actual results - the numbers and ranges - for Vit D and Folate.

If everything is optimal then because thyroid, adrenals and sex hormones are all connected, it might be necessary to start looking at more than just thyroid and nutrient levels. Even though my thyroid results are perfect on paper, my adrenals are out of whack and I'm working on that, and sex hormones were extremely low when tested.

[Clara9 in reply to SeasideSusie]

Do you think it would be a good idea to lower levo from 100 to say 87.5 and see if I feel better? Or even to 75 and wait a week or so to see how I feel and then if I feel undermedicated increase t3 from 15 to 20?

[SeasideSusie Remembering in reply to Clara9]

Clara9

I can't say, your current levels would be perfect for me, it's very individual so we have to experiment. But any dose change needs 6 weeks to be fully effective so seeing how you feel after a week or so wont be an accurate reflection of the dose change.

If your iron panel isn't good, and your Vit D and folate aren't optimal, and your adrenals and sex hormones are out of whack, then you may be looking at that as a source of your problem.

[Clara9 in reply to SeasideSusie]

They did Serum Iron and that was middle of range the same with ferritin. Folate was 16 and according to doc good. They had no upper limit. Latest vit d last autumn was 90.

The rest I don't know.

The thing is that I feel irritated all the time and that has been the case before when on too much meds. But my period came a week earlier last time so something else is going on too I think.

[SeasideSusie Remembering in reply to Clara9]

Clara

Well if you know feeling irritated is a sign of being overmedicated, then you'll have to decide which you want to reduce, but I would only do 12.5mcg Levo or 5mcg T3. If you reduce Levo then wait 6 weeks and retest, if you reduce T3 you might not need quite so long. I always err on the side of caution as I seem to need to wait 8 weeks after any dose change for it to be fully effective.

[Clara9 in reply to SeasideSusie]

Do you think it would be safe to increase t3 to 20 instead and leave levo as it is. Or is it likely to push ft3 over range?

[SeasideSusie Remembering in reply to Clara9]

Clara

It might push you over range, it might take you to the very top, no-one can say. If you want to try it then add 5mcg and if you stick with it then retest in 6 weeks.

I added 1/4 of a Cynomel T3 tablet (6.25mcg) and went from 72% through range to 108%, Levo dose stayed the same, but that doesn't mean you will react the same way.

[Clara9 in reply to SeasideSusie]

Thank you ever so much for your advice. How did you feel when you went over?

[SeasideSusie Remembering in reply to Clara9]

I honestly can't remember. I've done so much tweaking but I have other conditions which make me feel pretty rubbish so it's hard to say because I can't always tell what causes which problem (apart from obvious ones). Because of that I do tend to use the blood tests as a guide and have found that for me 75% through range for both FT4 and FT3 is where I feel best thyroid-wise.

[HughH]

T3 is the active thyroid hormone which controls almost every cell in the body. T4 needs to be converted to T3 to become active.

Free T3 is the best measure of available T3 and this is therefore the most important to get right. Your Free T3 appears good but many people need their Free T3 to be top of range or even above range to feel well.

If you are not sure if you are over or under medicated you need to look at symptoms and basal temperature is useful. This is taken while still in bed in the morning. If it is low you are likely undermedicated - if high then overmedicated.

[Clara9 in reply to HughH]

Ok, thanks. Do you think 5mcg extra t3 would put me over range?

[HughH in reply to Clara9]

It is difficult to predict the impact of an extra 5 mcg T3. When you take Levo it needs to convert to T3 to become active. The conversion is regulated by the body's control system to try to maintain what the body thinks is the correct level of T3.

It is possible that adding 5 mcg T3 will increase the Free T3 level. It is however also possible that the extra 5 mcg of T3 will mean that less Levo gets converted to T3 and the T3 levels stay the same.

There is therefore an element of trial and error in increasing T3 or Levo.