Please advise on test results. Should I increase Levo?

[Purple_Green]

Hi everyone. I just got a few new tests done and now struggling to understand what to do next.

I'm currently on 100mg Levo. The latest results are:

TSH 2.05 (0.27 - 4.2)

T4 20.7 (12 - 22)

T3 4.3 (3.1 - 6.8)

For comparison, these were my numbers from January when I was on 50mg:

TSH 9.65 (0.27 - 4.2)

T4 16.6 (12 - 22)

T3 4.26 (3.1 - 6.8)

T4 and TSH have improved, but T3 has barely moved. Do you think I should increase my Levo dose a bit more as there seems to be room for it? Or is it time to consider adding T3/NDT?

I'm gluten free, also started taking Selenium recently but have no idea if this is helping yet. I should probably say I feel ok-ish in general and better on Levo than no-Levo.

I'll attach a picture of my recent vitamin results.

Vit D doesn't make any sense to me. It's 70 now and was 71(same range) in Jan, but I've been supplementing with 4000ui this whole time! 🤦‍♀️

Ferritin is back to dire 27.7 (24.5 in Jan), even though I've been working on it and only a month ago it was 61.

These are frustrating to say the least. Why might vit D and ferritin be so weirdly off? All tests were done properly as advised on the forum.

Earlier, my Dr had suggested to start taking zinc so I tested them both with copper. What is an optimal range and ratio for zn/cu?

Huge thanks for any advice! ❤️

[radd]

Purple_Green,

Results are heading the right way and yes, you have room for another dose increase.

T4-T3 conversion should improve once all nutrients are optimised, so still much too early to think about the need for added T3. Adequate iron is essential in making thyroid hormone replacement work well.

[radd in reply to radd]

Purple_Green,

Actually having relooked I don't think you have much room for an increase as FT4 is nearly top of range.

I still think it too early to add T3 as raising iron & Vit D should help conversion, and also inadequacies of iron can make introducing T3 meds difficult.

You may find supplementing a little bit of glandular such as Metavive alongside Levo will help with conversion. Your zinc is good and the additional selenium should encourage better conversion too. Zinc & copper must be balanced. We only need tiny amounts so levels should stay within reference range. Are you supplementing Vit C with iron to aid absorption?

Sometimes it’s just a waiting game. How long have you been on the higher dose of Levo?

[Purple_Green in reply to radd]

Thanks a lot for taking time to look into this radd. Yes, I take 500mg vit C with a ferrous fumerate tablet daily. Hm that's interesting that a low level of iron can mess up T3 introduction. Can it affect glandular intro too?

It's been about 7 weeks that I'm on 100mg. Agree, it's a waiting game and I still hope to improve conversion over time.

[radd in reply to Purple_Green]

Purple_Green,

I wouldn’t have thought glandulars have enough hormone to be intolerant of low iron levels but I’m not an advocate of glandulars as they made me feel spacey & weird . I have tried several different glands but always the same head rushes, etc. However, many members have done well with them. If you do introduce, just go low & slow, ie 1/4-1/2 tablet to begin. Also adrenal glandulars can support adrenals compromised through supporting many years of low thyroid hormone.

I don’t supplement iron but see how some members struggle to raise it. Like thyroid hormones it can’t be rushed as the higher the dose the less is absorbed in ratio to the dose taken, due to regulatory safety mechanisms designed to prevent sudden poisoning from free iron. Just plug away with your sups and eat iron rich foods. Heme is easier to absorb but of course it’s all dependant on a healthy gut and strong immunity which Hashi compromises. Enzymes that play an important role in the T4-T3 conversion have been found in the intestinal wall so contributing to total T3 levels. If your gut has absorption issues it might be indicating issues such as not enough stomach acid or good flora, etc. Just post another question for advice cause its a big common problem in hypo people.

Androgen dominance can happen to us females when testosterone levels become elevated relative to declining oestrogen and progesterone production (are you menopausal?) Most circulating testosterone is bound to SHBG (sex hormone-binding globulin), hence yours is high in-range to match over range testosterone. I too had elevated testosterone which I was mortified to learn might give me a hairy chin if left unaddressed! 😳. Because O & P weren’t just deficient but totally non-existant I was put on bioidentical HRT which balanced all sex hormones eventually. And no hairy chin 😁. Further info in the Drs. John Lee and David Zava book ‘What Your Doctor May Not Tell You About Breast Cancer’.

