Please can you check these thyroid results for us? And tell us if everything’s ok or not , thanks so much in advance

[Isobelfred]

Had some new thyroid results for my mum who’s doing ok but struggling with being wiped out after exercise, chest pain and sometimes palpitations.

We made sure the test was done perfectly (without coffee like the last test) and of course without medicine until after.

Antibodies always come back at 80 which we always expect.

TSH - 0.53

Ft4 - 18 (10-24)

Ft3- 5 (4-8)

Been taking 50mcg Levo since last test, and since November last year.

She’s occasionally tried to take 75 but it absolutely wipes her out asleep for the entire day from exhaustion and chest pain. We know for sure that “upping the dose” isn’t an option it really makes her ill.

[greygoose]

OK is really not what we're aiming for. We're aiming for optimal. Yes, they're OK, FT4 slightly over mid-range. FT3 under, but not bad. But, unless she feels good, they're not optimal.

If she cannot take an increase of 25 mcg, she could try an increase of 50/75 on alternat days. Or 50/50/75. There are all sorts of combinations that will give her a slight increase that might do the trick, without giving her too much hormone.

But, at least she seems to be converting not too badly. And that's a blessing.

[Isobelfred in reply to greygoose]

Thank you. We did try alternate days but it was still as bad, the effect of 75 is immediate, just boiling hot skin constantly eating and exhausted, she will sleep all day on a day of 75.

What’s about the chest pains and palpitations ? This is new for her. And slightly more exercise intolerant as of late

[Isobelfred in reply to Isobelfred]

My thought was to reduce ? seems like her symptoms are of hyperthyroid?

Or would you say not

[greygoose in reply to Isobelfred]

I don't think I'd reduce.

She can't be hyper because she's hypo, and the thyroid doesn't jump around like that. She could be over-medicated, but she isn't. Her FT3 isn't even mid-range. If she were over-medicated, her FT3 would be over the top of the range. If anything, I think she's under-medicated.

I don't know about the chest pains (indigestion?) but palpitations can be symptoms of under-medication, as can sleeping abnormalities and exercise intolerance. What sort of exercise are we talking about?

You say that increasing increases her appetite, but is she actually eating enough, now? Low calorie intake will reduce conversion.

Has she had her nutrients tested: vit D, vit B12, folate, ferritin?

[Isobelfred in reply to greygoose]

She’s never been a big eater , maybe that’s the prob?

Her chest pain she describes as too much coffee. If her TSH is at 0.53 in a morning with no Levo surely an increase will knock it way down? Her TSH began at 11 and is now here. We seems to find that as her t4 rises her t3 goes down and if her t4 is low her t3 is above range ! It’s crazy ?

Exercise is just walking the dog for an hour everyday. X

[greygoose in reply to Isobelfred]

Not eating enough could certainly be part of her problem, yes.

I've no idea what too much coffee feels like, I don't drink it! lol

If she increases her levo, her TSH probably will go down, but so what? If that is necessary to get enough hormone into her, then so be it. You cannot dose by the TSH. She needs what she needs. And, the only other alternative is to add T3 to her levo (or take NDT). Which will suppress her TSH. But, don't worry about the TSH, that is the least of her problems. The important number is the FT3.

We seems to find that as her t4 rises her t3 goes down and if her t4 is low her t3 is above range ! It’s crazy ?

Well, perhaps not. It could mean that she still has some working thyroid, and it's compensating by increasing production of T3. That is a possibility.

Perhaps you should try reducing her levo, then. See what happens. If she doesn't mind being experimented on.

Walking the dog is excellent exercise!

[Isobelfred in reply to greygoose]

Is it a possibility that a reduction is needed ? Could we try it ? Just throwing in a few 25s?

[greygoose in reply to Isobelfred]

What do you mean by 'throwing in a few 25s'? Sounds weird. lol

[Isobelfred in reply to greygoose]

In a week of taking all 50s everyday , just taking a few 25s instead and seeing how she feels after 6 weeks maybe ? All we know for sure certain absolute lol is that 75 is a no go area. Grey goose, is it normal for a TSH of 11 to go down to 0.53 on 50mcg? Is she going to turn to overactive ?

[greygoose in reply to Isobelfred]

She can't turn over-active. I explained that, above. Her thyroid is under-active, that's quite clear. It can't suddenly regenerate to the point of being over-active. Levo is not a treatment for the thyroid, it doesn't make the thyroid work better. It's thyroid hormone replacement, replacing the hormone her thyroid can no-longer make enough of.

And, I did say above she could try taking 50/50/75. Or even 50/50/50/75. It might be complicated to keep track of, but I'm sure you could deal with that.

