Test results... assistance needed

[HelgaW]

The results of my latest blood test are as follows:

Free T3 1,95 ( 2,43 - 3,98)

Free T4 0,92 ( 0,80 - 2,10)

TSH 3,47 ( 0,27 - 4,2)

I’m Hashi/ hypo for many years.

I take 50 mcg of levo and 10 mcg T3.

What do you think- shall i add some T4 or T3? Or both?

Thanks so much for any help!

[HelgaW]

Forgot to mention that i’ m extremly tired, loosing hair, started putting on weight.

[shaws Administrator]

Your overall dose is quite low - i.e. 50mcg of T4 and 10mcg T3 equals approx 80mcg of levo.

I am not medically qualified but I'd add 1/4 tablet of T4 and T3. Your TSH should be 1 or lower. I'd add 1/4 tablet of T3 and T4 and after two weeks you can add another. Take note if your symptoms are being relieved If pulse or temp rises too high, drop one or other.

[HelgaW in reply to shaws]

Thank you, shaws.

I’ve never had my TSH around 1 while taking T4. It was always higher than 2.

But when i was on T3 only for about 3 months my TSH was less than 1 and i took 18,75 mcg of T3. I don’t understand why(

[shaws Administrator in reply to HelgaW]

T4 is an inactive hormone - it has to convert to T3. T3 is the only Active Thyroid Hormone needed in our millions of T3 Receptor Cells.

For examble:-

25mcg of levothyroxine doesn't equiate to 25mcg of T3 which is around 100mcg of levothyroxine in its 'effect'.

[HelgaW in reply to shaws]

Tyank you, shaws, but what i mean- 18,75 mcg of T3 was enough for me and 10 mcg of T3 plus 50 mcg of T4 are absolutely unsatisfied. 50 of T4 plus 10 of T3 totally would make more than 18,75 of T3 as far as i think. Or not?

[shaws Administrator in reply to HelgaW]

Your latest results:-

Free T3 1,95 ( 2,43 - 3,98)

Free T4 0,92 ( 0,80 - 2,10)

FT3 which is the most important is well below the bottom of the range. FT4 is as well.

You are on an insufficient dose. TSH is to be 1 or lower.

I am not medically qualified but you might have some sensitivity to T4, (levothyroxine.) Some people have Thyroid Hormone Resistance which means the person cannot convert T4 into T3 and only improve their health by T3 alone . This is a link:

web.archive.org/web/2010103...

I think you should drop T4 and take T3 alone.

[HelgaW in reply to shaws]

Thanks so much, shaws, will think about it.

[shaws Administrator in reply to HelgaW]

If you would prefer to go back to the dose that made you well, you might have to source your own T3 and that seems to be quite difficult for many members as they've had to source their own and there's a shortage somehow.

The aim, as stated above is a TSH of 1 or lower with a Free T3 (or FT4) towards the upper part of the ranges.

[HelgaW in reply to shaws]

Thanks a lot for your help, shaws!

[SlowDragon Administrator]

When you were on just Levothyroxine dose should have been increased until TSH was under one and FT4 towards top of range and FT3 at least half way in range

NICE guidelines saying how to initiate and increase. Note that most patients eventually need somewhere between 100mcg and 200mcg Levothyroxine

cks.nice.org.uk/hypothyroid...

Then if adding T3 to T4 dose of Levothyroxine either is reduced a small amount (25mcg) or left same

What are you vitamin D, folate, ferritin and B12 levels like

[HelgaW in reply to SlowDragon]

Thank you, SlowDragon. I take all of them as supplements. I have also pernicious anemia and iron deficency anemia and while it’s easy to control by myself B12 levels it is very difficult to obtain an IV with ferrum as doctors are always wait until my ferritin level dropped below minimum. During these months while ferritin goes down my TSH is always increasing. Now i have ferritin around 40 and after the last IV six month ago it was around 100 and i felt myself much better with that level of ferritin. Unfortunately all the doctots i’ve seen rejected the connection between TSH level and ferritin.

[SlowDragon Administrator in reply to HelgaW]

Eating liver or liver pate once a week, or other iron rich foods will help. Especially if have vitamin C alongside, either as supplement or orange juice

Your not on enough replacement thyroid hormones, so this doesn't help. Getting thyroid optimal will help vitamins and vice versa.

[HelgaW in reply to SlowDragon]

Thank you, SlowDragon, will try to increase my T4 + T3.

Can’t eat liver even if i die - i’m vegetarian for about 30 years, but my level of iron always was low since the early childhood even when i ate plenty of meat and liver.

[SlowDragon Administrator in reply to HelgaW]

Then you are possibly looking at gluten intolerance as reason for ongoing low vitamins

You will have to take iron supplements instead then plus vitamin C with each one.

[HelgaW in reply to SlowDragon]

It’s autoimmune gastritis that’s why i’m on IV injections as iron supplements are not being absorbed due to that kind of gastritis.

As regarding gluten intolerance i stopped all the gluten consumption two years ago and frankly speaking do not see any change for the better.

[SlowDragon Administrator in reply to HelgaW]

Have you had antibodies tested since gluten free, many people find TPO drop slowly on gluten free

[HelgaW in reply to SlowDragon]

Yes, it dropped from 600 to 140, but it’s still not in range.

[SlowDragon Administrator in reply to HelgaW]

No but impressive drop and definitely heading in the right direction. It can take several years to drop within range