Sorting all these extra issues out will eventually make thyroid hormones work better because all hormones are interconnected. Just google HPA axis, HPT axis, HPG axis for further info.

[Purple_Green in reply to radd]

Wow thanks a ton! I'll have a good look into what HPA, HPT, and HPG are, and I think I need some further investigation on my other hormone levels - still no idea what's up with those.

are you menopausal?

No, I'm 30. My thyroid symptoms became obvious when I was 28.

I too had elevated testosterone

Ouch, a hairy chin 😳 Damn testosterone!

My main problems with testo are acne and hair shedding which might as well be hypo related.

If your gut has absorption issues it might be indicating issues such as not enough stomach acid or good flora, etc.

Hm I guess I should really get my head around the gut topic. Why are humans so complicated 😅

[Katidesred]

Don't feel qualified to comment on whether you need to add more thyroid medication but, I recall my GP noting that my vit D was low at the end of summer and I should supplement this. She explained that it should be higher towards end of year (in the UK) and would typically be lower as we come out of winter....so by that it would suggest you should continue to supplement and remeasure at the end of summer for a truer result, which would hopefully then be higher (and more normal?)

[Purple_Green in reply to Katidesred]

Thanks Katidesred, I think this sounds logical. I've also read on this forum that we might need more vit D supplement in winter, so since my level stayed the same I probably just accidentally found a winter maintance dose

[JAmanda]

You don't have a lot of room really but could try 12.5 (25 if you fix allows) extra? My experience was that my T3 didn't raise that much so I added in some T3 - and that's another story and journey! Try the little increase and see how you go.

[Purple_Green in reply to JAmanda]

Hi JAmanda, thanks for your suggestion. I agree it's probably not more than 12.5mg to add if any. I hope your journey with T3 is going well!

[pennyannie]

Hello Purple Green ;

The accepted conversion ratio when on T4 - Levothyroxine only is 1 / 3.50 - 4.50 - T3 / T4 ; with most people preferring to come in at around 4 or under ;

To find your conversion ratio when on T4 only you simply divide your T3 into your T4 :

In March on 100 T4 your conversion ratio is coming in at 4.81 :

In January when you were on 50 T4 your conversion ratio was coming in at 3.89 :

so you seem to have stopped converting as well as you did on the lower dose in January.

However in January your TSH was very high and your needing dose increase obvious, but I just think if you should have just gone up by 25 mcg and waited to see the results on 75 mcg a day after 6-8 weeks, as you might have " overshot " where your dose currently needs to be.

It's a difficult since you have Hashimoto's and are liable to having " swings " of erratic thyroid hormone production from when your gland comes under attack from your immune system response and ultimately your glands production will reduce and you will ned to increase your thyroid hormone replacement to compensate accordingly.

I read of Dr Izabella Wentz as being well versed in Hashimoto's as she has this disease herself and understand those suffering with Hashimoto's benefit from healing their gut and looking to remove certain foods from their diet, that trigger their immune system response like gluten, wheat, dairy and processed foods.

As I understand things ferritin needs to be over 70 to assist in the conversion of T4 into T3 and I know I feel better when my ferritin is around 100 : vitamin D around 100 : folate at around 20 and active B12 70 + or serum B12 500 + :

I see you have problems maintaining ferritin, why is this, has your doctor any suggestions ?

I can't see any inflammation numbers as these can hinder conversion of T4 into T3 and I can't see any antibody levels to judge how active your immune system may have been recently.

[Purple_Green in reply to pennyannie]

Hi pennyannie, many thanks for your reply. Yes in January I thought I was a pretty good converter but it doesn't look like this anymore 😅 Are there any potential reasons that people just suddenly stop converting well?

you should have just gone up by 25 mcg and waited to see the results on 75 mcg a day after 6-8 weeks, as you might have " overshot " where your dose currently needs to be

I did have a step between 50 and 100mg. On 75mg (6 weeks) my TSH was still over range so GP just increased my dose without looking. Mid-march test on 75mg:

TSH 4.86 (0.27-4.2)

T4 19.6 (12-22)

T3 4.52 (3.1-6.8)

T3 looks slightly better here. I was wondering if this drop could be related to reverse T3? I don't know much about rT3 though or if it's relevant at all.

