T3 timing question followup

[Coachgeorge]

My blood work is back this morning. It would be helpful if I had some suggestions before I go to the doctor today

Ferritin 81 (18-204)

ft4 1,32 (.8-1.80) Was 2.39 on July 5

TSH 4.49 (.4-4.5) Was 2.070 on July 5

ft3 3.2 (2.3-4.20) Was 2.8 on July 5

I've been on 5mcg of T3 medication since July 12. As I described in yesterday's posts, I'm not doing well. I am probably going to ask to see an endo. Any thoughts would be appreciated. Until this draw, my ft4 was steadily climbing.

I’m taking 50mcg of levo as well. Thank you!

[greygoose]

Your ferritin is too low. Are you sure about that upper range? 2040? Or 204? In any case, it's low.

And your TSH is much too high. You're still hypo.

Your FT4 has gone down because you've added in the T3.

Your FT3 is just below mid-range, you probably need it higher, as I suggested yesterday. Adding another 5 mcg would be a good thing to try.

[Coachgeorge in reply to greygoose]

It was a typo, I think I corrected it. What would bring the TSH down? Do I even need to be concerned about it?

[greygoose in reply to Coachgeorge]

I doubt if it would bring the TSH down. But, the TSH is not your main problem. It's raising the thyroid hormones that is important. But, if your ferritin is too low, it could affect all sorts of other things. I don't think you need to be all that concerned about it, though. Could you try eating liver once a week, to raise it?

[Coachgeorge in reply to greygoose]

The thought turns my stomach but it’s certainly better than what I’m going through now. I’ll try anything. My red blood cell count is usually high. Will liver make it higher?

[greygoose in reply to Coachgeorge]

I'm afraid I don't know much about red blood cell counts. But, it might. So, check with your doctor first - although he'll probably think your ferritin is 'perfect'.

[Coachgeorge in reply to greygoose]

Thank you. I took my thyroid meds about an hour ago. My body is already starting to tingle. In another few hours, I’ll be sick as a dog. The frustration continues... ugh!

[greygoose in reply to Coachgeorge]

Well, in that case, it has nothing to do with the hormone. It's the fillers that are upsetting you. Have you tried different brands of levo to see if they suit you better?

[Coachgeorge in reply to greygoose]

I always take what’s given at the pharmacy. I should probably check to see if the brand has been consistent. I’ve heard folks ask for synthroid only. Would that help?

[greygoose in reply to Coachgeorge]

If synthroid agrees with you, yes. You need to find which brand you do well on.

But you could check ingredient on internet, see if there's a pattern.

[Coachgeorge in reply to greygoose]

I’ll check with my pharmacy to see what they’ve been giving me. Thank you

[greygoose in reply to Coachgeorge]

You're welcome.

[NWA6]

Are you absolutely sure that you are not making yourself more ill by taking such a small amount of T3?

[Coachgeorge in reply to NWA6]

Not sure I understand your question. More? Sorry

[NWA6 in reply to Coachgeorge]

Sometimes if we had replacement meds if we don’t add enough we can actually feel worse. Your FT4 is only 52% through range and your FT4 is only 47%. You’re not taking enough of either hormone. So as has been suggested up the dose of one or the other. Your T4 probably shouldn’t have been reduced so much. If it were me and I added more T4 I’d probably only wait a few weeks before testing again and add more if needed. Then another couple of weeks and add T3.

I’m saying that to be cautious but hell if I were as ill as you I’d probably just slowly increase both at the same time.

[Coachgeorge in reply to NWA6]

I just got back from the doctor's office. Since it's been less than 6 weeks since my last draw, she wants to give it another couple of weeks before we increase. She said I'm moving in the right direction but is concerned about going too fast. She also gave me a presciption for Vitamin D. My ferritin is a little low but my hemoglobin/red blood cell count is borderline high. She's concerned about adding iron at this time. We are also going to retest my folate and B-12 in a couple of weeks. I'm anxious to feel better but also understand that this process takes time. I'd rather jump in and increase the doses but from what everyone says, it takes about 6-8 weeks. That timeline coincides with her plan to test again. I am miserable but she sees improvement as does my husband. It's so hard for me to tell how I'm doing from day to day. I've been sick for seven months and we just figured out it's my thyroid. Previously, we thought it was a reaction to steriods. Seems like the steriods weren't at the core of my problems, just made it worse. She told me to come back before my next appointment if I feel like I'm not improving. So, the bottom line is that I'm going to stay the course and see where I stand after these doses in a few weeks. I'm sure I'm going to bug you all and complain. I appreciate everyone and the great information. Thank you!!!

[SlowDragon Administrator]

Your TSH is far too high, FT4 too low and likely FT3 too low as well

Suggest you request 25mcg dose increase in Levothyroxine and retest again in 6 weeks

You may also need to add a 2nd 5mcg dose of T3 ....but we usually advise only make one change at a time

You also need vitamin D, folate, B12 tested

Taking ANY dose of T3, (even a tiny 5mcg dose) will significantly lower TSH .....turning your own thyroid production down

Your results clearly reflect that you are under medicated

[Coachgeorge in reply to SlowDragon]

Trying to understand, please forgive my ignorance. My tsh went up when I started the 5mcg of t3. Should it have gone down?

[SlowDragon Administrator in reply to Coachgeorge]

If you were on correct dose, yes

You're on very small dose on Levothyroxine and T3

You likely need increase in both.....but only do one at a time

Was Levothyroxine reduced when T3 was added?

If so, by how much?

