Latest test results following T3 treatment. Confused!

[Mickeydooley]

I was put on a trial of t3 just over 6 weeks ago. (The endo reduced my T4 from 75mcg to 50mcg at the time and gave me 10mcg T3 daily). I had bloods drawn at my 2pm appointment recently. I’ve just had my test results back and I’m a bit taken aback. I’ve felt awful but have had a very stressful time over the last few months and lost my dad recently and not sure if this would affect the results? Below are the results from August and latest ones for comparison. The endo has suggested I double T3 to 20mcg per day but has not changed T4 which I believe may be necessary? Any advice would be greatly appreciated

August 2019 (4pm appointment and meds taken in am)

TSH 0.31 (0.27-4.2)

FT3 4.9 (3.1-6.8)

FT4 21.8 (12-22)

TGAb no result

TPOAb 13 (<34)

Oct 2019 (2pm appointment. meds taken 24/12 hours prior as recommended, same ranges as above)

TSH 1.71

FT3 4.6

FT4 14.9

TPOAb not tested

TGAb no result yet.

Thank you. X

[Lalatoot]

Your ft4 has lowered because you are on t3. You ft3 may have lowered as you are not taking enough yet to replace the lower level of ft4. You can either increase t3 or levo but not both at the same time. No one knows where there ft3 and ft4 levels need to be so it is trial and error. Why not increase the t3 and then once 6 weeks are over retest and see how you feel. It may then be time to increase the levo.

[Mickeydooley in reply to Lalatoot]

Thanks for the reply. What I don’t understand is why my TSH has increased. I thought it would be suppressed when on t3 and would be lower than usual given that my bloods were drawn in the afternoon? Also don’t understand why when taking t3 my levels were lower than before I was taking it. I understand that it would have been affected by the reduction in levo but by 25mcg?

[SlowDragon Administrator]

Suggest you do as endocrinologist recommends and increase T3

We should only increase one or the other at any one time

Personally I take my 20mcg as 3 split doses. 10mcg at 7am, 5mcg at 3pm and 5mcg at 11pm

(dose and splitting as recommended by endo)

Keep an eye on FT4 at next test in 6-8 weeks. If FT4 has dropped further then, you might consider a tiny increase in Levothyroxine. Or you might wait a further 6-8 weeks and test again first

Obviously vitamin D, folate, B12 and ferritin need to be optimal too

What vitamin supplements do you currently take?

When were vitamin levels last tested

[Mickeydooley in reply to SlowDragon]

I spoke to my endo this morning. He reckons I shouldn’t have had my levo reduced at the time the t3 was introduced as I had also been taking metavive (which I cut out when t3 was introduced.). He has suggested that I go back up to 75mcg levo and double t3 dose. My vitamin levels were all good on last test but vit d could have been better.

[Mickeydooley in reply to Mickeydooley]

Actually he wanted me to go up to 100mcg but I told him I’d prefer to do the increase very gradually.

[Mickeydooley in reply to SlowDragon]

Why do I need to increase one or the other but not both? The endo has told me to go back up to 75mcg Levo (as it should never have been reduced) and to double the dose of T3. I’ve been doing that for a few days now and feeling fine so far. I’m reluctant to go back to him and tell him I didn’t follow his instructions, especially when he’s been so understanding.

[thyr01d in reply to Mickeydooley]

Hi Mickeydooley, I would do as your endo advises rather than others on here, however well-meaning, and I know everyone is. Your endo has experience of many different people's responses to the drugs, I am sure he/she is focused on your personally and your individual needs. Best of luck

[Mickeydooley in reply to thyr01d]

Many thanks. X

[SlowDragon Administrator in reply to Mickeydooley]

Well it's easy to over shoot the sweet spot....but if you don't feel over medicated then increase Levothyroxine as well (as advised by endocrinologist)

[Mickeydooley in reply to SlowDragon]

I’m keeping a diary and also monitoring basal body temp to keep an eye on it. If things change I’ll go back to him. Thank you. X

[Lalatoot]

Unfortunately our bodies haven't read the guidelines or the ranges so they do whatever they want. They don't always react the way we expect which makes this such a difficult thing to get right. Please be advised to change either t3 or levo but not both at the same time. That way you can fine tune and also gauge the effects either has on your very individual system.

[Mickeydooley in reply to Lalatoot]

Thank you. X

[thyr01d]

PS - adding to last message, also, I think it's important to show your endo you respect them and are taking his/her advice and also that you are reliable and trustworthy, after all, you want the endo to be those things.

Sorry if this sounds like a lecture, it just worries me when people on here advise not following the endo's advice.

[Mickeydooley in reply to thyr01d]

Again thank you. I’ve had a very difficult 6 weeks since I was put on T3 and I lost my dad this week. I was very surprised at my results (especially that T4 had decreased so much and that even on t3 treatment my T3 level had also decreased). I had to contact him regarding my latest results and he was very understanding. He suggested that I had been undermedicated since I was diagnosed in 2007 and should never have had a decrease in T4 when the T3 had been introduced. (I saw another endo at the clinic last time I was there.) Perhaps that and all the stress associated with my personal issues made things worse. I hated the thought of going back to him and saying I didn’t take his advice as if I knew better than he did. I have a good one here and am very grateful to him. Thanks

[thyr01d]

I am very sorry that you have lost your dad this week, you must be grieving and it's so difficult to deal with things like health at such a time. I read somewhere that our thyroids are badly affected by stress and grief. Your endo does sound good and I hope you are soon feeling much better healthwise.

(No need to send more thanks, I think we all care about each other on here)