Pls advise -latest results show only nominal improvement

[Apollo_Creed]

Hi folks,

Here are my latest results. My endo increased the T4 to 100mcg in a move he described as 'bold', however results are marginal at best although they do show improvement. As you can see my medication level is reasonably high for my profile - I'm 40yrs old and 75kg - yet the increase produced modest results and I'm nowhere near optimal range despite near full replacement dose.

11 Feb 2019

100mcg T4, 10mcg T3 x 2 daily

TSH 2.69 (0.27 - 4.2) 61.58% through range

FT4 11.4 (12 - 22) -6% through range

FT3 4.4 (3.1 - 6.8) 35.14% through range

Compared with previous results:

10 Jan 2019

75mcg T4, 10mcg T3 x 2 daily

TSH3.38 (0.27 - 4.2) 79.13% through range

T411 (12 - 22) -10.00% through range

T34.2 (3.1 - 6.8) 29.73% through range

My vitamin and minerals for 11 Feb 2019 are:

Ferritin 185 (30 - 400)

B12 >2000

Folate 3.7 (>2.9)

Vit D 67 (>50)

Any thoughts on why my results may be like this will be greatly appreciated.

Thank you

[greygoose]

A bold move! lol Oh, they do come out with some things! This is a good one!

How is it a 'bold move' to increase levo by 25 mcg when the TSH is at 3.38? It's what any doctor who knows his stuff would do. I would do it! And I'm not even a doctor. And why is he retesting after only four weeks? It takes at least six weeks - maybe eight - for the increase in levo to be fully processed by the body. Your TSH has come down a bit, and could come down even more in the next 2 - 4 weeks. Your FT4 has come up a bit, but what was he expecting on only 25 mcg - not that he could increase it by more in one go, but I don't think the results are unusual in any way.

Your FT4 is bound to be low when taking T3, anyway. And, your FT3 is not going to go up much with an increase in levo if you don't convert very well. But, even so, he retested too soon. It could go up even further. But, if you want your FT3 any higher, you're probably going to have to increase your dose of T3. Although, 20 mcg is quite a decent dose. How do you take it? Do you always take it on an empty stomach and leave at least an hour before eating, etc. just like levo?

[Apollo_Creed in reply to greygoose]

thanks greygoose

I agree the results are not surprising given my immediately prior results, that is, things are trending in the right direction albeit slowly as the dose change may not have had time to fully metabolise. However what I don't understand is why the tests show similar results to being under medicated. I am taking what ought to be fairly close to a full replacement dose and yet results for the last two months show TSH too high and T4/T3 too low.

I find the results odd because in Ag/Sept/Oct 2018 I was taking approx 75-125mcg T4, then added 10mcg of T3 - those amounts were adjusted throughout that period - but TSH was very low and T4/T3 were at top of range i.e. where they should be. Perhaps my thyroid was still producing hormone at that point and the combination of the thyroid and the medication provided an optimal dose (at least as far as the test were concerned, I still didn't fell 100%).

Perhaps the thyroid has now finally given up the ghost, but what I don’t understand, given the near replacement amount of medication, why my results would become so out of balance after previously being "optimal".

As for T3, I take it in the morn at the same time as levo and then in afternoon on its own, and I take it away from food just like levo, although I'm told T3 is not as sensitive to food/coffee as levo is.

Any thoughts greatly appreciated.

[greygoose in reply to Apollo_Creed]

100 mcg? No way is 100 mcg a full replacement dose. Most people need more that that. Did your doctor say it was?

Do you have Hashi's? That could account for the sudden drop in levels.

although I'm told T3 is not as sensitive to food/coffee as levo is.

Yes, I've often heard that said. But the results we see on here don't back that up.

In any case, I wouldn't stress about it, if I were you. Thyroid is always unpredictable, and recovery is never linear, there are always ups and downs.

[Apollo_Creed in reply to greygoose]

Yes, I see what you're saying. I was thinking a full replacement dose in terms of 100mcg levo plus 20mcg of T3. I guess that gets me to about full replacement, no?

Thanks for tip on absorption of T3. I will make sure it is taken on empty stomach.

Thanks!

[greygoose in reply to Apollo_Creed]

Everyone's full replacement dose is different. We all have different needs. I cannot remember off-hand how much hormone a healthy thyroid produces per day, but you don't have a healthy thyroid. You've had low thyroid hormones for possibly a very long time, with the result that your body has changed, and its needs have changed, and hypos often need a hell of a lot more hormone than a healthy person. We need what we need and we should not be comparing ourselves to anyone else - especially not to people without a thyroid problem. So, best to forget this idea of what is a full replacement dose, and just keep increasing until you feel well and your labs reflect that.

[Apollo_Creed in reply to greygoose]

thanks greygoose am curious, what makes you say I've had low thyroid hormones for possibly a very long time? What is the natural timeframe progression of the disease? I think these last few months my thyroid has been producing small amounts, and I commenced treatment at sub-clinical stage rather than post-destruction of the gland. Looking back, I have suffered from hypo symptoms for at least 4yrs and possibly much much longer. Is it possible, given natural progression of disease, to have suffered symptoms for 5+yrs? Is it possible, even in the absence of Hashi’s and before the on-set of the underlying auto-immune disease, that my thyroid was not functioning properly?

[greygoose in reply to Apollo_Creed]

All things are possible. Hypothyroidism doesn't happen suddenly - unless you have your thyroid destroyed by some means. The progress is slow. And, when your thyroid first starts to fail, the adrenals take up the slack, so you don't notice. Symptoms come on slowly, and by the time you get to the point where they drive you to consult a doctor, they have probably been there quite some time. I fully believe - and an endo backed me up on this one - that I've been hypo since I was about 8 years old. I was diagnosed at 55. I had lots of symptoms, but didn't know what they were - and neither did any of the many doctors I consulted! I was never tested until I was 55.

So, yes, it's more than likely that you've been hypo for 5+ years. But, forget about 'natural progression'. If you don't have Hashi's, you don't even know why you're hypo. It may not even be a disease, but due to external factors. Even with Hashi's, we know very little about the natural progression, because it differs from person to person - progression is a very personal thing.

And, forget this rot about 'sub-clinical'. Doctors don't even know what that means. It's like telling a woman she's sub-clinically pregnant at three months. Either you are or you aren't, never mind what the TSH says, it's a very bad indicator of thyroid status. But, if it's over 3, you're hypo. A 'diagnosis' of 'Sub-clinical' hypo is a very handy wheeze for doctors to play down the seriousness of hypothyroidism. Don't be taken in.