BUT, NWA6 raised a very good point: are the 75 mcg - or 25 mcg - a different brand to the 50 mcg? If so, it could be a problem of the fillers, rather than anything else.

[Isobelfred in reply to greygoose]

I know I must sound stupid, I guess I keep asking about reduction because we know 75 is not possible on any day. I know it’s hard for you to believe it has that much of an effect , but when she’s had the 75 she’s just gone. Can not function, can’t move, has to stay in bed and feels like she’s done a marathon in her words. So ruling out an increase completely for now she wouldn’t take 75 again anyway even if I told her that’s what you guys have told her to do, because she knows it makes her ill to the point of days off work. After she’s gone back to 50 she felt relief and a release of a stressed feeling.

We understand Levo isn’t going to fix anything , it’s a replacement for a thyroid that’s not working.

How about 6 weeks of continuing with 50mcg, but adding in 2 or 3 a week of just 25mcg? Just to see ! And then test again at the end ? What do you think grey goose

[greygoose in reply to Isobelfred]

I do believe you. But, if it happens on the actual day she takes the 75 mcg pill, it has nothing to do with the hormone itself, because the hormone won't have had time to have done anything. Hormones work slowly. Therefore, it has to be the fillers, which is why I asked about a change of brand. But, you've been asked that three times and haven't replied. What brand is she taking, and does it change when taking 75 mcg?

So, if you understand about levo not fixing the thyroid, then you must know that she cannot 'go hyper'. It's a physical impossibility. She could be over-medicated, but she isn't. So, we come back to the fillers causing the problem.

And I really don't understand your logic of 'throwing in' the occasional 25 mcg. Because on those days, she will be taking 75 mcg, and you said she wouldn't contemplate taking 75 mcg ever again. I think I must be missing something, here.

[Isobelfred in reply to greygoose]

Yes, I didn’t say an additional 25. I said 25. That’s the part you misread and you’re missing.

I also did answer her when she asked about the brand. If you look you’ll see you replied to me. I told her the brand too, can you see it now ?

It won’t be the fillers , it’s bevause 75 is too much for her for sure.

[NWA6 in reply to Isobelfred]

You stated that your mum is only 8st 12, so she’s not a big person. Hence why she wouldn’t necessarily need a big dose of Levo to make a change (ie 11 down to below 1) Your mums TSH is fabulous but it makes not one bit of difference if she’s still feeling crappy.

I had similar story. Forever feeling like i need a dose increase because I was wiped out but when I did increase I felt like I’d drunk too much coffee (I’m sensitive to the stuff anyway but I know exactly what your mum I talking about when she describes her reaction as this, jittery, heart palps, tired but wired 😂) My T3 would never really increase to an optimal level but yes it would drop by .2/3 when I increased Levo so in that regard if it’s not an intolerance (I never ever got atopic reactions) then it may be that she needs to look at adding T3. But try different brands or checking the 25mcg tablet is the same brand. Then try diet and supplement changes/adding. I had a very poor appetite when under medicated.

[Isobelfred in reply to NWA6]

Thanks for this. It feels so hit and miss because no ones symptoms are the same. When mum was at her worst (TSH 11) she could not stop eating ! All day long ! Now she’s been on medicine for 6 months she doesn’t crave sugar or binge at all. Unless she takes 75 and then she cannot stop eating all day long ! I’m talking loooads lol !

We haven’t ruled out that her thyroid might balance itself out , a lot of people would shut us down immediately after saying that, but her hospital Endo has told us that it may or may not be life long replacement, he actually said to her that thyroids go through all kinds of changes when the body does things like experiences stress, child birth, quitting smoking or other things that create hormone imbalance.

But for now we’re staying medicated until we know for sure x

[Isobelfred in reply to greygoose]

Greygoose can just ask about what you said here regarding not eating enough and coversion? She eats like a rabbit , what is it that can happen here? Please

[greygoose in reply to Isobelfred]

You need a decent intake of calories to be able to convert correctly - somewhere around 2000 a day. If you don't get enough, then conversion of T4 to T3 slows down, and your FT3 drops.

This is a problem for everyone, hypo or not, and why sometimes people on very low calorie diets can find themselves putting on weight, rather than losing. But, it's especially problematic for hypos.

[NWA6]

Sorry to hear the worry your mum is experiencing, hard for you aswell to support her. So she’s on Levo? And she experiences side effects on increase immediately? That’s unusual and maybe a reason to look at the brand she is taking and change it (others are more knowledge of side effects of different brands)

Her FT3 defiantly has some wiggle room, esp if she is an active older person. FT4 is a good range and your mum should be able to increase (alternate days or adding in just 2/3 days of a higher dose) without sending her over range, if she could tolerate it. So I’m thinking it’s the brand that she’s not getting on with rather than the dosing. How are her vitamin levels and diet? (Again others are more knowledgable than me and o hope they reply)

Good luck in finding your answers 🤗

[Isobelfred in reply to NWA6]

Thanks so much

She’s a healthy woman ! She’s 54 and weighs 8 stone 12

Very healthy , tried to be as active as possible but exercise wipes her. This only started when she stopped smoking two years ago.

