Most recent blood test

[Blueskyyy]

Hi all

I just received the results of my blood test :

FT4 25.6 (12.2-20.1)

FT3 5.83 (3.8-6.7)

TSH 0.11 (0.4-3.7)

I take daily 125 mcg T4 + 30 mcg T3 (Splitted in two dose).

What do you think of These levels of Ft3, FT4 and tsh ?

Thx

[SeasideSusie Remembering]

When did you take your last dose of Levo and T3 before the test?

Levo should be 24 hours before and T3 should be 8-12 hours before blood draw.

[Blueskyyy in reply to SeasideSusie]

One thing I didn’t understand is last time I tested my FT4 was 21.1, this time even with same T4 dose my FT4 increased to 25.6 ..

Do you have an explaination for this ?

[Lalatoot in reply to Blueskyyy]

Lost weight? Better absorption? Different time of day for testing?

[Blueskyyy in reply to Lalatoot]

Yes I lost weight because I take T3

Time of test is same

[Lalatoot in reply to Blueskyyy]

There is a relationship between dose and weight. As a rough guide to how much levo a person on mono therapy is going to need is 0.8 times their weight in pounds. This is what made me think if you were lighter you might need less.

[SeasideSusie Remembering in reply to Blueskyyy]

Were conditions the same for both tests, i.e.

* same time of day

* same time gap between last dose of Levo and blood draw

* was the reference range exactly the same for both tests

* do you have Hashi's

[Blueskyyy in reply to SeasideSusie]

time of test is same, range is also same.

Yes I have hashi

[SeasideSusie Remembering in reply to Blueskyyy]

So the Hashi's might be responsible for the difference in test results as Hashi's can cause fluctuations in results and symptoms.

[Blueskyyy]

T4 24 hours Before Test

T3 8 Hours befpre Test ( dose taken at 12.00 AM and Tested at 08.00 AM)

By the way I finally managed to get my tsh down, I had in the past Problem lowering tsh with T4

[SeasideSusie Remembering in reply to Blueskyyy]

FT4 25.6 (12.2-20.1)

FT3 5.83 (3.8-6.7)

TSH 0.11 (0.4-3.7)

T4 24 hours Before Test

T3 8 Hours befpre Test

In that case those results suggest that you are taking too much Levo.

When taking combination Levo + T3, one expects to see TSH low in range, even suppressed, FT4 lowish in range and FT3 in the upper part of the range. Some of us may need a higher FT4 than others, it's a very individual thing, but not over range.

[Blueskyyy in reply to SeasideSusie]

So according to you, what should I reduce ? T4 of T3?

By the way, I am getting a slight headache after taking my second t3 dose.

Doctor told me today that I should keep T4 at 125 mcg and Lower t3 by 10

Also, is a tsh of 0.11 too low ?

Is it suppressed ? Or still in range ?

[SeasideSusie Remembering in reply to Blueskyyy]

So according to you, what should I reduce ? T4 of T3?

If you lower your dose of T3 then your FT3 level will lower. Your FT3 is currently 70% through range which is generally a pretty good place to be when taking T3.

Your FT4 level is over range at 169.6%. You need to lower your FT4 level to get it back into range so you reduce your dose of Levo.

Doctor told me today that I should stay with 125 mcg T4 and Lower t3 by 10

I'm not sure your doctor really knows how to interpret blood tests or how to dose with combination Levo + T3. Why on earth would he leave your FT4 so far over range yet want to lower your FT3 when it's in range?

[Blueskyyy in reply to SeasideSusie]

Thx !

Will my TSH spike again if I lower FT4?

And how much T4 should I take ?

Currently I take 125 T4 and 30 T3

[SeasideSusie Remembering in reply to Blueskyyy]

Will my TSH spike again if I lower FT4?

What do you mean by "spike" - go over range, go to the top of the range, increase by just a small amount?

It shouldn't do because taking T3 generally tends to keep TSH low. But I don't know your individual thyroid journey or if you have any particular reason for TSH not doing what generally happens.

And how much T4 should I take ?

Changes in Levo should be no more than 25mcg at a time, retesting ater 6-8 weeks which is the time needed for levels to stabilise. When fine tuning, reducing by a lower amount might be needed - 12.5mcg, 6.25mcg, even lower.

You also have to factor in that you have Hashi's, and this makes things even more difficult because of the fluctuations that come with Hashi's, if you go through a "hyper" phase you may need to lower your hormone replacement temporarily until things settle down.

[Blueskyyy in reply to SeasideSusie]

Ok

And what is the Risk if I keep everything as it’s now I mean keep using the same dosage?

[SeasideSusie Remembering in reply to Blueskyyy]

Too much T4 (as you already have) which can make reverse T3 rather than freeT3 if you still have some natural conversion. Possibly other things I have no knowledge of.

