Hi! I have an underactive thyroid as a result of a radioiodine treatment (I previously had Graves disease). I'm currently taking 100 μg Levo and 12,5 μg T3.
Below are my latest test results taken 8 weeks after adding T3 to my medication. Before that both my T4 and T3 were higher (but so was my TSH), how is it possible that I'm taking more medications, but my results are worse?
TSH 0.81 (0.35 - 4.94 mIU/L)
Free T4 11.87 (9.01 - 19.05 pmol/L)
Free T3 3.84 (2.63 - 5.70 pmol/L)
Iron 22.4 (6.6 - 26.0 μmol/L)
Ferritin 35 (10 - 120 μg/L)
B12 240 (138 - 652 pmol/L)
Folic acid 11.6 (7.0 - 46.4 nmol/L)
Vit. D 38.4 ( >30.0 μg/L)
Thank you!
Written by
Thea1
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Can you please give us a little more information as to your thyroid journey, as to when you had RAI and is this a NHS prescription or are you self medicating.
It's difficult drawing a conclusion without your previous results but I can see immediately that your vitamins and minerals, namely ferritin, folate B12 and vitamin D need to be worked on.
They might well be in the NHS ranges and therefore not " qualify for a NHS prescription " but no thyroid hormone replacement works well if these core strength vitamins and minerals are not maintained at " optimal " levels, and would suggest you work on getting to well over 50% through those ranges given and work on vitamin D building to about 100.
I have Graves and post RAI back in 2005 and found myself on here a few years ago looking for answers. I now manage lingering Graves, thyroid eye disease and hypothyroidism and am self medicating as I was refused a trial of T3 on the NHS in early 2018.
If you don't know of the Elaine Moore Graves Disease Foundation it is a good adjunct to this amazing forum where you can learn further of this poorly understood and badly treated auto immune condition.
I'm not from the UK, but I get prescrbed Levo and started adding T3 without a prescription. My doctor will not change my medication if my levels are within range (even if I don't feel good on that dosage).
I had RAI 5 years ago, when I was 20 years old after having Graves for about 7 years. My doctor told me that since I'm out of puberty it won't go away on it's own and that it's better to have RAI and then take Levo for the rest of my life. He basically presented it as if it's no big deal, and unfortunatelly I just trusted him and didn't do any research on my own.
I'm going to start supplementing B12 and D3, any idea of how much I should take daily? I can also see that my folate acid low, should I take a supplement?
I'm a bit confused about my iron levels. If I understand it correctly it seems that the levels of iron in my blood are good, but I'm not absorbing it, that's why feritin is so low? Is that correct?
Well, yes, I too regret having RAI though I was 58 at the time !!
So, it's an auto immune disease, and as such, it's for life.
I know for a fact that my conversion of T4 into T3 improves when my ferritin is up at around 100 : I think your assumption is correct, though not sure what you can do to improve that except take the supplements 4 hours away from everything else with plenty of vitamin C to aid absorption.
Hopefully some one else will come along and advise more thoroughly and I hope to find @ SeasideSusie as this lady is our very own vitamins and minerals Queen.
Where do you live ?
P.S. Just to add, now on T3 and T4 it's essential that you dosed and monitored on T3 and T4 blood test results and most people seem better when both these vital hormones are in the upper quadrant of the ranges and this may mean your TSH probably going low/suppressed but this doesn't matter and is the least important of all the numbers.
I'm from Slovenia. So does it look like I should increase both Levo and T3? But maybe just one at a time? I'm just worried that if my TSH gets too low, my doctor will decrease my Levo (I'm adding T3 on my own).
It is imperative that you are dosed on T3 and T4 blood test results.
You have Graves Disease and it is known that in Graves patients the TSH is a very unreliable marker of anything and must not be used in isolation.
I was dosed and monitored on just a TSH result and became very ill.