We have tried to hard to tolerate the 75 it’s impossible, she’s debilitated her knees are in pain and she has to have the day off, but we found this to be a positive in that we know for sure it is not an increase that’s needed. She’s out of it on that dose, and her skin feels like a radiator. X

We are working on low iron xx

[NWA6 in reply to Isobelfred]

This sounds more like intolerance to the brand or Levo rather than because she’s trying to increase. And as a funny/not funny FYI Isobella Wentz states that smoking actually delays the onset of underactive. Don’t quote me but it’s in her book. So when your mum stopped smoking it may have had something to do with her problems. But ofcourse don’t start her on 20 a day again 😂😬

[Isobelfred in reply to NWA6]

We read that too ! It can cause so many issues can’t it. It sounds like intolerance to me too of some sort.

Fingers crossed , I’ll get her better

Thank so much

[greygoose in reply to Isobelfred]

That's a good point I hadn't thought of. Does increasing to 75 mean a change of brand?

[Isobelfred in reply to greygoose]

No guys, always the same brand.

[NWA6 in reply to Isobelfred]

😩 well at least that’s one reason ticked off! Just out of interest what brand is it?

[Isobelfred in reply to NWA6]

It’s called almus? Or albus? I’ll ask her when she’s finished work.

[NWA6 in reply to Isobelfred]

Yes Almus is a brand. Try doing a search on for this forum and see if anyone has had problems with it.

[Isobelfred in reply to NWA6]

That’s a great idea , I’ll do that thank you

[greygoose in reply to Isobelfred]

OK, well, that's good, anyway.

I don't think you've replied about her nutrients - I asked if they'd been tested - unless I've missed that somewhere.

[Isobelfred in reply to greygoose]

Sorry it’s because I try to relay info to her and I get mixed up on this rubbish laptop ! I really am greatful for the help we get on here and I don’t mean to miss questions, she’s low on iron but we’re working on it.

[greygoose in reply to Isobelfred]

Have you got the results for the vit D, vit B12 and folate? Just because your doctor says they're OK, doesn't mean they are. Best if you post the actual results and ranges.

I've just had a thought… When she takes 50 mcg, presumably that is one 50 mcg pill, yes? So, when she takes 75 mcg, is a one pill? Or 50 + 25? I believe that sometimes the fillers can be different in different strengths. Is it possible for you to check on the fillers?

[Isobelfred in reply to greygoose]

I’ll check up on both of things you’ve said greygoose. I do know for sure she took one tablet of 25 and one tablet of 50 to make 75. Both almus brand.

Her doctor is a horrible rat bag and he’s pretty mean and dismissive, so we have to go through the receptionists and get them to tell us exactly what the screen says. I will get a print out of the vit levels and post a photo it’s easier.

Some of them are on my last post but not the recent ones.

It’s a massive comfort to actually work through it with people who know what they’re on about , so thank you.

I’ll post all of those results, and also new results in 6 weeks time after taking some 25mcg tablets instead of 50 mcg, so it goes somthing like 50, 50, 25. Then retest and post.

With the new chest pains and new tiredness it’s worth a try and see what happens.

[greygoose in reply to Isobelfred]

OK, so by 'throwing in some 25 mcg' you actually meant a reduction in dose, not an increase! Well, my honest opinion is that it probably won't make much difference to anything. I think she's under-medicated, but we'll see how she feels.

But, I do think you should check on the fillers, to see if there's a problem there.

[Isobelfred in reply to greygoose]

Yes I did mean that I should write what I mean more clearly.

Ok, I’ll do that. See you all in 6 weeks

[greygoose in reply to Isobelfred]

Good luck!

[Isobelfred in reply to greygoose]

Me again guys, just found out my mums tablets are different brand.

The 25 is mercury pharma and the 50 is almus.

Greygoose what shall we do now we know this? Which brand do we use ? The almus ?

Which will mean cutting pills up if we were going to try 50 50 50 75 as you recommended we try

[greygoose in reply to Isobelfred]

Presumably she was ok on the Almus? In which case, stick with that one.

It's ok if you have to cut the pill. You can do that with a good pill cutter. Worth a try, anyway.

[Isobelfred in reply to greygoose]

Yeah she was ok on that one , ok thanks again

[greygoose in reply to Isobelfred]

You're welcome. And, I hope it works.