Up & Down! Up and Down!

[Jefner]

Results from November. Was on 100mcg Levo, 10mcg T3

hs-CRP 0.25 <5.0 mg/L Ferritin 97.8 13 - 150 ug/L

TSH H 5.70 0.27 - 4.20 mIU/L

T4 Total 95.4 66 - 181 nmol/L

Free T4 16.80 12.0 - 22.0 pmol/L Free

T3 3.77 3.1 - 6.8 pmol/L

Immunology Anti-Thyroidperoxidase abs H 175.0 <34 kIU/L

Anti-Thyroglobulin Abs H 208 <115 kU/L

Vitamins Vitamin B12 H 675 Deficient <145 pmol/L

Folate 26.50 8.83 - 60.8 nmol/L

From results I upped Levo to 125mcg - Results today 2 months later

TSH 0.31 0.27 - 4.20 mIU/L

Free T4 19.00 12.0 - 22.0 pmol/L

Free T3 4.06 3.1 - 6.8 pmol/L

Is my TSH now too low, report attached to results says I am on the brink of overmedicating now. Up and down, up and down for the last 3yrs. I have absolutely no idea what to do.

I was thinking of upping my T3 by 5mcg. I did manage to increase up to 20mcg a couple of years ago when I first trialed T3 but it sent me over range, although I didn't seem to feel hyperactive.

Whatever my results I just seem to feel the same all the time ie. rubbish. Anxiety, fatigue. Surprisingly hairloss stopped when I was undermedicated but has recently started again.

Do I go back to my 100mcg Levo and risk TSH going up again or stay on 125mcg and risk going over active? Or...... go back to 100mcg and add another 5mcg T3 and see how I fair? I am just stumped completely I really am

[SeasideSusie Remembering]

Is my TSH now too low

No, it's still in range. And you are taking T3 which tends to lower, even suppress TSH.

I was thinking of upping my T3 by 5mcg

That's what I would do if those were my results. Retest in 6-8 weeks, see where your FT4/FT3 levels are then, and reassess.

Plus, of course, you have Hashi's which complicates things and you will have fluctuations with symptoms and results due to antibody activity.

[Jefner in reply to SeasideSusie]

I don't feel better whatever dose I am on. Should I go back down to 100 Levo then if I am adding a tiny bit more T3?

[SeasideSusie Remembering in reply to Jefner]

That's up to you. You shouldn't change both at the same time, if you do you wont know for definite which has made you feel any difference or altered your hormone levels. You might find that adding more T3 could lower your FT4 (taking T3 can lower FT4). Your FT4 is 70% through range, that's roughly where I need mine to be and I'm on Levo/T3 combination, although we are all different in where we need our levels to be. If those were my results, I'd just add the extra T3 now, wait 6-8 weeks, retest levels, decide if I need to tweak any dose then.

[Jefner in reply to SeasideSusie]

oh I didn't know that T3 could lower FT4. Could having taken the TEVA rubbish for a few days before I tested have skewed my results because I know it doesn't suit me and I have felt very ill the last few days?

By the way what happened to Clutter?

[SeasideSusie Remembering in reply to Jefner]

Could having taken the TEVA rubbish for a few days before I tested have skewed my results because I know it doesn't suit me and I have felt very ill the last few days?

It's not a good idea to do thyroid tests when we are ill, we should wait a few weeks after any illness to test. Your results may not be accurate.

By the way what happened to Clutter?

She hasn't participated in the forum for a while.

I was always told on here that if you tweak say T3 ie. upping it, you need to lower your T4?

You should only change one thing at a time, for the reason mentioned above. If you already had a low FT4 and a low FT3 and increased your T3, would you lower your dose of Levo?

[Jefner in reply to SeasideSusie]

I was always told on here that if you tweak say T3 ie. upping it, you need to lower your T4?

[Jefner in reply to Jefner]

I feel ill all the time Susie so it wouldn't make much difference in my case I don't think

[SlowDragon Administrator]

As you have Hashimoto's are you on strictly gluten free diet?

Also no vitamin D result?

What supplements do you currently take?

[Jefner in reply to SlowDragon]

gluten free for over 2yrs, vit D very high and working with an FD to help with issues and on various supplements

[SlowDragon Administrator in reply to Jefner]

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and fasting. Do not take Levothyroxine dose in the 24 hours prior to test, delay and take immediately after blood draw. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

If also on T3, make sure to take last dose 8-12 hours prior to test

Is this how you did the test?

If so, I would try a small 5mcg increase in T3

Do you take T3 as split dose?

Two or three times per day ?

Or all in one go?

Personally I take my T3 as 3 doses per day - 8 hours apart. Waking, mid afternoon and bedtime

[Jefner in reply to SlowDragon]

I test before I take my meds in the morning but didn't test until 10am the other day when I normally do it a little earlier and it would have been a full 24hrs after I had my meds. I usually take T4 and T3 together before I get up. I was wondering whether to add the 5mcg later in the day although it's only a small amount. Plus I have severe anxiety in the mornings and because T3 is a stimulant I wonder whether to take it later in the day?

[SlowDragon Administrator in reply to Jefner]

Why not try splitting your 10mcg - 5mcg in morning and 5mcg mid afternoon.

Retesting in 6 weeks, leaving only 12 hours maximum between last T3 dose and blood test

So day before test, delay mid afternoon dose until 8pm and test 8am following morning

Leaving 24 hours is too long

Then perhaps consider adding a further 5mcg towards bedtime, but see what results are like first

Several endo's recommend 8 hour dosing

With Hashimoto's adrenals are often under stress

Daily vitamin C may be helpful too

[Jefner in reply to SlowDragon]

yes my adrenals are not good and I can't tolerate the slightest bit of stress anymore and I do have vit c every day as well. I was thinking of taking the small increase of 5mcg T3 in the morning and 10 during the day or even splitting the 10 into 2?