Advice on my results please

[ade1961]

Hello all and thanks for a great resource. I am male, 58yrs and weigh 103kg, 6.00ft tall. I was diagnosed under active in March, 2018 but had been since at least 2013. May I show my results since June,19 as I have titrated Levothyroxine :-

5/6/19 - tsh 1.16(0.35 -4.5) ft4 15.8(11-26) ft3 4.4(3.9-6.8) at this point my g.p.and private endo would not further increase but I still had symptoms so continued to increase with my own supply and medichecks tests.(I had read a lot on here).

So medichecks results and levo dose. - ranges tsh (0.27-4.2), ft4 (12-22), ft3 (3.1-6.8)

22/8/19 - on 137.5 mcg tsh 0.758, ft4 19, ft3 4.21

07/11/19 - on 150 mcg tsh 0.842, ft4 19.6, ft3 4.62

18/2/20 - on 175mcg tsh 0.023 (supressed), ft4 20.7, ft3 4.95 (50% of range)

I am not sure what to do now, if anything ? There has been a definite improvement since diagnosed but I still have some lingering annoying symptoms which are - The need to sleep 10hrs a night (more if possible), missing outer eyebrows and the worst being excessive sweating on exertion or any upward change in temperature. This heat intolerance thing has been a constant symptom from the start although I do believe it has improved a little. I have never had raised anti-bodies but I have recorded a raised white blood cell count for over 15 years, now normal.

I would be most grateful for advice, sometimes I think its hard to tell if things could be better or if maybe this is a natural part of aging ???

Thank you all, Ade

[greygoose]

Your problem is, you're a poor converter. Your FT4 level has risen, but your FT3 has stayed more or less where it was. And, if you continue to raise the dose of levo, conversion could even get worse.

Have you had your nutrients tested: vit D, vit B12, folate, ferritin? Low nutrients could be the cause of your poor conversion. So, best to get those checked, if you haven't already.

Do you always have your blood draw early in the morning, after fasting over-night, leaving a 24 hour gap between your last dose of levo and the blood draw?

[ade1961 in reply to greygoose]

Hi Greygoose, thanks for replying. With regards testing ,yes, I follow the advice on here, ie. early morning, no dose night before. I have had tested vit.d, b12, folate and ferritin. All okay except vit d which was a little low at 56.7 nmol/L (50-150) I have been using vit d 'better you spray' for about 5 months now.

[greygoose in reply to ade1961]

That's not 'a little low', that's very low. What were your other results?

If you're taking vit D, are you also taking its cofactors: magnesium and vit K2-MK7?

I follow the advice on here, ie. early morning, no dose night before

Not sure what you're saying, there. Are you saying that you take your levo at night? And you miss the dose the night before the blood draw? Making the gap between the last dose and the blood draw something like 36 hours?

[ade1961 in reply to greygoose]

I have been taking my levo at night before bed so yes the time from dose to morning test would be approximately 32 hours. No I,m not taking cofactors, I wasn't aware of them. Vit B12 452 (197-771), Folate >20 (3.89-26.8), Ferritin 85 (30-400). Thank you

[greygoose in reply to ade1961]

In that case, you have false 'low' FT4 results, It should only be a gap of 24 hours. So, forget what I said about poor conversion, you need to retest just leaving 24 hours.

Personally, I would want my B12 higher than that - over 550. And ferritin could be quite a bit higher, too.

[ade1961 in reply to greygoose]

Thank you greygoose, I am confused, wouldn't that mean my ft4 would be higher so conversion would appear even worse ?

[greygoose in reply to ade1961]

Yes, you're right, sorry. Getting confused myself! Yes, your FT4 would be higher if you only left 24 hours.

[ade1961 in reply to greygoose]

Would you consider the ft3 to be too low and possibly lead to continuation of symptoms ? I don't think I should go up anymore on levo, what are your thoughts please ?

[greygoose in reply to ade1961]

Yes, I would. The highest your FT3 has been is mid-range. Most hypos need it higher than that. And, it's low T3 that causes symptoms.

What you need, of course, is some T3 added to a decreased dose of levo. But, that's not so easy to obtain.

[SlowDragon Administrator]

What are your vitamin levels like?

Presumably you test vitamin D, folate, ferritin and B12 as well on medichecks?

Optimal vitamin levels helps improve conversion of Ft4 to Ft3

Can you add actual results

Ft4 is 87% through range

Ft3 only 50% through range

Are both TPO and TG antibodies always negative?

Have you tried strictly gluten free diet?

[ade1961 in reply to SlowDragon]

Hi SlowDragon, I posted the results above, D was quite low so I supplement with the mouth spray. My TPO and TG antibodies have always been negative. I did have unexplained white blood cell rise for many years but they are now normal so I do suspect that may have been an auto immune attack on my thyroid but that's a guess. No I haven't tried gluten free. Not sure what to do next. I am considering ndt for the t3, thanks

[SlowDragon Administrator in reply to ade1961]

Retesting vitamin D here

vitamindtest.org.uk