Taking T3 does tend to lower TSH so maybe if you told your doctor you were taking Liothyronine s/he wouldn't be as obsessed with the TSH ? ( and pigs might fly !! )
You may need to increase both T3 and T4 but, yes, one at a time, as I read most people feel better when both T3 and T4 are in the upper quadrant of their ranges.
It's fine tuning to find your best place and realistically only you can do this :
Doctors work to guidelines and ranges, and very rarely take into account the whole person's wellness and I think you will start to feel so much better when you get those vitamins and minerals into optimal ranges.
These well then boost your own conversion of T4 into T3, which is the active hormone which the body runs on - too little T3 and you have the debilitating symptoms of hypothyroidism and too much T3 and you may have symptoms of hyperthyroidism, and nobody wants that either.
Ferritin is low but your serum iron is high in range, you don't appear to have iron deficiency so iron tablets aren't suggested as they would take your serum iron over range. You can help raise your level by eating liver regularly, maximum 200g per week due to it's high Vit A content, also liver pate, black pudding, and including lots of iron rich foods in your diet
This is low. According to an extract from the book, "Could it be B12?" by Sally M. Pacholok:
"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".
"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."
Do you have any signs of B12 deficiency – check here:
If you do then list them to discuss with your GP and ask for testing for B12 deficiency and Pernicious Anaemia. Do not take any B12 supplements or folic acid/folate/B Complex supplements before further testing of B12 as this will mask signs of B12 deficiency and skew results.
If you don't you could supplement with B12 together with a B Complex to balance all the B vitamins. Just one bottle of methylcobalamin 1000mg then once that is finished continue with the B Complex only, your B12 should hopefully have risen enough for the B12 in the B Complex to be enough to maintain it.
Folic acid 11.6 (7.0 - 46.4 nmol/L)
This is low. Folate is recommended to be at least half way through range so that would be 27+ with that range.
If you don't have any signs of B12 deficiency you could start supplementing with a good bioavailable B Complex now, eg Thorne Basic B or Igennus Super B. This will help improve both folate and B12 levels. Also check out folate rich foods.
If you do have any signs then don't start taking B Complex until further testing of B12 has been carried out and B12 injections or supplements have been started.
Vit. D 38.4 ( >30.0 μg/L)
The recommended level is 40-60 ng/ml which is the same as μg/L so you are just slightly low here. Supplementing with D3 throughout the winter months may help, maybe 2,000iu daily. Retest in the spring.
Thanks so much! I don't have any symptoms of deficiencies, so I'll start on B complex and B12. When does it make sense to test again?
Do you have an opinion on my T3 and T4 levels? Am I right in assuming that I should be taking more Levo and T3? Or is it possible that my levels are this low because I'm low on vitamins level? In that case, should I wait to get that in order before changing my medication?
Maybe retest the B vitamins in 3 months. If B12 is still below 400pmol/L I would supplement with 1000mcg sublingual methylcobalamin again until that bottle is finished, along with the B Complex.
Do you have an opinion on my T3 and T4 levels? Am I right in assuming that I should be taking more Levo and T3? Or is it possible that my levels are this low because I'm low on vitamins level? In that case, should I wait to get that in order before changing my medication?
I would work on optimising nutrient levels first at the moment as that should hopefully help your thyroid meds to work better, particularly ferritin as I have read that the optimal ferritin level for thyroid function is between 90-110 ng/ml (which is the same as ug/L).
As you are taking Levo plus T3 then your TSH is going to be low, even suppressed, as that's what T3 does so you wont be able to get round that with your doctor if he doesn't like your TSH low if it goes below range.
Also, taking T3 tends to lower FT4 and it's a very individual thing where those of us on combination hormone replacement need FT4 and FT3, some are fine with a low FT4, some of us need it higher in range, so we have to find that balance ourselves through trial and error.
Your FT4 is 28.49% through range and your FT3 is 39.41% through range. Your FT4 may be OK for you at that level, it may not, and your FT3 could be higher, but you will have to experiment yourself to see what suits you, but only change one thing at a time.
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