Advice on latest results and endo's thoughts

[Eimear78]

Hi folks - me again. I had my latest endo catch up today and need thoughts and a sounding board really. I feel pretty rubbish of late and it has been building up as the benefits of the meds start to wear off once again. I am on 75mcg Levo and 25mcg Tiromel and my bloods are as follows:

TSH <0.01

FT4 12 (12 - 22)

FT3 5.4 (3.1 - 6.8)

B12 459 (200 - 700)

Folate 4.8 (3-20)

Vit D 93 (haven't got a range as this was the combo of 2 scores but this is the best my vit D has been since I have been tested)

Nothing on antibodies but they haven't been a problem to date and nothing is flagging autoimmune

Last time I saw him I was on the decline and he recommended 20,000iu once a week Vit D as he wanted to see there if there was any improvement. This time he immediately said he wants to increase my levo slightly as my FT4 is too low. He's concerned about me going overactive so we are going to do it slowly. I will take 75mcg 5 days a week and 100mcg for 2 days a week and do bloods in 6 weeks.

Still feel rubbish though - I know I am in need of the Christmas break as I am self employed and don't take much time off but I am cranky and short tempered (my poor children must hate me :() and alternate that with crying at most things, I am so tired and struggle with even doing the smallest bit of shopping (I criedd in the Trafford Centre a few weeks ago), I have had a twitchy eye for a month (i will see the doctor when I get a sec), I have joint ache and cramps too.

I feel pretty miserable and am sick of this neverending medication balancing act which never yields anything. Based on the bloods above is his incremental approach a good idea?

In the New Year I am going to pay to see a functional Dr/nutritionist about the nutrition side of things as I don't want to do things on my own and I am working my way through Dr Peatfield's book about all of the nutrients etc but I am so annoyed that the minute I start to feel better the whole thing wears off.

Any thoughts or reassurance gratefully accepted.

[humanbean]

Your twitchy eye could be low magnesium. Deficiency of it is extremely common.

Look up "best and worst forms of magnesium supplement", check a few sites and find something that appeals to you and that several sites agree on.

There is no such thing as a good test for magnesium so don't waste time worrying about testing. The only thing you need to worry about is if your kidneys are reasonably healthy. If they are then they will get rid of excess magnesium in your urine.

[greygoose]

I feel pretty rubbish of late and it has been building up as the benefits of the meds start to wear off once again.

Umm… not really, no. The benefits don't 'wear off'. And it's not 'meds' you're taking in the normal sense of the word. You're not taking a drug that you can become accustomed to. You're taking a hormone: the thyroid hormones T4 and T3.

The usual pattern of treating with thyroid hormone is that you start low and increase slowly. With T4 (levo) that means starting on 50 mcg and increasing by 25 mcg every six weeks.

If you need to add in T3 - because of poor conversion, or whatever - one looks at the FT4 level and, if it's high, reduce the dose by 25 mcg and add in 1/4 tablet of T3. If the FT4 isn't very high, there's no need to reduce the dose. You then keep on that dose and slowly increase the T3 - 1/4 mcg every two weeks. Is that the way it happened with you?

OK, so when you first increase a dose of either T4 or T3, it's usual to feel good at first, and then the symptoms come creeping back in. But, it's not because the benefits are wearing off, it's just that it's time for an increase in dose. How long have you been on 75 mcg T4 and 25 mcg T3? Your FT3 isn't that high, and you could probably do with an increase in dose.

For the FT4, it's perfectly normal for it to be low when taking T3. How low depends on whether your doctor reduced your levo by too much when he added in the T3. I have a feeling yours did. Whether or not you really need it any higher is debatable. Some people do, and some - like me - are perfectly happy with an FT4 of zero. And there are others who come somewhere in between. You have to find your own personal optimal level. Unfortunately, endos, with their preconceived ideas, rarely allow the patient the freedom to find their own sweet-spot. But, personally, I would want my FT3 a bit higher before I started experimenting with the T4. After all, T3 is the active hormone, and it's low T3 that causes most symptoms.

So, why was T3 added to your levo in the first place? Because you're a poor converter? If so, there's not really much point in fussing with the FT4 level. It's the T3 you need. And, if that's the case, increasing your levo is hardly likely to make you 'overactive', which is a physical impossibility is your thyroid is under-active because the thyroid cannot regenerate. Once it stops working correctly, it stays that way. You could be over-medicated, but not unless your FT3 is well over the top of the range. And, I very much doubt that will happen on the tiny increase in dose he's giving you. It probably won't have much effect at all, because it's too small. But, I suppose he has to find that out for himself.