Blood levels and overmedication?: Hi, I suffered... - Thyroid UK

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Blood levels and overmedication?

Blackbird28 profile image
22 Replies

Hi,

I suffered Atrial Fibrillation 10 weeks ago (lasting 24 hours- none since) and was told that my FT3 was sky high at 30 ( range 3.1-6.8) and was the cause at 50mc a day of liothyronine.

I was also taking 100mc Levi at the time and my TSH was <0.04

I am now on 75mc levi and 2x5mc liothyronine

My latest results are:

TSH 0.05 (0.27-4.25)

Ft3 3.1 (3.3-6.8)

Ft4 10.8 (12-22)

Folate 4 (3-20)

B12 56.1 (180-914)

Ferritin 33 (10-307)

Vit D 58 (50-150)

I’m also on 1.25 Bisoprolol which I’m desperate to get off!! My GP doesn’t want me to come off them because he says my Ft4 is too low but I think a few of my numbers are low in range?

I am gaining pounds which is really upsetting me despite still running 5-6 miles each day but I can’t see a specialist as we are still on lockdown!

Any advice would be really gratefully appreciated!!

<3

Thank you x

My

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Blackbird28
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22 Replies
Blackbird28 profile image
Blackbird28

Aha sorry my B12 is 561 not 56.1 doh!!! Xx

SlowDragon profile image
SlowDragonAdministrator

Folate, ferritin and vitamin D are all too low

What vitamin supplements are you currently taking?

Presumably you have Hashimoto’s?

Diagnosed by high thyroid antibodies

Are you on strictly gluten free diet?

Blackbird28 profile image
Blackbird28 in reply toSlowDragon

Hi,

I’m not gluten free but I avoid carbs as much as possible.

I have other family members so that’s why I presume it’s Hashimoto’s but I’ve not been tested.

I take vitamin C but have just got myself some Florodix to try and help.?

Thank you

SlowDragon profile image
SlowDragonAdministrator

How long have you been on 75mcg plus 2 x 5mcg T3?

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)

If/when also on T3, make sure to take last third or half of daily dose 8-12 hours prior to test, even if this means adjusting time or splitting of dose day before test

Is this how you did your test?

Blackbird28 profile image
Blackbird28 in reply toSlowDragon

Yes I skipped meds and had a test first thing on an empty stomach-no Levi and my last T3 dose the day before so there was 24 hours clear ahead of tests.

SlowDragon profile image
SlowDragonAdministrator in reply toBlackbird28

So you left far too long between last dose T3 and test ...so Ft3 is false low

Last dose of T3 should be maximum of 12 hours before testing and last levothyroxine 24 hours

bantam12 profile image
bantam12

Have you had any cardiac tests done ? You can still have episodes of AF but not always be aware of it, you should be careful pushing yourself with the running in case there is an underlying heart problem.

Blackbird28 profile image
Blackbird28 in reply tobantam12

Yes I’ve seen a cardiologist privately and had ecg, and scans which showed all ok and no structural damage

I have a smart watch so I can check for AFib of which I’ve had none and my resting pulse is around 45-55 which I guess is partly due to my beta blockers

bantam12 profile image
bantam12 in reply toBlackbird28

Keep Afib from other causes in mind because tests don't always show the problem, I had numerous tests over the years and told all ok but it wasn't and I now have a pacemaker!

Marz profile image
Marz

From reading this Forum for many years - it is often suggested that levels of B12 - Folate - Ferritin and VitD are optimal before starting T3. Low Folate and Ferritin can also cause heart issues. Do you have your results from before starting T3 ?

Ferritin and Folate are good mid-range and VitD at 100+ ...

Iron is transported around the body in the red blood cells. Oxygen adheres to iron for transportation. Low Iron=Low oxygen - and so the heart beats faster in an attempt to create more oxygen. Simplistically put 🤔

Blackbird28 profile image
Blackbird28 in reply toMarz

Aw that makes sense thank you!

And no I didn’t have tests before T3 began it after a couple of months on T3 (initially 10mc 3x per day), I felt so much better!

SlowDragon profile image
SlowDragonAdministrator in reply toBlackbird28

But then increased dose far too much.

Typically on levothyroxine plus T3 the dose of T3 is 10mcg, 15mcg or 20mcg in total per day

fuchsia-pink profile image
fuchsia-pink

So 10 weeks ago you were on 100 mcg of levo and 50 mcg of lio and you are now on 75 mcg of levo and 10 mcg of lio. That's a huge reduction in a short time - was it all in one go or phased? Have you been on the same dose for at least 6 weeks before re-testing bloods?

As you can see your free T3 and free T4 are now under range, but your key nutrients are also low, but it would seem there is some scope to increase dosage (although not as high as before).

Slow and steady is usually the best I suffered physically when my endo halved my lio from 40 mcg to 20 in one go [before I had found this forum] - so it can't have been easy for you dropping that much quickly.

I suggest you follow SlowDragon and Marz 's wise words and improve your nutrients, then add a VERY SMALL amount to your medication before re-testing, and keep adding very slowly until you find your sweet spot. Good luck x

Blackbird28 profile image
Blackbird28 in reply tofuchsia-pink

Thank you, I will maybe add another 5mc of T3 during the day? Yes I’ve gained weight which causes me real anxiety - my GP and cardiologist is unsympathetic as I started at 8st (5’6 ) but that’s my comfy weight

My mood is low but there are environmental factors so I can’t blame it solely on my thyroid

I will try to improve my nutrients thank you!

greygoose profile image
greygoose

I don't understand any of this. Did they really reduce your T3 from 50 to 10 in one go? fuchsia-pink asked the question, but you didn't reply. And, why did they reduce your T4? What was your FT4 result at that point? And, who did it?

