Am I a poor converter and if so how do I obtain combination therapy as my next step???

[Supermisshelen]

Dear Thyroid experts

Can I please ask for some advice in advance of my doctor calling on Monday to review my levothyroxine dosage. As she’s been away for a couple of months and has been very good in trying to help me, I have been following the previous advice you’ve all given me on here and used medichecks for testing, and so in the 3.5 months I have been taking North Star levothyroxine. I’ve increased it from 50mcg to 100mcg taken last thing at night. I haven’t noticed any changes to my symptoms, not least by far the worse thing of all, my hair loss.

I will attach my most recent blood results that were from just before increased the levothyroxine but what I’m wanting to ask, given that my T4 has increased by a significant jump from right at bottom of normal range to mid range, but my T3 has stayed the same, if this makes me a poor converter? I’m keen to try a combined therapy now as among other things, this seems to be how people actually get their hair back.

My ferritin , bit D, B12, folate and zinc were all optimal finally, at last check.

How do I best go about approaching my doctor about getting a prescription for a combined therapy ? I know it’s all about using the right language and approach when it comes to accessing more expensive things on the nhs!

Thank you so much in advance everyone.

Helen😀

Results from early sept 20:

TSH

0.27 - 4.2 R

1.5

mIU/L

FREE T3

3.1 - 6.8 R

4.35

pmol/L

FREE THYROXINE

12 - 22 R

16.7

pmol/L

Previous free thyroxine reading was 12.9 pmol/l range (12-22)

Free T3 4.4 (3.1-6.8)

[SlowDragon Administrator]

What vitamin supplements are you currently taking

What are your most recent vitamin results and ranges

Was this test done 6-8 weeks after increase to 100mcg

Test done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test?

If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test

If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal

Ft4 is only 47% through range

Ft3 is 33% through range

[Supermisshelen in reply to SlowDragon]

Hi slow dragon thanks for your response sorry I should have said that the results I posted have been I think 4-6 weeks after taking the 100mcg dose and I did follow the instructions about not having the levothyroxine the night before the morning I took the test myself (;with nothing but water first) I didn’t delay the two day previous however, just the one before, so will do that next time as you’ve said. I’m on holiday at mo so haven’t got my doctors blood ranges for the vitamins and minerals to hand and they probably need doing again as about 4 months old, but I take Inessa multivitamin if that means anything , with extra 1000mcg of b12 each morning too.

[Supermisshelen in reply to Supermisshelen]

Sorry it was after increment of 25mcg so those results are from 75mcg dose and now for 4 weeks or so I have been taking the 100mcg and will test again 😀

[SlowDragon Administrator in reply to Supermisshelen]

Looking at previous posts you don’t appear to have Hashimoto’s as antibodies are negative

Have you ever had thyroid ultrasound scan

20% of Hashimoto's patients never have raised antibodies

healthunlocked.com/thyroidu...

Paul Robson on atrophied thyroid - especially if no TPO antibodies

paulrobinsonthyroid.com/cou...

Multivitamins are never recommended on here, especially with Hashimoto’s (you don’t appear to have Hashimoto’s)

healthunlocked.com/thyroidu...

Inessa contains iodine

inessawellness.com/products...

[Supermisshelen in reply to SlowDragon]

Thank you slow dragon for your really helpful advice and the suggestion of a scan I think that’s a great idea as I’ve wondered about the Hashimoto without antibodies scenario and that world I guess rule it out or otherwise. I think one advisor on here did suggest that my consistent low/slightly below range wbc could possibly indicate it.

I will look to change the multivitamin too... is there a range or brand that you might recommend ?

Many Thanks indeed for your advice 😀xx

[SlowDragon Administrator in reply to Supermisshelen]

Suggest you follow recommendations of the forum and test vitamin d, folate , ferritin and B12

Come back with new post once you get results

[Supermisshelen in reply to SlowDragon]

Thank you slow dragon I’ll do that and I will. Thanks for digging out my previous results too😀

[SlowDragon Administrator in reply to Supermisshelen]

Probably need maintenance dose of vitamin D

Trial and error what that is ....perhaps try 1000iu daily

Might need more ....might need less

[SlowDragon Administrator in reply to Supermisshelen]

3 months ago

Vitamin D - 103 nmol/L (25-300)

B12 - 466 ng/L. (130-800)

Serum ferritin - 74 ug/L (12-250)

Folate - 24 ug/L (4-20)

Zinc - 16 umol /L (11-24)

Perhaps consider a daily vitamin B complex....one with folate in (not folic acid) Remember to stop taking this a week before ALL Blood tests as biotin can falsely affect test results

How much vitamin D are you currently taking?

Look at iron rich diet to maintain/improve ferritin

[fuchsia-pink]

I think you need to see what your bloods are like 6-8 weeks on from the increase from 50 mcg - which is only a "starter" dose. Doubling up rather than a 25 mcg increase is a big jump, so best to see how you feel on that first.

As far as your latest bloods are concerned, free T4 is 47% through range and free T3 is 33.7% - so both are too low on 50 mcg but you aren't a truly dreadful converter

You'll probably feel much better on the new dose - and may find it's enough to bring your "frees" up to the top third of range and for you to feel like you again. Given how tricky it is to get lio, let's hope levo-only, at the right dose, does the trick x

[Supermisshelen in reply to fuchsia-pink]

Hi Fushia-pink sorry I should have been clearer in my post and said that the blood results of the higher free T4 was taken around 4-6 weeks after starting the 75mcg as I cut the tablets in half to take that dose so have been about 4-6 weeks now taking the 100mcg so it remains to be seen what the results will be but possibly following the pattern again of the free T4 going up and the free T3 staying the same

[fuchsia-pink in reply to Supermisshelen]

OK - that's probably kinder to your body! Yes, test again after 8 weeks on 100 mcg - and I'd say keep adding to levo until free T4 is at least 2/3 through range ... and see what free T3 is doing then.

And in the meantime, if your GP is good, say that you are concerned about possible poor conversion, and would she agree to refer you to an endo if you can get your free T4 nice and high but free T3 is still much lower than you would like?

And start doing research on who you would want to see ... it can take a while to see someone. You don't have to see the nearest person - but obv needs to be reasonably convenient. You want one who will prescribe lio - and not many will, because it's very expensive, it has a short half-life and is difficult to measure, and lots just plain don't believe it helps [guessing none of them are poor converters themselves!] - even if they concede "anecdotally" that patients themselves feel better on it ... You can get a list of T3-friendly endos from Dionne at Thyroid UK - [e-mail] - and set up a new post in due course asking for recommendations of people near-ish to you.

But as I said before, life is easier if you don't need to jump these hoops and enough levo gets you to where you need to be x

[Supermisshelen in reply to fuchsia-pink]

Thank you ever so much fushia-pink, I was thinking that in the beginning.. I really want the levothyroxine to work on its own as it’s just so so simple and I can see that the doctors don’t have a problem with me having it one bit. Your advice is ever so useful for me going forward very kind of you. xx