Advice please on next steps ........thank you

[Eton]

I have provided details of my "Thyroid Journey" todate on my profile.

You will see from my results on my profile that I dont convert well so I am trying to introduce T3. I have been taking 50mcg T4 and 15mcg T3 (10mcg at 6am and 5mcg around 6pm.) for almost 7 weeks.

Blood tests were 23.5 hours after last levo and about 11 hrs after last 5mcg of T3. Results were tsh 0.07 (3.1-6.8); t3 4.1 (3.1-6.8); t4 10.1 (12-22). This is the highest result I have ever had for T3 yet I dont feel well. I actually thought I was overmedicated as i have been feeling restless at night, and for some reason my heart rate is high when I wake from my sleep. It can be 80-85 bpm which is really elevated for me. My resting heart rate is usually in low 60s.

I would really welcome advice on where to go from here. When I started to introduce T3 I was on 75mcg Levo. All was well with the first 10mcg T3 but when I added a further 5mcg I got insomnia and raised heart rate so I reduced levo to 50mcg. Maybe I should have persevered with the 75mcg T4 but I was a bit frightened? So now I don,t really know what way to turn and there is no point seeking advice from my GP or endo.

Thank you in anticipation.

[SlowDragon Administrator]

Having read your helpful profile, have you ever had thyroid antibodies tested or ultrasound scan of thyroid

Likely you have autoimmune thyroid disease, have you ever tried strictly gluten free diet?

Re T3 ...have you tried splitting the 15mcg into 3 x 5mcg doses

7am, 3pm and 11pm (approx)

Many people find taking small dose T3 at bedtime improves sleep

Your Ft4 is now too low and suggests you need to increase levothyroxine up ....you could increase slowly by taking 50/75 alternate days

Do you always get same brand of levothyroxine?

[Eton in reply to SlowDragon]

SlowDragon,

Thank you for your reply. I had antibodies test April 2020 = Thyroglobulin 18 (less than 115)

Thyro peroxidase 67.5 (less than 34)

. (I have now added this to my profile). I think this confirms autoimmune thyroid disease?

I have never had an ultrasound done. Do you think I should - what would it be looking for?

I did try gluten free for several months a few years ago but didn't notice any difference in my digestion or how I felt. So I didn't continue with it.

The reason I take the T3 as 2 doses at 6am and 6pm is so that I can be at at least 2 hours after my meal and at least an hour before I will eat again. I dont know if it necessary to take away from food? It really does "get in the way" as I need to eat several small meals a day to help with digestion and consume enough calories and nutrients.

I will do as you suggest and try increasing the levo, alternating 50 and 75 , if no problems I will hold for 6 weeks and retest? Maybe I should have stuck with the 75mcg levo and just added 10 mcg split dose of T3 but hindsight is a great thing...Its all a bit complicated.......

I had been using 25mcg Teva and 50mcg Accord to give me the total 75mcg t4. This seems to be what my pharmacy dispenses.

I noticed you mentioned in your profile supplementing with selenium. I have never been tested for that and so dont know if deficient. I do not supplement but I do eat a couple of brazil nuts daily and also fish about once a week, plus turkey, chicken and a little liver. I just wonder if I could improve my conversion with some more selenium?

Thanks again for taking time to give me the benefit of your wisdom and experience which I can see from your profile.

Kind regards

[SlowDragon Administrator in reply to Eton]

Did you try splitting T3 into 3 doses

Fast heart rate can be because you have too long between T3 doses

Does fast heart rate drop after taking T3 in the morning

Did you increase levothyroxine...how’s that going?

[Eton in reply to SlowDragon]

Thanks Slow Dragon. I take T3 about 5am/6am when I wake to go to bathroom but the high heart rate manifests itself when I wake to get up around 9am. It was over 100bpm this morning but settled at around 80 within 15-20 minutes of getting up. Could it be related to adrenals? I read that if there is an adrenal problem then raises in thyroid meds may be difficult. I also have very low bp.

I am back on 75mcg of levo and have been for about 2-3 weeks.

[SlowDragon Administrator in reply to Eton]

Sounds like it could be

Perhaps consider cortisol and dhea testing

regeneruslabs.com/products/...

[Eton in reply to SlowDragon]

Thanks Slowdragon. I have just ordered the test. If there is a problem with adrenals what are the possible treatment options?

[SlowDragon Administrator in reply to Eton]

Teva brand of levothyroxine upsets many many people

Teva contains mannitol as a filler, which seems to be possible cause of problems. Teva is the only brand that makes 75mcg tablet. So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half

Teva and Aristo are the only lactose free tablets

healthunlocked.com/thyroidu...

Teva poll

healthunlocked.com/thyroidu...

academic.oup.com/jcem/artic...

Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).

Levothyroxine is an extremely fussy hormone and should always be taken on an 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 convenient and perhaps more effective taken at bedtime

verywellhealth.com/best-tim...

No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.

Some like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away

(Time gap doesn't apply to Vitamin D mouth spray)

[Eton in reply to SlowDragon]

Thanks Slow Dragon. I use Wockhart 25mcg and Actavis 50mcg T4. Always take as you directed.