[Coachgeorge in reply to SlowDragon]

Yes, I was on 100mcg for years. She reduced to 75 mcg. When she added t3, she reduced to 50mcg.

[SlowDragon Administrator in reply to Coachgeorge]

Levothyroxine should only have been reduced if FT4 was to high

What were results on 100mcg?

Same question....what were results on 75mcg?

Do you always get same brand of Levothyroxine

Many people find Levothyroxine brands are not interchangeable.

Once you find a brand that suits you, best to make sure to only get that one at each prescription.

Watch out for brand change when dose is increased or at repeat prescription.

Many patients do NOT get on well with Teva brand of Levothyroxine. Though it is the only one for lactose intolerant patients.

Teva is the only brand that makes 75mcg tablet.

Do you have autoimmune thyroid disease also called Hashimoto's diagnosed by high thyroid antibodies?

[Coachgeorge in reply to SlowDragon]

My FT4 was 2.03 at 100 mcg and 2.39 at 75mcg. She reduced to 50mcg and added the 5mcg of T3. I need to check with the pharmacy before I go to the doctor's today. I haven't been watching the levo brands. I've never been diagnosed with Hasi. My antibodies and vitamins were in range. I was a little low on D and ferritin but still in range.

[SlowDragon Administrator in reply to Coachgeorge]

Have you had BOTH TPO and TG thyroid antibodies tested?

So your FT4 was slightly high.

But many people on just Levothyroxine need high FT4 and suppressed/low tsh in order to have high enough FT3

What were TSH and FT3 results on 100mcg and 75mcg

[Coachgeorge in reply to SlowDragon]

She didn't check TG. My TSH on 100 mcg was 1.84 and on 75 mcg it was 2.070. My ft3 was 2.8 and 2.6 respectively.

[Coachgeorge in reply to Coachgeorge]

I looked on my pharmacy app to check brands of Levo. Amneal is the brand name with one exception back in December it was Lannett. My liothyronine is made by sigma pharm.

[SlowDragon Administrator in reply to Coachgeorge]

So on 100mcg Levothyroxine your results did not show over medication.

TSH right at top of acceptable levels for someone on Levothyroxine, and FT3 well within range ....if anything you might have benefited from small dose increase in Levothyroxine. (Or tiny drop in Levothyroxine - eg 100/75mcg alternate days and addition of T3)

Many people on Levothyroxine need TSH under one

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,

"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l.

Most patients will feel well in that circumstance. But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."

You can obtain a copy of the articles from Thyroid UK email print it and highlight question 6 to show your doctort

 please email Dionne at

[e-mail]

[Coachgeorge in reply to SlowDragon]

So now I’m thinking I might ask for 75mcg of levo. Stay there for 6-8 weeks and then consider adding 2.5 mcg of t3. Thoughts?

[SlowDragon Administrator in reply to Coachgeorge]

Definitely increase in Levothyroxine

Retesting after 6-8 weeks

Re-evaluate once you get results

[Coachgeorge in reply to SlowDragon]

Okay, so I'm looking at 75mcg and staying at 5mcg for T3? Appreciate the assistance.

[SlowDragon Administrator in reply to Coachgeorge]

Come back with new post once you get results and ranges in 6-8 weeks after Levothyroxine increase

[Coachgeorge in reply to SlowDragon]

I will! As I predicted this morning, my symptoms are really ramping up right now. It happens everyday around this time. I’m trying very hard to stay busy. It’s rough. Thank you

[SlowDragon Administrator in reply to Coachgeorge]

So you need to get TG antibodies tested

Many people have only high TG antibodies

[Coachgeorge in reply to SlowDragon]

Will try again. Thank you

[SlowDragon Administrator in reply to Coachgeorge]

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and fasting. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

Last Levothyroxine dose should be 24 hours prior to test, (taking delayed dose immediately after blood draw).

If/when also on T3, make sure to take last dose 8-12 hours prior to test, even if this means adjusting time or splitting of dose day before test

[Coachgeorge in reply to SlowDragon]

I followed this protocol for my last draw. thanks

[Hidden]

I second it, increase in Levo would make sense! You should feel something already around a seven day mark, I normally do, so hopefully you will too! Are you going up by 25 or 12.5? Your ft4 was high on 75 of Levo, but some people feel well if that is the case. I don't, I need to have it just around 60% if using t3. Your thyroid is still.producing t4 so when you take more levo like 100 mcgit suppresses production of thyroxine more than dose of 75 mcg. Your conversion isn't great so not sure how much your ft3 might go up by. Trial and error!

[Coachgeorge in reply to Hidden]

I go to the doctor today. I’ll see what she has to say. I’m hoping an increase of ft4 will help. I thought the t3 was causing my symptoms but maybe not. Trying very hard not to hit the bed. Thanks

[Barrett582]

I have been stable on 50mcg T4 and 15mcg of T3 for seven years. I take my T4 at night and my T3 in three equal doses during the day. I had always taken the Mayne T3 (Paddock, Perrigo, Mayne, Libertas). About two years ago, the pharmacy gave me SigmaPharm T3. I felt the buzzing that you describe and felt over medicated. I tried cutting the tablet into quarters (1.25mcg) and spacing the doses equally throughout the day. I still felt the buzzing and the over medication with each dose. I had the pharmacy order Mayne T3 and I have been stable since. You should try another brand of T3 if possible. It is hard enough to find your personal dosage and timing of T3. You definitely need a brand of T3 that agrees with you. Good luck.

[Coachgeorge in reply to Barrett582]

That’s good to know. I’ll talk to the pharmacist. Thank you for helping.

[Barrett582 in reply to Coachgeorge]

You’re welcome.