Worse results after adding T3 ( a small amount)

[Clara62]

Hello, these are my latest results, arrived today. Surprised to see that with the add of a minimum of T3 - only 5mcg for now- my results are worse than the previous ones when I was only on T4 ( 88mcg). Now I am on 80mcg T4 and 5mcg T3. Both times did the tests 24 after last dose of thyroid hormones. I had to change T4 medication brand though, from gel capsules to normal pills, because I couldn't go to Italy to buy them. I wonder if you have any suggestion for a better dosage of thyroid hormones especially and other supplements. Thank you.

( My worse symptoms are: reflux and bloating ,difficult sleep, low blood pressure, poor energy, dry skin, the need to eat often in order to have e bit more energy, physically lazy...)

Previous results were: ( on t4 only) Dec 2019

TSH 0.07 ( 0.27-4.2)

FT4 20.8 (12-22)

FT3 4.42 (3.1-6.8)

New results: ( on T4-T3) June 2020

hs-CRP 2.06 <5.0 mg/L

Ferritin 62.2 13 - 150 ug/L

Magnesium 0.87 0.7 - 1.0 mmol/L

Cortisol (at 8:30am) 349.0 6am - 10am 113 - 456 nmol/L

TSH L 0.11 0.27 - 4.20 mIU/L

T4 Total 93.2 66 - 181 nmol/L

Free T4 15.8 12.0 - 22.0 pmol/L

Free T3 3.71 3.1 - 6.8 pmol/L

Anti-Thyroidperoxidase abs <9.0. <34 kIU/L

Anti-Thyroglobulin Abs 11. <115 kIU/L

Vitamin D (25 OH) 95 50 - 175 nmol/L

Vitamin B12 413 Deficient <145 pmol/Insufficient 145 - 300. Consider reducing dose >569

Serum Folate 25.40 8.83 - 60.8 nmol/L

[SlowDragon Administrator]

First....You should only leave 12 hours maximum between last dose T3 and blood tests

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

So you have FALSE low Ft3

Obviously your Ft3 is extremely low so you probably need to increase T3 ....just taking 5mcg is a tiny dose

Adding a second 5mcg dose T3 mid-later afternoon

Retesting 6-8 weeks later

B12 and folate are rather low

What vitamin supplements are you currently taking?

[Clara62 in reply to SlowDragon]

Thank you Slow Dragon. Yes blood was taken first thing in the morning, fasting. I couldn't take the T3 separately because it was part of a compounded med, but now I have a proper T3 med so I can split the dose.

Supplement I take :

B1 100mg

B6 50mcg

D3 +K2 2000iu

Selenium 200 mg

zinc 30mg

Vit C 1000 mg

Magnesium citrate 150mg

Tumeric

Had no idea that b12 at 413 was low...

Now I could have 5mcgT3 in the morning and 5mcg in the afternoon ( I seem to crash mid afternoon , may be I'll take it around 3:00pm? )

[SlowDragon Administrator in reply to Clara62]

3-4pm is good time ....leave at least 45 mins after taking before eating or drinking anything..to be on safe side

[Clara62 in reply to SlowDragon]

SlowDragon, thank you 🙂

[adin]

Why you lowered the T4 dose? The T4 dose should be increased.

[Clara62 in reply to adin]

Good point, I actually don't know, I've read that sometimes they advice to lower it when adding T3...In reality it's difficult to self medicate but apparently it's the only choice right now.

[Batty1 in reply to Clara62]

Yes, Endo typically will reduce your T4 meds when they add T3.

[jgelliss in reply to Clara62]

Sometimes we don't have enough T4 for the T3 we are dosing with and it makes us feel like a T3 run out . Very uncomfortable feeling. Running labs with FT4 prior to adding any T3/NDT is very important.