Now you are grossly under-medicated.

I’m also on 1.25 Bisoprolol which I’m desperate to get off!! My GP doesn’t want me to come off them because he says my Ft4 is too low

As your GP know that your FT4 is too low, why doesn't he increase your dose? Has he not said anything about your FT3 also being under-range? That's the most important number. And, it's far worse for your heart to have an under-range T3 than an under-range T4. Or is he not increasing your dose because of the low TSH? That could take a while to rise, and in the meantime you're under-medicated.

You really should not be running with such a low FT3 - I'm surprised you can, actually, you must feel like death. A little gentle walking is all you should be doing. You really do need to be careful.

Do you have any other lab results from being on 50 mcg T3?

Blackbird28 profile image
Blackbird28 in reply togreygoose

Hi, they advised to stop the T3 altogether so I said I was worried about a sudden drop and said I would try 2x 5mc daily to avoid losing my prescription ( I think the overriding issue was, as always, the cost of T3 rather than either patient health or even numbers!)

I am very nervous about taking too much because they ( my private cardiologist) said that overmedication was the cause of my Afib. I intend to see a private endo but because of the pandemic, I have shelved plans to go to see one. Meanwhile I am ballooning and not sure what to do for the best!

The GP said my TSH is still low despite 7 weeks on 75 mc Levi and 2x5mc liothyronine so I’m nervous to add more although I’m thinking an extra 5mc T3 surely cannot hurt? Do you think?

greygoose profile image
greygoose in reply toBlackbird28

I am very nervous about taking too much because they ( my private cardiologist) said that overmedication was the cause of my Afib.

They always say that. They are terrified of T3 because they know nothing about it. But, an under-range FT3 is far more dangerous.

The GP said my TSH is still low despite 7 weeks on 75 mc Levi and 2x5mc liothyronine so I’m nervous to add more although I’m thinking an extra 5mc T3 surely cannot hurt? Do you think?

That is meaningless, especially as you had Grave's. What's the highest your TSH has ever been? If your FT3 is under-range, that tell you that you are very under-medicated, whatever the TSH says. TSH is not the important number.

Do you have any other lab results from being on 50 mcg T3?

SlowDragon profile image
SlowDragonAdministrator in reply toBlackbird28

Would suggest you cautiously increase levothyroxine to 100mcg. This should increase low Ft4 and slowly improve low Ft3

retest in 6-8 weeks making sure to leave correct times between last dose levothyroxine and last dose T3

To improve conversion of Ft4 to Ft3 we need GOOD vitamin levels

Vitamin D at least around 80nmol and around 100nmol may be better

GP will only prescribe to bring levels to 50nmol.

ouh.nhs.uk/osteoporosis/use...

But improving to around 80nmol or 100nmol may be better

ncbi.nlm.nih.gov/pubmed/218...

vitamindsociety.org/pdf/Vit...

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

Test twice yearly via vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function. There’s a version made that also contains vitamin K2 Mk7

It’s trial and error what dose we need, with hashimoto’s we frequently need higher dose than average. Suggest you try 3000iu per day and retest in 2-3 months

Also read up on importance of magnesium and vitamin K2 Mk7 supplements when taking vitamins

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

B12 and folate are both very low. Supplementing a good quality daily vitamin B complex, one with folate in not folic acid may be beneficial.

chriskresser.com/folate-vs-...

B vitamins best taken in the morning after breakfast

Igennus Super B complex are nice small tablets. Often only need one tablet per day, not two. Certainly only start with one tablet per day after breakfast. Retesting levels in 6-8 weeks

Or Thorne Basic B or jarrow B-right are other options that contain folate, but both are large capsules

If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before any blood tests, as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

Low B12 symptoms

b12deficiency.info/signs-an...

If vitamin D is low, B vitamins may be too. As explained by Dr Gominack

drgominak.com/sleep/vitamin...

healthunlocked.com/thyroidu...

GP should do full iron panel test for anaemia before you consider starting any iron supplements

SeasideSusie may comment on low ferritin and iron supplements

Blackbird28 profile image
Blackbird28 in reply toSlowDragon

Oh wow thank you! A lot of information here! I will read and re-read to absorb! Thank you again this is brilliant!

SlowDragon profile image
SlowDragonAdministrator in reply toBlackbird28

It’s important to only increase levothyroxine or T3 at any one time and then wait minimum 6-8 weeks and retest

At moment you probably need more levothyroxine....then reconsider once you get test results in further 6-8 weeks

All four vitamins need to be optimal and maintain them at optimal levels, so likely need to supplement virtually continuously at maintenance doses, once they are improved.

Strictly gluten free diet often helps enormously or is absolutely essential, the only way to know is to try it

Blackbird28 profile image
Blackbird28 in reply toSlowDragon

Ok well I eat a fairly strict diet so I will check it for gluten and get on top of my vitimans too. Thank you so much for your advice

SlowDragon profile image
SlowDragonAdministrator in reply toBlackbird28

It’s almost inevitable, when on any dose of T3 that TSH will become suppressed...it’s irrelevant

The most important results are Ft3 followed by Ft4. Some people need GOOD levels of Ft3 and Ft4.

Some are ok with lowish Ft4

But levels should be within range, not over range

Some people find taking T3 in one single dose works best....others (including myself) need to take three SMALL doses T3 spaced equally through the day

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