I have attached my recent blood results. I asked the Endo about adding T3 to my medication but she hasn’t done that. She has told me to increase the Levothyroxine to 75mcg from 50mcg. It looks like my T3 is only just in the normal range. But the thing is when I had my previous bloods done at a different lab the values were different. The previous lab showed my FT3 to be 3.1 pmol/L with the range being 4.3-8.1. So under the new lab I’m just in range but under the previous lab I’m well under range. So what do I do? I so badly need some advice as I really wanted to try adding some T3 to see if it would help me with all my thyroid symptoms. Also my TSH was 2.11 on my previous blood test and now it’s gone up to 3.0. I was previously taking my levo at 2am when I knew my stomach would be empty but then the Endo said to take it at night before I go to bed as getting up at 2am was making me tired during the day.
Need help with my results please: I have attached... - Thyroid UK
Need help with my results please
Endo is actually correct...you need dose increase in levothyroxine (at this stage)
Ft4 is low and only 37% through range
Bloods should be retested 6-8 weeks after each dose increase in levothyroxine
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)
Your TSH has gone up because you need dose increase
Levothyroxine should always be taken empty stomach and then nothing apart from water for at least an hour after
Many people take Levothyroxine soon after waking, but it may be more effective taken at bedtime
verywellhealth.com/best-tim...
About 8 weeks ago my TSH was 2.11. Changed the time of night I took the levo & now it’s 3.0. Should I go back to how I was originally taking it?
No. Taking levothyroxine at bedtime is perfectly fine
TSH has risen because your body has got use to initial dose, now ready for dose increase
50mcg is only a starter dose
Most people eventually end up on full replacement dose of 1.6mcg per kilo of your weight
Dose is increased upwards in 25mcg steps
I was hoping to try some T3 but my Endo feels that I don’t need it but I’m only just in range. What do you think?
Far too early to tell
First step is to get levothyroxine slowly increased upwards in 25mcg steps.....
Likely to eventually need full replacement dose of levothyroxine at 1.6mcg per kilo of your weight
If, once stable at this dose, and all vitamin levels optimal.....if Ft3 remains low ....then is time to consider possibly adding small dose of T3 alongside levothyroxine
If you have hashimoto’s trying strictly gluten free diet recommended
It looks like you have insulin resistance, and you are clearly still hypo. Insulin resistance tends to go hand in hand with hypothyroidism, I have the two together as well, and I am also a poor converter of T4 to T3...which you seem to be as well, from looking at your test results.
Hypothyroidism is already a tricky disease to treat...and being insulin resistant makes it even harder. Usually, people are prescribed Glucophage alongside Victoza or Saxenda in such cases, has your doctor not mentioned any of those medications to you? I am guessing not 😄. Though, in all honesty, those meds only work for a certain period of time and side effects can be hard to deal with for some.
I agree that you would likely benefit from adding some T3 but the chances of finding a doctor who is willing to take you seriously and prescribe it are slim to none. If you can afford it, you are better off making a yearly trip to Turkey and buying yourself some Tiromel (Turkish liothyronine T3) at a pharmacy there since some of them sell thyroid medication without a prescription (or ask on the forum if anyone is kindly willing you to PM you a legit source they use.) Legitimate and trustworthy online sources for thyroid medication are getting harder to find nowadays; I no longer have one for my usual medication, unfortunately.
*By the way, you could probably benefit from increasing your Free T4, too.
How do you know I’m insulin resistant from my results?
Because I had similar tests done and both my Creatinine was very high and my eGFR was low, too, and I was later officially diagnosed with insulin resistance.
High Creatinine and low eGFR usually indicate insulin resistance. You can read up about it online, just do a search on google and a lot of articles will pop up on the topic. I am very surprised your doctor did not at least point out that obvious part.
I think she has put it down to me having stage 3 chronic kidney disease. I guess I could be insulin resistant too as for the first time in my life I am putting on weight when I am mostly the same weight all the time.
Both GFR and creatine levels should improve as levothyroxine dose increases
Actually low GFR is common when hypothyroid and normally improves once on correct levels of levothyroxine
ncbi.nlm.nih.gov/pmc/articl...
High creatine is similar. Will improve when hypothyroidism is correctly treated
jamanetwork.com/journals/ja...
I am not a doctor or a licensed medical practitioner so I obviously don’t deem my advice to be 100 percent correct, I am only drawing similarities from my own experiences with blood test results, symptoms and being diagnosed by doctors...who are usually quite careless when it comes to endocrinology and related fields.
