Well, I’m not surprised. I knew my T3 felt high but didn’t expect it to shoot over range! So that must’ve been the mystery cause of my eyelid twitching all along. On 50mcg T4, 40mcg T3. Took T4 24 hours before, and T3 12 hours before.
TSH 0.01
FT4 8.3 (10.6-19.7)
FT3 6.01 (3.00-5.90)
Here were my previous results on 75mcg T4/25mcg T3. T4 was taken 24 hours before, but T3 was split into two doses of 12.5mcg T3, second dose 12 hours before test. Perhaps if I took the full 25mcg T3 the FT3 would’ve been higher.
TSH 0.01
FT4 10.6 (10.6-19.7)
FT3 4.63 (3.00-5.90) 56%
Seeing the Endo on Monday. Given I still have hypo symptoms such as dry skin, cold temperature and constipation, I must need a higher T4 dose.
I feel I need to increase my T4 and decrease my T3. I’m thinking about 88T4 with a reduction in T3 dose. Though I wonder if I should try to see if a combination that doesn’t suppress my TSH could work, before settling for a suppressed TSH. Perhaps larger T4 with small dose T3?
Lab Results on T4 / T3 Compounded 
Blood Test Results Showing High Reverse T3
Lab Results on 2 grains NDT - Switching to T3 Only
T3 increase was rather large. Perhaps cut back by 5mcg at time. Plus increase T4 at same time
When were vitamin D, folate, ferritin and B12 levels last tested?
Do you have Hashimoto's?
Hi SlowDragon. I had titrated in increments from 25mcg T3 to 40mcg T3 at the time, as recommended here.
B12, tested 2.5 months ago, was right at top of range. Ferritin, tested at same time, 144 (24-444).
Vitamin D tested over 6 months ago, 139 (75-150). Will recheck it soon enough. Folate testing is not available here.
As far as I know, I do not have Hashimotos. Have checked both TPOab and TGab, and had a thyroid ultrasound.
My mother has shown a similar pattern of high-normal TSH, low-normal T4/T3, negative TPOab (tested just once).
My younger brother just got a pituitary scan done. He’s being treated for low cortisol (low ACTH, secondary). This will be followed by his testosterone, which is below range, with elevated LH but normal FSH. Also had low prolactin.
His TSH was recently mildly elevated, and then a bit more, like from 3.88 to 4.72, range 0.47 - 3.41 for his age group. TPOab in past year and now, negative. To make sure, checked TGab, negative. Possibly from low cortisol or Divalproex.
Any who, I definitely will need my Synthroid increased to 88mcg. Now I was thinking of seeing how I feel on a non-suppressed TSH. But it was suppressed even when I was on NDT which was equivalent to 73 T4/17 T3.
Thinking of 88T4/15T3 but might not be enough for my symptoms. Perhaps 88/20, and can further increase T4 with even lower dose T3 in the future. The Endo is cooperative.
So when you increased T3 from 25mcg to 30mcg, did you wait 6-8 weeks and retested before increasing further ?
It's very easy to miss the sweet spot.
When you were on 75mcg/25mcg I would have been tempted to increase the Levo by 25mcg to 100mcg and left T3 at 25mcg
Unless you have problems with reverse T3?
Over treated symptoms can be remarkably similar to under treatment
Yes personally I need FT4 higher, say mid range and FT3 in top third of range
No I did not get to retest. I think 50T4 was going to make any T3 dose fail. On 75T4/25T3 I did feel the T3 was also increasing my in attention. Best way to describe it is that with low T4 my mind is slow, with high T3 my mind is sailing in the clouds!
The Endo asked if I’ve tried NDT, which I have though never tried to fine tune it. So he agreed to change my dose to 88T4/20T3. Will give me a good idea on what I need, by comparing to the 75T4/25T3 I was on before the 50T4/40T3.
Try to wait at least 6, or ideally 8 weeks, before retesting after each change in dose
Have you considered these DNA tests to see if problem is genetic
bluehorizonmedicals.co.uk/t...
Sorry for the late reply. As I live in Canada I cannot order that. Haven’t been able to find those tests here unfortunately.
Recently, the Endo simply said that we need to work on getting my hypothalamus working again. What the cause of that dysfunction is I don’t know. There is a subset of bipolar type 2 patients with Hypothyroidism, especially so-called subclinical hypothyroidism. It could be as simple as that.
He did ask if I wanted to try NDT but I will try to fine tune the T4/T3 combination therapy first. So far I took my old 25mcg T3 tablets for a week and now am on the 20mcg T3. But I found that taking T3 in the morning didn’t suit me, as I take other medications then. So I am back to taking it before bed again with the T4.
Hoping that I’m not too far away from fine tuning this. I do think it will come down to needing 20mcg or lower T3 with higher T4, perhaps as high as 112. Wish I saw him years ago but oh well, Endos that dose by clinical symptoms are rare these days.
Some of us find it essential to take T3 in two or three split doses
Two doses - 12 hours apart
Three doses - 8 hours apart
Others can take as single dose
It's very individual