New test results after minor increase in Levothyroxine! Can someone help me work out what to do next?

[Louise1610]

I was on 75mcg Levo for about 8 years and recently battled with the doctors to raise it, and they only reluctantly agreed to 75/100mcg alternate days, so equals about 87.5mcg a day overall, about 12mcg increase. I have also been taking Igennus Super-B Complex (2 tablets a day), Magnesium Complex (mostly Malate in it) once a day and the BetterYou Vitamin D oral spray 3000IU with K2 since my results in April.

Here are my previous thyroid results from 08.04.2020:

FT3- 4.5 pmol/L (3.1-6.8)

TSH- 1.81 mIU/L (0.27-4.3)

Thyroglobulin antibodies (TgAB)- <10 kU/L (0-115)

Thyroid peroxidase antibodies (TPOAb)- 15.9 kU/L (0-34)

Thyroxine (T4)- 117 nmol/L (66-181)

Free Thyroxine (FT4)- 16.5 nmol/L (12-22)

And here are my new thyroid results (20.08.2020) with my 12.5mcg increase in Levothyroxine (these were taken 8 weeks after my increase in Levo):

FT3- 4 pmol/L (3.1-6.8)

TSH- 1.26 mIU/L (0.27-4.2)

TgAB- 17 Ku/L (0-115)

TPOAb- 8.6 kIU/L (0-34)

T4- 100 nmol/L (66-181)

FT4- 19.1 pmol/L (12-22)

My other results from 20.08.2020:

Total iron-binding capacity (TIBC)- 63 umol/L (41-77)

Unsaturated iron binding capacity- 39 umol/L (24.2-70.1)

Ferritin- 54 ug/L (13-150)- the results from April were 94 ug/L (13-150)

Iron- 24.2 umol/L (5.8-34.5)

Transferring saturation- 38% (20-50)

Active B12- 95 pmol/L (37.5-188), results from April were 75 pmol/L (37.5-188

), but I have been on B12 injections for both of these, so believe the results are skewed.

Folate- 22.7 nmol/L (8.83-60.8), results from October 2019 were 9 ug/L (3.4-15.8)

Vitamin D- 105 nmol/L (50-175), results from April were 69 nmol/L (50-175)

So my questions are:

1. I don't understand why my FT3 has lowered with the increase in Levo and I absolutely don't feel any better at all! Shouldn't FT3 increase with more Levo?Any idea why FT3 might decrease with an increase of Levo?

2. My Vitamin D has increased with taking the 3000IU supplement with K2/Magnesium so this is positive- is this now optimal?

3. My Ferritin is a fair bit lower and I haven't been taking any iron supplements- any idea why it would go down? Are my iron levels optimal?

4. Does my Folate look a bit low? I'm already taking Folate in the Igennus Super-B Complex.

Any comments/suggestions based on the above results most welcome!

[greygoose]

1. I don't know for sure, but it could be that your FT4 has now risen to the point where the T4 converts to more rT3 than T3. Usually, it converts to an equal amount of T3 and rT3, but when the FT4 gets to the point that the body considers too high - and that point is different for everybody, so the range isn't much help - it converts to more rT3 than T3 so that you don't 'go hyper'.

It is surprising that your FT4 has jumped up so high on such a tiny increase. But, these surprising things do happen. It's also surprising that your TSH didn't drop further. So, one wonders if you don't perhaps have Hashi's despite the low antibodies. It does happen.

2. Your vit d is now very good.

3. Given the range, your folate could be quite a bit higher. How many Igennus tablets do you take a day?

[Louise1610 in reply to greygoose]

1- I've never felt well on Levo the whole time I've been on it and I certainly don't feel any better after the recent increase, so I'm wondering if I should look at trying an alternative medicine like NDT or T3 with a private practitioner instead?

I've never actually been told whether I have Hashimotos or not and don't think the doctor has any clue why I have hypothyroidism! I do also have low cortisol levels (not low enough for addisons), but still really low normal, so I wonder if this could negatively affect my thyroid levels?

2. That's good, at least one level is now sorted!

3. I take 2 Igennus tablets a day.

[greygoose in reply to Louise1610]

1. You've probably never felt well on levo because your FT3 level has never been high enough to make you well. T3 is the active hormone that causes symptoms when it is too low. So, yes, T3 or NDT would probably be a good idea.

3. Well, your folate is probably ok as it is. Or, if you want it higher, you could add in a separate methylfolate tablet for a while. But, don't take more than two Igennus tablets.

[Louise1610 in reply to greygoose]

Thank you

[greygoose in reply to Louise1610]

You're welcome.

[SlowDragon Administrator]

Like many of us, you have found that higher Ft4 doesn’t improve conversion of Ft4 to Ft3...it can make it worse

So you are likely to need addition of small dose of T3 alongside levothyroxine and reduce levothyroxine back down a bit

Adding T3 can dramatically improve low cortisol levels too ....as McPammy may pop along and testify to

Email Dionne at Thyroid UK for list of recommend thyroid specialist endocrinologists who will prescribe T3 ...NHS and private

[e-mail]

Roughly where in the UK are you?

[Louise1610 in reply to SlowDragon]

Thank you- that's really useful as my cortisol levels are quite low, so definitely looking to improve that as well as my thyroid levels.

I've already been referred to 2 NHS endocrinologists- the first one at Rotherham Hospital refused to see me and told me that, if I wanted to see an endo, to get referred somewhere else. The 2nd one at Sheffield Hallamshire Hospital, he sent me straight for a synacthen test without any consultations, said that was fine so discharged me- again with no consultation first. I then wrote him a letter instead to send him my private results, but he pretty much disregarded them all and said my TSH was fine so I didn't need any other medication but I could have a little bit more Levothyroxine, as long as my TSH didn't become suppressed (which led to the GP giving me a little increase).

I'm speaking to a private functional practitioner at Country Health in a few weeks' time to see if they can help with my thyroid/low cortisol levels. I'm guessing the price wouldn't be much different to a private endocrinologist anyway?

I'm not currently having a lot of faith in the NHS GPs and Endocrinologists lately!

I'm based in South Yorkshire