SlowDragon may very well have a point and you may be one of those patients with a straightforward case of just needing more levothyroxine. In fact, I hope you are.
As Redporti was only on 50mcg levothyroxine at this stage she only needs levothyroxine dose increase
Far too early to say if will eventually need T3
Maybe but my guess is that she will eventually need it, any way. Her test results indicate insulin resistance which is usually a symptom of being pre-diabetic type 2...which makes it a lot harder to treat hypothyroidism with just levothyroxine.
Then again, just finding the right dose of a T4/T3 combo is also a real hassle that can take years. Yayyyy.....
Or kidney function can simply be impaired due to being hypothyroid
To know if was pre-diabetic would need HbA1C tested
diabetes.org.uk/guide-to-di...
You can be hypothyroid and still have low HbA1C
My HbA1C is 37 mmol/mol range 20-42
So is fine
So should I increase the levo & have my bloods retested in 8 weeks? Then see what my T3 is then & if still low then see what the Endo says?
Well, SlowDragon made a good point above, regarding the HbA1C needing to be tested to rule out insulin resistance. I did have additional tests done myself - as per my doctor’s request back then. If you are able to have further tests done, they may help narrow down your diagnosis. Then you may have a clearer idea of how to go about dosing your thyroid medication and if, ultimately, you’d need T3.
I have posted my HbA1C result above.
Ok, I just found it. My bad, had to scroll up slowly to spot it. It’s still within the accepted range, if on the higher end.
However, you say you are putting on weight so that likely means for you, personally, you need it to be mid range or lower. Well, the only way to go about it now is via trial and error. Basically, see what happens after being on 75mcg of levothyroxine for a while. Some people end up needing at least 100 to 150 mcg. Some people end up needing some T3. But I would really consider asking your doctor about prescribing Glucophage(metformin) or Victoza/Saxenda (both have active ingredient liraglutide.)
Not unless absolutely necessary
Metaformin can result in B12 deficiency
empoweryourhealth.org/magaz...
Victoza side effects include increased risk of thyroid cancer
victoza.com/consider-using-...
Link to other posts on here that mention victoza
Yes bloods retested in 6-10 weeks
Likely to need further increase in levothyroxine after 2-4 months
Most people eventually need somewhere between 100mcg and 200mcg levothyroxine daily.
Only about 20% of patients eventually need T3
So the higher the dosage of levo the bigger chance of my FT3 going up?
Exactly.
In an ideal world the Ft4 and Ft3 are at equal percentage through range
Improving low vitamin levels helps improve conversion of Ft4 to Ft3
But in order to convert Ft4 to Ft3 we need enough Ft4 in the first place ....this comes from taking levothyroxine
All your vitamins are now very good. Presumably you have been supplementing
TPO antibodies are low
Ideally you should have TG antibodies tested too
Here in UK NHS refuses to test TG antibodies if TPO antibodies are negative
Have you had ultrasound scan of thyroid?
I had one a couple of weeks ago & everything is fine. I have only got half of a thyroid now as I had papillary cancer last July. My CRP is high too which is a bit of concern. It’s 21mg/L and range is 0-5. Not sure why.
Ok. So not autoimmune thyroid (hashimoto’s)
So you will eventually need full replacement dose
Apparently due to the appearances of the piece of thyroid they took out I have got Hashimoto’s. That’s why they think the lobe that is left in is not working properly.
So you do have hashimoto’s.
Hashimoto's frequently affects the gut and leads to low stomach acid and then low vitamin levels
Low vitamin levels affect Thyroid hormone
Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten intolerance. Second most common is lactose intolerance
According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find strictly gluten free diet reduces symptoms, sometimes significantly. Either due to gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)
Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies
While still eating high gluten diet ask GP for coeliac blood test first or buy test online for under £20, just to rule it out first
Assuming test is negative you can immediately go on strictly gluten free diet
(If test is positive you will need to remain on high gluten diet until endoscopy, maximum 6 weeks wait officially)
Trying strictly gluten free diet for 3-6 months
If no noticeable improvement, reintroduce gluten and see if symptoms get worse
chriskresser.com/the-gluten...
amymyersmd.com/2018/04/3-re...
thyroidpharmacist.com/artic...
Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,
"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.
In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l.
Most patients will feel well in that circumstance.
But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.
This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal
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