Test results and more questions than answers!

[Carna]

Hi I am hoping one of you more experienced people can help me move forward with my medication. I am currently on 75mcg Levo and 30mcg T3. I am greatly improved especially mentally - much calmer and no anxiety or feelings of panic. My weight has stopped piling on may even be reducing a wee bit - I no longer weigh myself as too depressing but go by how my clothes fit. I had to reduce from 100mcg to 75mcg (I was on 25mcg T3 at time) as I had fast heart rate that was quite disturbing. I then found myself with hypo symptoms creeping in and my private endo suggested a 5mcg increase to 30mcg and things seemed to settle again.

I am still incredibly tired and without much energy. Not as bad as I was as I don't often take to my bed now although my sleep is horrendous and I can't seem to find anything other than medication (that the GP will no prescribe) to help.

I am also quite achy which is unusual for me.

My questions re my Medicheck results are - see image.

The lab noted my folate results although in range are very low. This of course could explain my lack of energy. Should I supplement and if so by how much?

My TSH is very low but I guess that is expected - the GP won't like it but the endo will probably be ok. Should I be considering a calcium supplement?

My T4 is just below range but I would be reluctant to increase it to 100mcg pd because of what happened previously. Should I consider taking an extra 25mcg every other day?

What happens to T4 blood results when people are on mono T3 therapy? I sometimes feel that Levo is my problem and if I should consider trying T3 alone.

My antibodies are high. I have read here before that people feel better when these levels are lower. How do I reduce them? What would be a more reasonable figure given that I suspect they will always be above normal with my condition.

I am not gluten free. I limit my gluten but I didn't feel any different to when I tried a gluten free diet for a few months.

Any advice would be greatly appreciated. Thank you in advance.

[SlowDragon Administrator]

Your folate is low

Have you been taking vitamin B complex to improve

(Stopping week before ALL BLOOD TESTS because biotin in complex might affect test results)

Are you splitting T3 into 3 x 10mcg doses roughly 8 hours apart

Your Ft4 is very low

Many of us need GOOD Ft4 and FT3

Perhaps try increasing levothyroxine to 75mcg and 100mcg alternate days

Which brand of levothyroxine are you currently taking

I know you’re not Gluten free now

Did you see TPO antibodies drop when you were on strictly gluten free diet

Have you considered dairy free diet?

[Carna in reply to SlowDragon]

What level of supplementation should I take of folate?

I stopped taking a Vit B complex as my B12 was well over range. It is now ok.

I had trouble getting a blood test so hadn't been taking any supplements, except Vit D, for about a month.

Yes I am splitting my T3 into three doses.

Levo is Teva 75mcg although the 25mcg I have to up it is Mercury. I didn't retest during the gluten free period so not sure about antibodies but I didn't feel any different. Actually my anti bodies are marginally lower than before - but not much.

I haven't consider a dairy free diet - that would be a real problem in my farming household - could that lower antibodies? My digestion seems really good now I have T3 after years of constipation on T4 only.

Lack of sleep is a major issue for me. I also have low DHEA from a previous test but my endo just said I would have as am post menopausal.

[SlowDragon Administrator in reply to Carna]

The Thorne vitamin B complex has less B12 in it than Igennus

You could just take a folate, (Jarrow is good brand)

but often better to take a vitamin B complex

Teva brand upsets many people

But if lactose intolerant it’s often the best choice

Many people find Levothyroxine brands are not interchangeable.

Many patients do NOT get on well with Teva brand of Levothyroxine. 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

But for some people (usually if lactose intolerant, Teva is by far the best option)

Teva, Aristo and Glenmark are the only lactose free tablets

Most easily available (and often most easily tolerated) are Mercury Pharma or Accord

Note Accord is also boxed as Almus via Boots, and Northstar 50mcg and 100mcg via Lloyds ....but beware 25mcg Northstar is Teva

List of different brands available in U.K.

thyroiduk.org/medications-f...

Teva poll

healthunlocked.com/thyroidu...

Once you find a brand that suits you, best to make sure to only get that one at each prescription.

Watch out for brand change when dose is increased or at repeat prescription.

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)

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