Test results - Do I need to increase dose?

[Mj1986]

Hi All,

I was wondering if you could give me your opinion on my latest test results. I feel better but definitely don’t feel 100%, I still get some bouts of fatigue, brain fog and sore joints/muscles.

My view is that I have a problem converting T4 to T3.

Final test before levothyroxine supplementation:

•TSH 3

•T3 4 (3.1-6.8)

•T4 (12-22)

•TPO antibodies (<34) 114

Results after 10 weeks supplementation with Levothyroxine 50mg

•TSH 1.83

•T3 4.58

•T4 19.1

•TPO antibodies 16 *I have been following an anti-inflammatory diet for the past 3 months, including no gluten, dairy, caffeine, alcohol or soy

which has probably been the driver behind the decrease in antibodies

I am wondering if I should up my dose of Levo slightly (75mg 2 days/ 50 5 days). Based on the above it seems if I get my T4 to 22 my T3 will be about 5.1 (which still feels slightly low as it’s only just half way through the range?). My TSH can also go down more.

Should I consider supplementing with T3 or trial increase Levo?

My B12 and vitamin D was low at time of first test but has since been corrected. My Ferritin was 21 vs a range of 22-275, although my Serum iron levels are normal? My Ferritin doesn’t seem to be increasing though so wondering whether I should start an Iron supplement?

My folate is always at the top end of the reference range even without supplementation.

Thanks in advance.

[greygoose]

Based on the above it seems if I get my T4 to 22 my T3 will be about 5.1 (which still feels slightly low as it’s only just half way through the range?). My TSH can also go down more.

Ah, if only it were that simple! But, it isn't. If your FT4 goes up to 22, your conversion will get worse, so your calculations won't hold true - your FT3 could even decrease. When the FT4 reaches a certain point around the top of the range, T4 starts converting to more rT3 than T3. Meaning that you have to increase your levo by a considerable amount to get the FT3 high enough for your needs.

Your conversion is poor, and that could be down to your low ferritin. In fact, your ferritin is so low, your doctor ought to be doing a full iron panel to find out why. Supplementing iron is not the solution, I don't think. Iron is complicated, so you need a hematologist or someone who knows what they're doing. It's not a job for self-treating. What are your B12 and vit D now?

•TPO antibodies 16 *I have been following an anti-inflammatory diet for the past 3 months, including no gluten, dairy, caffeine, alcohol or soy

which has probably been the driver behind the decrease in antibodies

The fact that your antibodies have decreased is of no importance. It doesn't mean that your Hashi's has decreased. Antibodies are not an indication of severity of Hashi's, just an indication that it's there.

I'd go for adding T3, if I were you. It can take a long time to optimise nutrients. And it might not even be low nutrients that is causing the problem - there are so many causes. One of them being the mere fact that you have Hashi's. Hashi's people are often poor converters.

[Jasma in reply to greygoose]

Sorry greygoose. I didn't see your reply. You were obviously one of the "more knowledgeable" I had in mind.

[greygoose in reply to Jasma]

No problem.

[Mj1986 in reply to greygoose]

Thank you for replying, that's really useful. Re: Ferritin does it mean anything that my plasma iron was 20 (10-32)? In terms of T3 is this safe to take whilst trying to concieve/pregnancy? I don't think I'm going to try via NHS I'll just order from abroad. What dose would you recommend starting with?

[Alanna012 in reply to greygoose]

*If your FT4 goes up to 22, your conversion will get worse, so your calculations won't hold true*

Every time I think I understand this stuff......

[greygoose in reply to Alanna012]

There's a lot to understand.

[Alanna012 in reply to greygoose]

There sure is.

[Jasma]

Hi Mj1986,

I agree. Your FT3 should be 75% through the range. As to what you should do someone more knowledgeable will probably reply soon. One possible reason for poor conversion is your low ferritin. You need to get that way up so I'd pop out today and get a good iron supplement. I think people on here recommend ferrous fumarate. I'm taking ferrous biglycinate in Solgar Gentle Iron 100mg (5 x 20mg capsules) every day and it's coming up. You need to take it with vitamin C at least 4 hours after thyroid meds. Also don't take it with other minerals. With ferritin below 50 you get hair loss and it doesn't regrow until 70. You need it to get up to 100 or above. I've been supplementing for 2 months now and it's coming up. You say your B12 and Vit D are coming up but you didn't give results. Optimal may be a lot higher than what you're aiming for so it would be useful to post your values for those too.

[SlowDragon Administrator]

If your iron is ok but ferritin is low then look at increase in iron rich foods.

Eg Liver or liver pate once a week plus other iron rich foods plus daily vitamin c in form of orange juice or similar

[Mj1986]

Ok thanks. Will do. Do you think it's best to try and raise ferritin before exploring T3 supplementation. I really need to get my energy back