Recurring ear infection and over-medicating on T3.

[tcpace]

My wife, who is on T3 only (40 mcg per day), has a recurring ear infection, The GP surgery is now saying the ear infection problem might be due to over-medicating on T3 and they want to reduce her T3. I think that's rubbish. Thoughts anyone?

[RedApple Administrator]

tcpace, Without knowing your wife's recent thyroid test numbers, we can't really comment. Inappropriate levels of thyroid hormone certainly can be a cause of strange and recurring infections though, so I wouldn't rule it out completely.

[tcpace in reply to RedApple]

Thanks for the fast reply. Very recent results:TSH 0.003 (0.2 to 6.0); T3 9.1 (3.5 to 7); T4 0.7 (10 to 22)

She's been on T3 only for many years so the above results are par for the course except for the T3. On this occasion, the T3 is above range but, unfortunately, she took 20mcg T3 at 5:15am thinking that it wouldn't affect the blood test result - test done at 11:25am. Normally, on the day of the test she would have delayed taking the T3 until after the blood test. She can't tolerate T4 by the way - even 25mcg makes her feel unwell. She had half of her thyroid removed back in 2009 and has been diagnosed with Hashimoto's (antibodies > 1300).

The ear infection coincides with swollen glands in the neck and seems to come and go regularly - typically every 4 weeks. It lasts about 2 weeks. She's been having it for about 6 years now. It seems to have been triggered in the first place by having a 'flu jab in 2104. Prior to that she had been on T3 for about 4 years without any ear infections. In the early days, after a visit to Dr P, she went on to 20T3/75T4 but had to phase the T4 out to nothing eventually because she couldn't tolerate the T4.

All this seems to point away from T3 being the problem - possibly something to do with the 'flu jab in 2014.

She couldn't actually lower her T3 intake. She wouldn't be able to function - completely conks out mid afternoon if she forgets to take her second dose (she takes 20 in the morning and 20 in the afternoon).

Coming back to the original post. Is it likely that the T3 is causing the recurring ear infection?

[SlowDragon Administrator]

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 .

If/when also on T3, make sure to take last third or quarter of daily dose 8-12 hours prior to test, even if this means adjusting time or splitting of dose day before test

Is this how you do your tests?

Suggest you get testing redone leaving correct timings on last dose of T3

For full Thyroid evaluation she needs TSH, FT4 and FT3 tested.

Also EXTREMELY important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common with Hashimoto’s

What vitamin supplements are is she currently taking

Ask GP to test vitamin levels

Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins

List of private testing options

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Thriva Thyroid plus antibodies and vitamins By DIY fingerpick test

thriva.co/tests/thyroid-test

Thriva also offer just vitamin testing

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code

thyroiduk.org/getting-a-dia...

monitormyhealth.org.uk/thyr...

As she has Hashimoto’s is she on strictly gluten free diet?

[tcpace in reply to SlowDragon]

Thanks for the information (which we were already familiar with having followed this site for many years). My wife just slipped up on this occasion by taking one half of her daily dose too close to the test time (about 6 hours before). Previously, thanks to the valuable information on this site, she's always taken her last dose of T3 about 12 hours before the test. She won't make that mistake again!

She's taking the various supplements D3 etc and is well aware that the B12 levels etc need to be well up in the range (again from what we've learnt from this site). What I was really interested in was knowing whether anyone knows of a link between recurring ear infections and medicating on T3 only.

[tcpace]

Thanks for your reply. She got it wrong on this occasion by taking 1/2 of her daily dose about 6 hours before the test. She normally waits until after the test but as this one was much later in the morning than usual she thought she might get away with it by taking it very early in the morning. Lesson learned!

Yes they are the usual "free" ranges. Normally, on testing, her T3 is in the upper quartile if she doesn't take any of her daily T3 dose before the test . No symptoms whatsoever of over-medication. Basically she's not overmedicated - the T3 result on this occasion was just a blip as a result of mistiming things. The T3 is as prescribed by an endo. She does have Hashis.

Having said all of that, the point of my original posting was to see if anyone knew of a possible link between 'T3 only' therapy and a recurring ear infection. I don't think there is but someone out there may know otherwise.

[NWA6]

Hi. I very much doubt that T3 is the cause of your wife’s ear infections. The GP surgery has no one qualified to say otherwise. And as you say your wife made a simple error with her dosing before her test and yet even with that simple mistake her T3 is barely over range. So I think you’re right, I’d park that theory!

What I probably would do is insist on an ENT referral because you say that this is recurring every 4wks.

[tcpace in reply to NWA6]

Thanks for that. She has had scans of the lymph glands but I think it would be useful to have a proper ENT examination.

I was interested in your comment about the T3 only being "barely over range". The range for our area is 3.5 to 7 and hers was 9.1 (as you picked up on). My suspicion is that the results for someone on exogeneous T3 will fluctuate a lot (given its short half life and time dose last taken) so any T3 result returned on testing must be open to question but no one ever says the result should be taken with a pinch of salt. On one occasion (when in A&E), she had a blood test done (which included thyroid) and that gave a FT3 of nearly 12 because she had taken a 20mcg T3 tablet not long before the blood draw (not knowing she was going to have a blood test which included thyroid). In other words, the FT3 can vary massively depending on the circumstances.

[NWA6 in reply to tcpace]

Agree re T3, what we all have to remember is that these blood tests are guides only. They are to be used in conjunction with how the individual feels, symptoms or lack of, wellbeing or lack of. The numbers are useful but we mustn’t get caught up in them or we’re no better than the useless GP’s and Endos who can’t see past the end of their nose 😬

[tcpace in reply to NWA6]

I must admit we've always been a bit nervous about T3 and have wondered whether we should adopt the pre-TSH approach of increasing until "normality" (as per Dr Skinner and others) but that's probably a subject for a separate post.

[NWA6 in reply to tcpace]

Start a new post, debate is always helpful and educational 🤗

[tcpace]

Sorry, I completely missed that! Looks interesting. Thanks for getting back to me.

[tcpace]

I've now read the article you referred me to. It's really about autoimmune inner ear disease and hearing loss so there is clearly a thyroid issue involved. In my wife's case, it seems more like a persistent outer ear infection which is not affecting her hearing, although she does get mild giddiness so, of course, it could also be thyroid related. NWA6 suggested an ENT referral which is well worth following up. Thanks again.

[SlowDragon Administrator]

On 40mcg T3 a day ....recommend splitting into 3 doses per day ....especially before a blood test. Even if not every day

20mcg waking, 10mcg mid afternoon and 10mcg bedtime

[tcpace]

For information, Hashimoto’s Thyroiditis: A Rare Cause for

Rhinosinusitis

e-mjm.org/2004/v59n3/Hashim...