Should I add T3? Or Increase / decrease 100 Levo? Looking for advice on recent bloods please (after 2 months on same meds)

[Sophie01]

I’ve been on Levo 100 for over 2 months now, and am hoping for some feedback on recent bloods please (I’m including the previous 2 thyroid panels for comparison)

8/5/19 after approx 2 months on 100 Levo (bloods drawn in Italy) -

TSH 2.08 (0.45-4.29)

FT4 0.79 (0.54-1.18)

FT3 3.43 (2.27-4.08)

14/4/19 after 4 weeks on 100 Levo -

TSH 2.29 (0.50-4.00)

FT4 17.5 (10.0-19.0)

FT3 3.7 (3.6-6.5)

31/3/19 After 2 weeks on 100 Levo -

TSH 4.42 (0.5-5.5)

FT4 12.6 (9.0-19.0)

FT3 2.9 (2.6-6.0)

These latest tests were done in Italy, so the units of measurement and ranges are quite different from those at home (Australia) but I THINK that now my TSH is just below mid range, FT4 just below mid range, and FT3 is just above mid range. So, T4 has dropped quite a bit, is this ‘normal’? But T3 has increased, so presumably moving in right direction?

I’m feeling ok-ish, not fab, but do crash every afternoon after lunch, sleeping well but wake unrefreshed....relevant Vitamin levels are pretty good, adrenals not perfect....I’d really appreciate any thoughts you might have about where to go from here?!

Thanks!

Sophie

[SeasideSusie Remembering]

Sophie01

TSH is generally best for us treated hypo patients when it is 1 or below, so we don't need to worry about how far through range that is, just look at the result.

FT4 and FT3 are generally best in the upper part of their ranges.

Previous results 14/4/19 :

FT4 17.5 (10.0-19.0) = 83% through range

FT3 3.7 (3.6-6.5) - 3.45% through range

Current results:

FT4 0.79 (0.54-1.18) = 39% through range

FT3 3.43 (2.27-4.08) = 64% through range

Did you do both tests under exactly the same circumstances? Early morning blood draw after an overnight fast (water allowed) and leaving off Levo for 24 hours?

Do you always take your Levo on an empty stomach, one hour before or two hours after food, with a glass of water only, and take any other medication and supplements at least 2 hours away from Leve (some need 4 hours)?

In answer to your questions:

Should I add T3?

No, not based on your current results.

Or Increase / decrease 100 Levo?

Increase Levo. 25mcg now, retest in 6-8 weeks.

relevant Vitamin levels are pretty good, adrenals not perfect....

What are these pretty good levels? If adrenals aren't perfect are you addressing that issue?

Calculator to check % through range for FT4 and FT3

chorobytarczycy.eu/kalkulator

norma od = lowest point of range

do = highest point of range

Oblicz = calculate

[Sophie01 in reply to SeasideSusie]

Dear SeasideSusie! I'm writing a very late sincere thanks for your reply about my bloods back in May - I really appreciate your feedback, it's invaluable! I've not written as I came down with shingles while overseas, holiday went severely pear shaped, have just recovered recently....so, I'm really sorry for this late reply! I'm only 50, young for shingles, but was quite rundown after lengthy run trying to stabilise thyroid meds....anyway, I followed your advice, and tried the increase of 25 Levo for a few days, but felt it was a little much (woke up several times at night, and felt slightly aggro) so for the past 10 weeks I have taken the extra 25 Levo every second morning (averaging out to daily increase of 12.5, to 112.5) I do always take bloods under same circumstances (early morning after fasting) and do always take my Levo as you recommend. I have taken bloods again recently, and wonder if you might offer some advice please?

18/7/19 after 10 weeks on 112.5 Levo

TSH 2.64 (0.5-5.5)

FT4 12.6 (9.0-19.0)

FT3 2.5 (2.6-6.0)

TgAb <10 (<115)

TPOAb <10 (<35)

I have been feeling overall much better with the increased Levo, but definitely much room for improvement (low arvo energy, and quite depressed) According to your calculator link (great, thanks!) FT4 is 36% and FT3 is -2.94%.....I wonder if my iron levels have dropped, and I'm not converting well, I'll have ferretin checked after see doc next week, just wanted to check in with you before I see doc, so I'm armed with a plan! I have been on zinc, B's magnesium, D3 etc for several years, all of those levels are optimal, but ferritin has been a problem in the past (had infusion about a year ago)

Thanks Susie, I really appreciate your help....please do let me know if you'd rather that I make a new separate post about the recent bloods?

Cheers

Sophie

[SeasideSusie Remembering in reply to Sophie01]

Well, something strange appears to be going on with your FT3 result. Looking at the results you've posted

31/3/19 After 2 weeks on 100 Levo -

TSH 4.42 (0.5-5.5)

FT4 12.6 (9.0-19.0) = 36%

FT3 2.9 (2.6-6.0) = 8.82%

I think you changed from NDT to Levo so it was too soon to test and when on NDT you can't know how well you convert because you are taking exogenous T3 in the NDT. You can only see how well you convert when on Levo only.

14/4/19 after 4 weeks on 100 Levo -

TSH 2.29 (0.50-4.00)

FT4 17.5 (10.0-19.0) = 83.33%

FT3 3.7 (3.6-6.5) = 3.45%

8/5/19 after approx 2 months on 100 Levo (bloods drawn in Italy) -

TSH 2.08 (0.45-4.29)

FT4 0.79 (0.54-1.18) = 39.06%

FT3 3.43 (2.27-4.08) = 64.09%

18/7/19 after 10 weeks on 112.5 Levo

TSH 2.64 (0.5-5.5)

FT4 12.6 (9.0-19.0) = 36%

FT3 2.5 (2.6-6.0) = -2.94%

On Levo only, you seem to be swinging from poor conversion to good conversion.

TgAb <10 (<115)

TPOAb <10 (<35)

Even though your current antibody levels are very low, your first post on the forum tells us that you were diagnosed with Hashi's in 2015

healthunlocked.com/thyroidu...

and you quoted these results

3/ 09/ 2018

TgAb - 24 (<115)

TPOAb - <10 (<35)

24/11/18

TG 29 (<60)

TPO <28 (<60)

Do you have results from when Hashi's was diagnosed because those results don't show Hashi's.

Are you addressing the Hashi's with a gluten free diet and supplementing with selenium?

I don't know if the Hashi's is causing the strange results but your current results from 18/7/19 show you are undermedicated with a TSH of 2.64 and FT4/FT3. The aim of a treated hypo patient generally is for TSH to be 1 or below or wherever it needs to be for FT4 and FT3 to be in the upper part of their reference ranges, if that is where you feel well. So an increase in Levo is needed but as you seem to have trouble with that you may be someone who needs to take it very slowly and gradually.

How is your ferritin level now? Essential that all vitamins are optimal for good conversion:

Ferritin - at least 70 for thyroid hormone to work properly, I've seen it said that 100-130 is a good level for females.

Vit D - 100-150nmol/L or l40-60ng/ml according to the Vit D Council/Vit D Society.

B12 - minimum 550pg/ml (or ng/L) for Serum B12 but that isn't the most accurate test, Active B12 test is better and it should be well over 70 (below 70 suggests testing for B12 deficiency).

Folate - at least half way through range.

Are your adrenals optimal now:

Waking + 30 minutes - top of range

Noon - 75% of range

Evening - 50% of range

Nighttime - near bottom of range

If you want further comment from other members then make a new post and link back to this one for background information.