Do I need T3 medication too?

[Redporti]

I am new to hypothyroidism as I was diagnosed with papillary thyroid cancer in May 2019. I had half of my thyroid removed. I started on 25mcg Levothyroxine & 4 months later I’m now on 50mcg. My TSH is 2.11 & my free T3 is 3.1. As my TSH goes down so does my free T3. Does this mean I need to be on T3 medication too?

[greygoose]

We would really need to see full test results - TSH, FT4 and FT3 - with ranges to be able to answer that question.

[Redporti in reply to greygoose]

My test results are: TSH 2.11 mU/L ref range (0.465-4.68). Free Thyroxine 15.0 pmol/L ref range (10.0-28.2). Free T3 3.1 pmol/L ref range (4.3-8.1).

[greygoose in reply to Redporti]

OK, well, to begin with, you need an increase in levo. Your TSH is too high, and your FT4 is only 27.47% through the range. That's much too low. And, your FT3 is under-range. You do possibly have a conversion issue, but with such a low FT4 it's difficult to tell. You need to get your TSH down to at least 1, and your FT4 up to about mid-range, to see how well you convert, and if you need to take T3.

[Redporti in reply to greygoose]

Thank you. I am staying on 50mcg of Levothyroxine for another 4 weeks & then more bloods. The Endo wants me to take the levo at midday instead of 2am in the morning. I will start doing that today.

[greygoose in reply to Redporti]

Why does he want that? What's the point? As far as I can see, there is not point, just him being difficult. Taking your levo at 21 midday poses all sorts of problems about food. What time do you have your breakfast? What time do you have lunch?

[Redporti in reply to greygoose]

I wake up at 8.30 am & take my stomach medication so I can eat. I then eat within half an hour otherwise I get really dizzy & migraine. I have my lunch at 12.30pm when I have another stomach pill. At about 11.30am I have a biscuit. So my tummy is not empty from breakfast to lunch.

[SlowDragon Administrator in reply to Redporti]

Is this lansoprazole or omeprazole or similar PPI?

[Redporti in reply to SlowDragon]

Domperidone

[greygoose in reply to Redporti]

So, if you take your levo at 12, your stomach is going to have food in it and half an hour later, you're going to put more food in, with the result that you're not going to absorb much of your levo. Seems to me that 2 am is exactly the right time to take your levo! But, did you wake yourself up to take it? Or was it a time you usually get up for the toilet? If you're up anyway at 2 am, you might just as well take it then - at least you stand a chance of absorbing it! Or, you could take it just before you go to bed, 2/3 hours after your last meal.

What sort of stomach medication are you taking? What is wrong with your stomach?

[Redporti in reply to greygoose]

I have gastroparesis & take domperidone. I was setting an alarm to wake me at 2am.

[greygoose in reply to Redporti]

OK, I understand. Setting the alarm to wake you up is perhaps not a good idea. But, can't you take it before going to bed, as suggested above? That would be better, you'd absorb more hormone, than taking it at noon.

How was your gastroparesis diagnosed? Are they 100% certain it is gastroparesis?

[Redporti in reply to greygoose]

Yes I had the stomach emptying test several times. About 20 years ago I had over 4 ft of my small intestine removed due to it twisting. They damaged the vagus nerve when they operated on me.

[greygoose in reply to Redporti]

OK, I see. I was just wondering if, perhaps, the reason your stomach didn't empty well was due to low stomach acid - which most hypos have.

[Redporti in reply to greygoose]

How many hours does it take to have an empty stomach? I finish dinner at 6pm but have a light snack at about 9pm. I go to bed at midnight. Would my tummy be empty enough to take the levo at midnight?

[greygoose in reply to Redporti]

Yes, it would, that would be perfect.

[Redporti in reply to greygoose]

She said taking it at 2am was disturbing my sleep & that is why I feel sleepy all day!!!

[soupybp in reply to Redporti]

Yes, that may have been contributing, but being sorely under medicated, as your results indicate, is probably a bigger factor.

