Pls advise - latest results show only nominal improvement with persistent symptoms

[Apollo_Creed]

Hi folks,

Here are my latest results. I'm currently on T4 125mcg and T3 20mcg per day. My medication level is reasonably high for my profile - I'm 40yrs old and 73kg - yet I'm nowhere near optimal range despite near full replacement dose.

I also have persistent symptoms of fatigue, head throbbing and ears ringing. TSH is slightly suppressed and T4 and T3 still well below range despite high dose.

My main concern is persistent head throb as it suggests an underlying problem that could lead to long term neurological damage.

Latest results: 21 March 2019

125mcg T4, 10mcg T3 x 2 daily

TSH 0.19 (0.27 - 4.2) -2.04% through range

FT4 15.7 (12 - 22) 37.00% through range

Total T3 2.0 (1.3 - 3.1) 38.89% through range

Previous results: 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

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

Thank you

[Judithdalston]

What you don’t mention are your ferritin, folate, b12 and vit D levels, these need to be optimal in upper ranges, to aid thyroid health and conversion. Some of your symptoms might be related to low vits/ mins. Are you Hashi with high autoimmune antibodies, as we get low nutrient levels due to poor gut absorption? Once you are taking T3 your FT4 will go down, as will your TSH...it’s really only the FT3 that is important, tho some feel better on high FT4 others get rid of F4 altogether. Taking T3 is tricky... I might have upped T3 dose rather than the levo. Are you doing this thru an endo, or DIY? Have you tried flooding the receptors with onedose of T3 instead of two doses? What about recording bp, pulse, basal temp. - do they give any idea what seems to be better for you?

[Apollo_Creed in reply to Judithdalston]

hi Judithdalston thanks for your reply. Vitamins are OK. See results below. Yes I have Hashi.

Yes I think I will up the T3 and lower the T4. I'm am doing this through and endo and the dose change is on his recommendation to see how things go. I have taken T3 all in one go. I don't specifically recall whether that was effective. The endo subsequently advised against it and now I do split dose.

Ferritin 185 (30 - 400)

B12 >2000

Folate 3.7 (>2.9)

Vit D 67 (>50)

[Judithdalston in reply to Apollo_Creed]

Ok, not used to these ranges....but keep a regular eye on them as can quickly come down, in an unpredictable manner eg just one plummets. Because as you say you ‘didn’t recall’ ...keep a diary ....perhaps as evidence to fight endos advice in future. I take it you were on something like 200 mcg levo. at one point, as you talk about near full replacement dose. Did you not convert properly? Unfortunately the idea of ‘replacement doses’ doesn’t always work like that...I had never been higher on levo than 150 mcg, but never got FT3 to halfway thru range , even tho got FT4 above it. But even on 100mcg T4: 50 mcg T3 combo , which would be ‘equivalent’ of 300 mcg T4...it didn’t work, so now on T3 only currently 62.5 mcg only, and rising. How quickly do you raise T3...hopefully no quicker than only 1/4 pill every 2 weeks ( or same lowering it)? Sadly can’t explain you headaches etc.

[SeasideSusie Remembering]

I'm nowhere near optimal range despite near full replacement dose.

What's a "full replacement dose". Don't we all need whatever dose is appropriate to give optimal results and improvement of symptoms?

TSH is slightly suppressed and T4 and T3 still well below range despite high dose.

Latest results: 21 March 2019

125mcg T4, 10mcg T3 x 2 daily

TSH 0.19 (0.27 - 4.2) -2.04% through range

FT4 15.7 (12 - 22) 37.00% through range

Total T3 2.0 (1.3 - 3.1) 38.89% through range

Your TSH is where one would expect it to be when taking T3 - it tends to lower, even suppress TSH.

Your FT4 is not below range, you've worked out that it's 37% through range. Again, taking T3 tends to lower FT4. It may or may not be at the level that's best for you. I take a combination of Levo and T3 and I need both FT4 and FT3 about 75% through range, but we are all different and my level wouldn't suit everyone.

Total T3 is not a useful test, it doesn't tell us anything. It's Free T3 that's needed when on T3 hormone replacement.

If you get your test repeated, to include TSH, FT4 and FT3, we can then see how you're doing with that dose of T3.

I also have persistent symptoms of fatigue, head throbbing and ears ringing

Have you got current results for

Vit D

B12 - Active B12 as this was only 63.3 six months ago and you were going to get tested for pernicious anaemia. Serum B12 can be good but that doesn't mean Active B12 is going to be good.

Folate

Ferritin

[Apollo_Creed in reply to SeasideSusie]

Hi SeasideSusie thanks for your response. Yes, not surprised that TSH is low. What confuses me is why T4 and T3 are below mid-range despite taking significant amounts of both? How/why does taking T3 lower T4? If I were taking artificial T4 (i.e. medication) would that not show up in blood test?

Re total T3, yes they made a mistake and ran the wrong test. It should have been free T3. The endo says it won't make too much difference in terms of results. Not sure about that?

As for vitamins, things are OK on that front. I had a loading dose of B12 over the last couple of months and tested negative for pernicious anaemia. Recent results:

Ferritin 185 (30 - 400)

B12 >2000

Folate 3.7 (>2.9)

Vit D 67 (>50)

[silverfox7 in reply to Apollo_Creed]

I was told that once we detect the T3 our body can't see the point of holding onto much T4 and then having to convert it.