Ft4 risen after starting liothyronine, what's going on?

[liekki]

Hello all.

Now, I would like you to weigh in on my latest results, and more specifically my rascally ft4! Apparently it doesn't give a hoot what I'm doing and is determined to live a life of its own...

I've been on combination trial for about two months now, taking 125 mcg t4 and 10 mcg t3 and this is what my current levels look like:

TSH 0.41 (0,5-3,8)

Ft4 19 (10,2-21)

Ft3 4,4 (3,2-6,5) -before morning meds

Ft3 5,6 -about three hours after morning dose of 5 mcg lio

What's confusing is that my ft4 has risen since last tests, taken in february, when I was on 150 mcg of thyroxine:

TSH 1,36 (0,5-3,8)

Ft4 17 (10,2-21)

Ft3 4,1 (3,2-6,5)

At the moment I have good days and off days, and I really don't know if I'm over- or undermedicated.

I was so sure just a week ago that I needed some more thyroxine because my resting heart rate was really low in the mornings and my extremities were cold until liothyronine kicked in. This result threw me off and I'm not sure what to do next.

So, what do you people think is going on with ft4 here, I thought it usually drops further after adding t3? I guess my thyroid remnants could be dumping hormones but ft3 seems about right.

Stay safe!

[SlowDragon Administrator]

As you have Hashimoto’s levels fluctuate unless taking high enough dose to completely suppress TSH

Are you on strictly gluten free diet

[liekki in reply to SlowDragon]

Thank you for responding, Slowdragon.

I'm not exactly gluten free, but have started changing my eating habits and get all of my gluten from soy sauce and such, If there is any left after fermentation.

I'm never going to get to suppress my TSH, it has to stay over 0,5 according to my endo.

Endos have only recently started to prescribe T3 in our public health service so their clinical experience is likely non-existent, and frankly, they are still afraid of the finnish oversight department Valvira, which hounded doctors over "unorthodox" t3 use last decade.

Personally I wouldn't have thought that my levels would still fluctuate that much, since my thyroid is almost toast. I don't think my ft4 has ever been that high, and now it went up after 25 mcg decrease.

What a frustrating condition this is.

[SlowDragon Administrator in reply to liekki]

Strictly gluten free diet does need to be absolutely strictly gluten free to be effective

Avoiding sharing butter, jam, separate toaster for any GF bread. Certainly no soy sauce (unless getting gluten free version)

Vitamin D, folate, B12 and ferritin need to be at very good levels

Personally I find T3 taken as small split doses 3 x per day at equal 8 hour gaps is the most effective. But others take it as single dose

We are all different...trial and error what works for each individual

[liekki in reply to SlowDragon]

Are males also susceptible for ferritin and folate deficiensies? I'm currently taking d's, B12 and magnesium, which seems to be effective for my buzzing ear and minor palpitations.

I've tried different dosing regimes, but have settled for twice a day for now. It's likely I need some T3 through the night, but can't take it at bedtime due to minor difficulties falling asleep. I have at least one or two false starts before falling asleep.