Antibody levels are almost the same as in Jan: TG 430 (0-115) and TPO 369(0-34)

I see you have problems maintaining ferritin, why is this, has your doctor any suggestions ?

Yes, ferritin is back to be very low, even though it was better a month ago. I have an appointment next week, hopefully my Dr will comment on this

[pennyannie in reply to Purple_Green]

Oh, ok then -

So on 75 mcg your conversion is coming in at 4.35 so moving out from " acceptable " :

Your January results " looks the best of the three " - but the question is were you feeling better in January ? The TSH was at it's highest but the TSH dosn't give you symptoms it is T3 that causes the symptoms you are suffering.

Too high a level of T3 and you have symptoms of hyperthyroid and too low a level of T3 and you have sympoms of hypothyroid.

With Hashimoto's there is a tendency of erratic thyroid hormone production and so be aware that these Hashi's swings swing back and forth, but ultimately you'll become more hypothyroid as the gland is disabled.

Everybody has some reverse T3 and it is simply surplus T4 that the body hasn't used and it is excreted on a regular basis.

It's simply the way the body regulates itself, as we convert the storage hormone T4 throughout the day and sometimes there is some T4 " let over " and it then becomes suplus and referred to as reverse T3 ;

Liken the process to cooking in a saucepan, you keep the lid on to reach a certain level then need to adjust to a simmer, you either put the lid half on, turn the gas down, and or allow the excess steam to be released through the vent hole in the lid :

So nothing boils over - and so you don't experience symptoms of overactivity by converting all the T4 into T3 sending your levels higher than normal and boiling over.

Does that make sense ?

It 's the body's qay of regulating of your set point and metabolic rate .

I don't think the NHS test reverse T3 - and it's now not seen as necessary anyway.

I think once you get your ferritin up you'll feel much better.

I don't think just reading a TSH and dosing up and down blindly is really helping you :

Is your doctor able to order T3 and T4 blood tests, and if not, maybe you need a referral to an endocrinologist.

I think you need to be dosed and monitored on your T3 and T4 blood test results with a view to getting T3 and T4 balanced at around a 1/4 ratio :

Adding a little T3 will automatically take your TSH down, and you'll likely feel better when you get a TSH under 1 : and since you have an AI thyroid disease the lower your TSH equals the less stimulation of the gland which is already struggling and damaged.

Your antibodies are still very high showing that the thyroid gland has been further attacked by your immune system and again, if you can start to look at the AI " triggers " for Hashimoto's, this might help with your overall well being.

Apart from the usual suspects of ferritin, folate, B12 and vitamin D conversion can also be compromised by any physiological stress ( emotional or physical ) inflammation, dieting, depression and ageing so, whilst we can't turn back the clock, there maybe some food for thought there ?

[Purple_Green in reply to pennyannie]

Thank you for such detailed explanation ♥️ I hope I understood it right. So it now seems pointless to increase T4 further as I'm probably not gonna absorb more than I already can and all extra T4 will just be discarded by the body into rT3. Unless I improve ferritin and other vitamins, and gut function to absorb them all as radd explained.

were you feeling better in January ?

Honestly I don't feel much different now. Starting Levo was a massive improvement overall, but nothing is changing with higher doses.

I was looking to buy Isabella Wentz's book for some time now, I think it's time to do it.

Thank you x

[pennyannie in reply to Purple_Green]

Yes, I think you've got it right - and there are several balls to juggle but I just wish there was a magic wand and I could " wish you " an big increase in your ferritin to give you a head start.

If other people have said similar - that is reassuring, and this is a patient to patient forum, as most of us have been there and are works in progress, some further along than others.

So vitamins and minerals are crucial and it's just a shame that this can take considerable time, especually with ferritin.

I think you need to try and find out why ferritin drops so much so quickly.

I was very unwell back in around 2016 and my ferritin was at 22 - and was referred for colon and endoscopy : all clear and a prescription for ferritin offered :

Just another thought, and apologies if I have forgotten - have you had a blood test for coeliac ?