Latest results after 9 weeks on T4 and T3

[Hashi-hacker]

Hi, I've done 9 weeks on 75mcg levo and 2 x 5mcg lio and would like your thoughts on my latest results. I feel like I have had a dip in symptoms, mostly mood and energy, so suspect I am still under on meds. Prior to this I was on 100mcg levo and won the T3 lottery with an NHS prescription of T3. Would you go for an increase in T4, T3 or a combo, if so, what do you think?

Thanks in advance

Inflammation

CRP HS 0.43 mg/L (Range: < 5)

Iron Status

Ferritin 149 ug/L (Range: 13 - 150)

Vitamins :

Folate - Serum 11.04 ug/L (Range: > 3.89)

Vitamin B12 - Active 94.000 pmol/L (Range: > 37.5)

Vitamin D 66.1 nmol/L (Range: 50 - 175)

Thyroid Hormones :

TSH 0.637 mIU/L (Range: 0.27 - 4.2)

Free T3 3.91 pmol/L (Range: 3.1 - 6.8) <-- about 22% through range

Free Thyroxine 14.000 pmol/L (Range: 12 - 22)

Autoimmunity :

Thyroglobulin Antibodies X 281.000 kIU/L (Range: < 115)

Thyroid Peroxidase Antibodies X 154 kIU/L (Range: < 34)

[Lalatoot]

Your FT3 is still low. It is low FT3 that creates the symptoms. Many seem to need it in the upper third of the range so you are looking at somewhere in the 5s. Some folks are ok withe low FT4 if they take T3; some are not.

I would increase the T3 by a quarter tablet. Don't alter two things at once.

[SeasideSusie Remembering]

You may or may not have needed to reduce your Levo. Taking T3 lowers FT4 anyway. What was your FT4 level on 100mcg Levo before adding T3?

We are all different where we need our levels when on combination replacement. I take Levo plus T3 and with FT4 as low as yours I would be very unwell.

Your FT3 is low for someone on combination replacement.

Your vitamins are OK apart from Vit D which is recommended to be 100-150nmol.

[SlowDragon Administrator]

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .

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

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

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

Is this how you did your tests?

[Hashi-hacker in reply to SlowDragon]

Yes, I've been paying attention to the good advice here

[SlowDragon Administrator in reply to Hashi-hacker]

Then your results show you need dose increase

Perhaps adding a third 5mcg dose T3

I find smoothest way is 3 doses per day at 8 hour intervals. Approx 7am, 3pm and 11pm

But everyone is different. Experimenting with what suits you.

Some find small dose T3 at bedtime improves sleep. Others find it doesn't

[Hashi-hacker]

Thanks all. I got a surprisingly quick reply from my endo who has recommended an increase in T3 to 2 x 10mcg. I think I will go for a week on 10mcg at 8am (that's a 5mcg increase) then 5mcg at 5pm and then maybe switch the timings of the later doses to add in the last 5mcg say 3pm and 10pm, and as always, track how I feel.

Thanks to all on this forum, it is invaluable and your time is always appreciated.

[Laundretta in reply to Hashi-hacker]

Your endo sounds like a good’un! 🙂