New Results, Need Advice Please.

[Rosebud1955]

Hi all,

These are my results taken November 2019. Presently taking T4 100mcg + 10mcg T3, all taken & 6a.m. Tsh: 0.02 (0.32-4.00). FT4: 11 (9-19). Ft3: 3.5 (2.6-5.8) all nutrients all optimal and I’m on maintenance doses. Endo reluctantly agreed to increase but tells me to increase T4 and to decrease T3. I get pressures in my head and he feels the T3 is too powerful because of my age. (64) MRI of the pituitary is unremarkable. ACTH, Aldosterone, DHEAS are elevated. Could this be an adrenal issue? I would appreciate any suggestion from you knowledgeable members. He suggested increasing T4 to 125mcg and decreasing T3 to 5 mcg. I’m confused as to what I should do. I gained 10 lbs in 3 months, all around my abdominal region ( I look 6 months pregnant) loosing all my hair, very dry pale skin, muscle pain and hip pain, plantar fasciitis and heel pain both feet, no motivation, afraid to leave the house, probably depression.

Thanks to all.

[Nanaedake]

Are you taking any medication besides thyroid meds? Could your muscle pain be side effects from other medicines?

[Rosebud1955 in reply to Nanaedake]

Thanks for replying. No, I’m not taking any other medications, jus my vitamins. I have chronic Lyme disease though. When I say muscle pain I really mean that my thighs feel very heavy and weak, I do get bad muscle cramps in my legs. Not sure what causes that. Thanks!

[Lora7again]

I think you could try an increase because your T3 still looks low. Your T4 will be lower than normal because you are taking T3 btw. Your T3 should be near the of top the range to feel well in my honest opinion.

[Lora7again in reply to Lora7again]

As for his comment about T3 being too powerful well if you feel jittery you reduce the dose because T3 is soon used up by the body. I have had a T3 of 18 when I was most hyper and I was like super woman lol but it didn't kill me just made me go 24 hours without sleep and I was a size 8 and looked super fit but it soon made me burn out and my thyroid then went under-active so I was then a size 14, balding and bedridden the thyroid is the power house of the body.

[Rosebud1955 in reply to Lora7again]

Thanks, i’m thinking of increasing T3 to 12.5mcg. Bloodwork is scheduled for 6 weeks. Will post after 6 weeks.

[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 do your tests?

When were vitamin D, folate, ferritin and B12 last tested?

[Rosebud1955 in reply to SlowDragon]

Thanks for replying. I follow the protocol suggested on this forum. Blood draw 24 hours for T4, 10 hours for T3. Vit. D, Folate, Ferritin, B 12 are all close to the highest range. I eat healthy, gluten free and dairy free. I have been splitting the T3 into 2 doses, doesn’t seem to be effective. I started taking the 10mcg T3 & 100 T4 all at 6 a.m. over the last two days. Strange enough, I’m starting to feel a little better, even my heel pain is showing a slight improvement. I’m tempted to increase my T3 to 12.5 mcg. Would this be too much? Kindly have a another look at my labs done November 21.

Thanks for your advice.

[SlowDragon Administrator in reply to Rosebud1955]

Well we are all different.

Some of us find we need good FT4 levels as well as good FT3

Your FT4 is quite low. If you increase Levothyroxine, this should also increase FT3 result

Perhaps try Levothyroxine at 100mcg and 125mcg alternate days (or 112mcg every day by cutting 25mcg in half)

Retesting in 6-8 weeks

We always recommend only changing one thing at a time.

[Rosebud1955 in reply to SlowDragon]

Thanks! I value your advice. I will increase the Levo to 112 and leave the T3 @ 10. Will post new results in 6 weeks.

Great advice as usual.

[Hidden]

As usual they are going by the TSH level, which is suppressed - a normal effect of thyroid replacement medication - instead of the T3and T4.

From your symptoms it definitely seems you are undermedicated. Most of us need T3 and T4 high in range, even if it does suppress TSH. Maybe best to increase Levo as advised but remain on the same level of T3. Have another test after 6-8 weeks.

I don't know much about adrenals except they try to compensate for low thyroid levels. Also the adrenals themselves need thyroid hormones to function properly.

So it could be that increasing thyroid meds would correct your adrenal levels.

[Rosebud1955 in reply to Hidden]

So you think it’s best to increase the Levo. I was thinking of increasing the T3 to 12.5mcg. I’m a bit scared to make mistakes and have an even bigger setback. I take 100 T4, 10 T3.

Thanks for your advice.

[Hidden in reply to Rosebud1955]

I dont really know as I have no experience with T3 and no medical training but you do seem undermedicated.

I was questioning whether you should reduce the T3 at the same time as increasing levo. It's usually best to only change one at a time

[Hidden in reply to Hidden]

I didn't see SlowDragon 's post until now, but her advice does seem best.

"Perhaps try Levothyroxine at 100mcg and 125mcg alternate days (or 112mcg every day by cutting 25mcg in half)"

[Rosebud1955]

Thanks! I will probably increase the T4 to 112.5 and leave the T3 at 10mcg.

[Hidden in reply to Rosebud1955]

As long as your endo is OK with not decreasing the T3 just yet. or, if asked, you could explain that you want to go a bit more slowly and are a bit nervous about increasing the levo so quickly and decreasing the T3 at the same time. Best perhaps not to mention the advice given on here, as you don't want to cause unnecessary offence.

If you do get any hyper symptoms (feeling "Wired" for example) you could reduce the T3 slightly, or leave it off for a day or so as Lora7again said.

[Rosebud1955]

Thanks to all for the helpful advice. I will stick to the plan of increasing T4 to 112.5 and keeping T3 @ 10. Yes, I will monitor symptoms. I’m not a good converter so not much chance of becoming over medicated with 12.5 of T4. I will post new labs in six weeks.You folks are awesome, everyone’s input is valuable. MANY THANKS!!!!

[klr31]

Do you have absorption issues?

Karen

[Rosebud1955 in reply to klr31]

I think I have conversion issue, that’s why I was given T3.

Thanks for asking.

[Stourie in reply to Rosebud1955]

Hi, if you have conversion issues I don't think that taking more t4 would help. A small raise in t3 would be worth a try as your t3 is low in range and that's not really good. You need it to be optimal. Jo xx