Why would you even consider keeping your FT4 so far over range?

[Blueskyyy]

This is my second test after adding T3.

Precious test done in September showed a TSH of 7.5, at that Time i was taking 125 T4 + 12.5 T3 ( Uni Pharma Greece ).

After the test, I asked my doctor to prescribe me Thybon 20 T3.

Then I left T4 at 125 mcg and started taking 20 mcg T3 (Thybon), then two weeks before test (since 1st October I increased t3 to 30 mcg daily ) and tested yesterday and tsh is now 0.11

[SeasideSusie Remembering in reply to Blueskyyy]

You are not leaving enough time between dose change and testing.

For levels to settle you really need to leave 6-8 weeks.

[Blueskyyy in reply to SeasideSusie]

Previous test was at 09.09.2019 and the most recent test was yesterday 14.10.2019

That’s a five weeks time difference

[SeasideSusie Remembering in reply to Blueskyyy]

(since 1st October I increased t3 to 30 mcg daily ) and tested yesterday

That's only two weeks since increasing T3.

[NWA6 in reply to Blueskyyy]

12.5mcg of T3 to 30mcg in 8wks ish? That’s quite a jump.

When your T4 is over range as it is now then this can lower conversion so it’s not much use and testing after 2wks isn’t a good idea either as you’re not settled.

Increases have been a bit scatty.

Your T4 was already over range when you increased the T3. Your T4 should have been lowered by 25mcg before introducing more T3.

As your T3 is only 70% keep your T3 dose as is. Lower your T4 to 100mcg and then retest in 6wks. This may result in conversion being better and so a raise in T3 but you have 30% to play with so this could be ok.

[rosetrees]

You haven't said how you feel. Do you feel a bit hyper, feel ok, feel hypo?

Looking at those numbers I would say that maybe you don't convert t4 to t3 as effectively as you should, which is why you need to add t3. Your ft3 appears to be comfortably in range, and it is your FT4 that is over range.

Maybe try reducing your dose of levo to bring your ft4 back on range, whilst hopefully leaving your FT3 where it is - see if that makes you feel better/worse/no different.

[Blueskyyy in reply to rosetrees]

I feel good, I have signs of hyper as I have lost some weight.

My story started last year when my TsH was 64!

Doctor increased then my T4 to 100, 112.5 and then 125, all that couldn’t reduce tsh to normal until we added t3, we started initially with 12.5 mcg T3 then increased to 20 then 30 mcg.

Actual combi is 125 T4 + 30 mcg T3 seems to have normalized TSH and FT3 increased to 70% of the range.

FT4 went far beyond the range up to 167% however just a few weeks ago was 117% even with same dose, it seems losing some weight increased my FT4.

Now it’s wise to reduce T4 to 112.5 mcg and in a few weeks Test again.

Do you think TSH 0.11 is too low ?

[rosetrees in reply to Blueskyyy]

I've never taken T3, (I'm currently on Natural Dessicated Thyroid), but I think taking T3 can suppress your TSH.

If it was me, I would experiment at home. Try reducing your levo a little - see how you feel. Or try reducing your T3 a little and see how you feel. If you can find a combo that works for you, then you can tell your doctor. Otherwise you're at their mercy and waiting for them to tell you - and they might get it wrong.

Personally, I choose to take control, but I realise that isn't for everyone.

[Blueskyyy]

Hi

I have just added a screenshot

It shows the various levels of FTs/tsh in correspondence with the T4/T3 dose

It would be great if you can advise me on the optimal dosage for me !

Thx

[NWA6 in reply to Blueskyyy]

Definitely lower your T4 by 25mcg for 6wks then retest. Like I said above this may help conversion to T3. After 6wks you can decide if you need to add T4 or T3. For me I take my T4 150mcg x 5 days and 125mcg x2 days. You may need to do something similar. I started with every other day of the higher dose and then introduced it to 5 days. On the first 6wks I had 15mcg T3 but since then (6mths) it’s remained on 20mcg and I’ve just played around with my T4.

[Myro]

As it was told. You have to change dose if you have symptoms. So you have to know symptoms. If you can not sleep ... Lover dose but slowly. But tablet with hammer and make portion.

By lovering T4 you will lower FT3. But symptoms are showing if it is necessary. What effect can a little higher level of T4, I don't know. It is to be chacked. But I thing it is not important so far Your FT3 is OK. If you find out by symptoms to be necessary to low FT3 you can try to lower dose of T4. You are lucky one. You have find nearly ideal doses.

[Blueskyyy]

Hi

I am starting experiencing overfunction symptoms such as headache, sweating and heart palpitations!!

Actually I am taking 100 T4 and 30 T3.

Does anyone having such symptoms ?