[Redporti in reply to soupybp]

I agree with you. I have decided to take my levo at midnight when I go to sleep. I will have my last snack by 9pm. My other medication I will take at 10pm and that gives me 2 hours before the levo. I will have my bloods done in 4 weeks & I will have been on 50mcg for 8 weeks by then.

[SlowDragon Administrator]

What is FT4 result and range?

The aim of Levothyroxine is to increase the dose slowly in 25mcg steps upwards until TSH is under 2 (many need TSH significantly under one) and most important is that FT4 is in top third of range and FT3 at least half way through range

NHS guidelines on Levothyroxine including that most patients eventually need somewhere between 100mcg and 200mcg Levothyroxine.

nhs.uk/medicines/levothyrox...

Also what foods to avoid (eg recommended to avoid calcium rich foods at least four hours from taking Levo)

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also EXTREMELY important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially if you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies

Ask GP to test vitamin levels

You may need to get full Thyroid testing privately as NHS refuses to test TG antibodies if TPO antibodies are negative

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)

All four vitamins need to be regularly tested and frequently need supplementing to maintain optimal levels

[Redporti in reply to SlowDragon]

Free T4 is 15.0 pmol/L ref range (10.0-28.2).

[knitwitty in reply to Redporti]

That is a huge range, it makes me think that virtually no one would be able to get a diagnosis in your area!

[SlowDragon Administrator in reply to Redporti]

FT4 is only 27% through range

Helpful calculator for working on percentage through range

chorobytarczycy.eu/kalkulator

Dose of Levothyroxine should be increased slowly in 25mcg steps upwards until FT4 is roughly 70% through range and FT3 at least half way in range

Ideally they should be similar percentage through range

Essential to test vitamin levels they are frequently low on just Levothyroxine

Levothyroxine MUST be taken on empty stomach and then nothing apart from water for at least least an hour after

Seems madness to suggest taking Levothyroxine at lunch time, this will substantially reduce its effectiveness.....and you already clearly need dose increase

[Redporti in reply to SlowDragon]

That’s what I thought when she said change it from 2am to 12pm. She said that taking it a 2am was disturbing my sleep & that might be why I feel sleepy all day. Don’t know what to do as I didn’t take the 2am dose this morning & it’s now coming up to 12pm. When I first wake up I have to take other medication & need to eat within half an hour. Finding it hard to know when I can take it.

[SlowDragon Administrator in reply to Redporti]

What other medication?

Many of us find taking Levothyroxine at bedtime much more effective

Also stops evening snacking as a bonus

Your tired because your under medicated

Have you had vitamin levels tested?

[Redporti in reply to SlowDragon]

I take domperidone. At bedtime I take Ramapril & contraceptive pill. I found I couldn’t stop snacking in the evening as it was causing stomach acids.

[SlowDragon Administrator in reply to Redporti]

Vast majority of hypothyroid patients have LOW stomach acid

This causes virtually identical symptoms to high stomach acid....but very different treatment

Would suspect your gut issues are due to being under treated and still hypothyroid

You will find 1000's of posts on here about low stomach acid

healthunlocked.com/search/p...

Low stomach acid can be an issue in its own right but also highly likely to have LOW VITAMIN levels as direct result

Ask GP to test vitamin D, folate, ferritin and B12

Come back with new post once you get results

articles.mercola.com/sites/...

thyroidpharmacist.com/artic...

stopthethyroidmadness.com/s...

healthygut.com/articles/3-t...

naturalendocrinesolutions.c...

[Redporti in reply to SlowDragon]

Yes & I take b12 injection weekly, vitamin D spray daily & folic acid daily. All my levels are good now.

[SlowDragon Administrator]

High blood pressure is also hypothyroid symptom

You can take ramipril anytime of day

After breakfast would be fine

nhs.uk/medicines/ramipril/

Contraceptive pill - ask your GP if you can take this with domperidone

nhs.uk/medicines/domperidone/