Rookie mistake?

[NWA6]

I just got my latest my results

FT4 July 14.1 (10-20)

May 16.2

FT3 July 4.7 (3.5-6.5)

May 4.8

Background - 10yrs on Levo, sometimes ok, other times very symptomatic, eventually crippling symptomatic leading me to add T3 after consistent low FT3 scores showing poor conversion rate.

Before adding T3 I was on 150 x5 175 x2 Levo

After adding T3 125 x5 150 x 2 Levo + 15mcg T3. Initially I took the 15mcg in 3 split doses. After 2wks I took 10mcg in the morning and 5 at bedtime. So in May I would have had 5mcg 8/10hrs before the morning blood test.

After the May blood test I increased T3 to 20mcg

Split in 2 doses. After 3wks I decided to take all 20mcg in one dose in the morning as I really tolerate it well with no side affects.

I didn’t adjust the timings before my blood test so it would have been 24hrs since I took any meds at the time of my blood test.

The drop in my FT4 reflects the drop in Levo after 10wks so I’m not surprised at that. I think I was expecting an increase in FT3? But I guess the result is a reflection on the timings of ingestion to blood test?

I feel very good, very active, started running ect again in the last 2wks with no drop in energy. The only thing I have left over from my 10yrs of Hashi’s is stiff and sometimes painful joints (mainly ankles and pelvis) So for example I can’t sit on a hard chair or floor and I can’t sit with my leg under me or else I walk like a cripple for the first few strides. But also if I’m sat for a couple of hours on the sofa I can be stiff too.

So should I just accept the fact that I’m well and not worry or should I adjust my timings of T3 for the next blood test?

[greygoose]

If we use the rough calculation of + 20% to adjust for the bad timing, that gives us 5.64. So, if it were me, I'd try an increase of 5 mcg T3, and see if that helps.

[NWA6 in reply to greygoose]

That’s really helpful thanks greygoose 🤗 The only thing that would concern me with an increase is this

Levo only RHR average 45bpm (insomnia)

15mcg T3 RHR 63bpm (sleep by 10.30 latest)

20mcg T3 RHR 71bpm (sleep by 11.30 )

Should I play with the Levo amount instead? I know that a drop in Levo dose is usual when introducing T3 but I was never really comfortable with the drop, as I was so unwell. There’s only a difference of 125mcg per week on this reduced dose but what if I went back up to my original dose of 1100mcg per week first and try and raise that FT4 number?

Would this keep me more stable than adding more T3 as I do convert (usual results around 3.5 (3.5-6.5)?

My thoughts are that I have enough energy but I don’t want to go to sleep any later than I already do and I don’t want anymore increase in RHR.

Or sod it I need to back to at least 2 split doses?

[greygoose in reply to NWA6]

Frankly, only you can decide that. I've told you what I would do, but I can't tolerate T4 at any price. Maybe you need more T4, because we're all different. But, you're going to have to experiment to find out what is the best dose for you, and when it's best for you to take it.

[SeasideSusie Remembering]

Paula6

But I guess the result is a reflection on the timings of ingestion to blood test?

Yes, you have a false low as you took your last dose of T3 24 hours before the test.

So should I just accept the fact that I’m well and not worry

If you feel well, there is no need to adjust dose.

or should I adjust my timings of T3 for the next blood test?

Yes, use the recommended timing of last dose of Levo 24 hours before test, last dose of T3 8-12 hours before test.

[NWA6 in reply to SeasideSusie]

Thanks SeasideSusie 🤗 So in the future would I take all my 20mcg at night instead OR would I split it 10in the morning, 10 at night. Because I’m my mind 10 at night would only reflect the 10mcg?

[SeasideSusie Remembering in reply to NWA6]

I normally take my T3 in one dose early morning. The day before I do thyroid tests I split my dose - first dose with my Levo 24 hours before I do the test and second dose of T3 between 9pm and bedtime which will be 8-12 hours before the test. I do it that way because most people split their T3 dose so I imagine that's what the advice originally was based on.

[NWA6 in reply to SeasideSusie]

So really in essence your FT3 result is half of your actual dose?

[SeasideSusie Remembering in reply to NWA6]

So really in essence your FT3 result is half of your actual dose?

No, the result of a test done 8-12 hours after taking your dose is said to show the normal circulating amount of T3 hormone. T3 is said to have a half life of about 24 hours, and the dose you take is said to be undetectable in the blood after 12 hours (but of course it will be in the cells).

[SlowDragon Administrator]

If your not sleeping so well, you may need to split dose T3 and take 5mcg before bed

Many people find T3 improves sleep

If you left 24 hours between last dose Levothyroxine and blood tests, I would increase Levothyroxine slightly

You don't want FT4 to drop any further.

Or just play around with changing timing and/or splitting of T3 dose

Just because you can tolerate taking T3 in one go, doesn't mean you are getting best out of it by doing that

I definitely wouldn't increase T3 without retesting leaving correct time gap between last dose of T3 and blood test

[NWA6 in reply to SlowDragon]

I’m sleeping well just an hour later than on 15mcg and overall that’s nice. But as I said in previous post somewhere the only downside to T3 is lots of dreaming which while not nightmarish, not always the same as ‘dead asleep’ But I agree that I’d rather raise my T4 than my T3 at this stage. I think I’ll take your advise and go back to a split dose. I was hoping that it would alleviate my dream state but it hasn’t.

Overall I’m in the best health EVER in my whole adult life, even before Hashi’s diagnosis I could be quite melancholy and since adding T3 I have such a positive mental attitude even when life throws their best at me (ie my daughter not feeling well, my son pushing the 16yr old boundaries, 13yr old doing the same and now homeschooling my 11yr old. Still I can cope with it all rationally)