Hi, I was diagnosed with Hashimoto’s over 3 years ago and since then my symptoms have been all over the place. I took an allergic reaction about 2 month ago to antidepressants the doctor wanted me to try then a week after that I took shingles. I then took what I hope was a bad flare up of my symptoms. I couldn’t bend my fingers to grip anything my joints felt like they were on fire and I was in constant pain. I still am but the symptoms are slowly getting betting since I took dairy out of my diet and have changed my thyroid medication. The endocrinologist told me to drop from my current level of Levothyroxine of 125mg to 100mg until I got approval from my GP of a prescription of T3 medication, then I was to drop my levothyroxine to 75mg and 20mg of Liothyronine. He didn’t take my bloods so I sent away for my own so I had a base line of what they were at. While I done this I had dropped my thyroxine to 100mg and I was so fatigued at points I had to stay in bed, I physically felt like I couldn’t lift my arms, legs well actually everything!
My levels came back as the following:
TSH 0.09
T4 15.9
FT 4.6
These were taking 24 hours after taking my last levothyroxine and not eating or drinking anything.
I started taking the new dose of mediation while waiting on my results because I felt so awful. However I did not start taking the full 20mg as advised by the endocrinologist because when I done research it told me to start it in low increments and slowly increase. First 4 days of taking the 75mg levo and 5mg of Liothyronine I had little fluttering in my chest but generally felt better in energy than I had in a long time, however my migraines appeared again so I increased on the 4th day to 5mg in the morning then 5mg in the evening and after a couple of days, dare I say it felt some sort of resemblance of normal where I could actually run about with my children in the garden for 20mins and not have to immediately lie down because I felt sick and dizzy.
I will be testing my bloods in 6 weeks time again and this time include my vitamins with it to see where they are sitting.
I was just wondering if anyone had some advice for me regarding the first lot of bloods above? I know going by Izabella Wents book that my FT3 and T4 are just under the new classification as optimal in the US, I know the UK don’t go by it at the moment. But my TSH levels are low. As I said I felt awful at the time these were taken.
I’ve attached a picture of the ranges from her book for reference.
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Purple_dog
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First thing, forget the reference ranges in that picture. There are no standard reference ranges, they vary from lab to lab and country to country so you can only use the ranges that come with your results.
TSH 0.09
T4 15.9
FT 4.6
What are your ranges?
Also, "optimal" is not somebody else's idea of where the result should be, optimal is where you feel best.
So those were your results whilst on Levo only (100mcg?)
What they are indicating is undermedication of Levo as FT4 is 39% through range. With FT3 at 40.54% through range this indicates excellent conversion of T4 to T3 and doesn't suggest the need for the addition of T3, just an increase in dose of Levo.
Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine (the professional publication for doctors):
"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l. In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance. But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l. This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l).*"
*He recently confirmed, during a public meeting, that this applies to Free T3 as well as Total T3.
You can obtain a copy of the article by emailing Dionne at
tukadmin@thyroiduk.org
So Dr Toft is saying that we should aim forTSH in the lower part of it's range to give FT4 in the upper part of it's reference range. He doesn't give reference ranges so ignore his figures, the upper part of your reference range for FT4 would be around 19.5+. He then goes on to say that some people need an even higher FT4 and lower TSH to feel well and that it's OK to go over range with FT4 and suppress TSH as long as FT3 stays within range.
So what would have been the first step would be for your endo to increase your Levo until you reached the upper part of the FT4 range. By adding T3, given your excellent conversion already, you are very likely to have too high a FT3 level and taking T3 tends to lower FT4 so your FT4 level is likely to go too low. I don't really understand your endo's thinking.
Yes, I had done that previously but when I increase my levo I get very bad palpations and symptoms again as if I’m over medicated. I find it very difficult as I used to be a very energetic person, fitness has always been part of who I am and I’ve not been able to do it because of my energy levels plummeting over the years. I’ve been taking the T3 now for over a week with the lower dose of T4 and it’s the most energy I’ve had in a while. I know it’s still very early stages but I’m hoping it maintains. The levo doesn’t seem to work itself for me without some bad symptoms if I increase it yet at the lower dose I don’t function either with T4 alone. I think because of this he has suggested the T4 and T3, I don’t agree with the full 20mg of T3 though as I think I only need a little which is why I’m only using 10mg now
I was just wondering if anyone had some advice for me regarding the first lot of bloods above?
and that's what my response addressed, plus the fact that you can only use your own results/ranges and not what anyone else gives as an example.
Once you've done new tests after the appropriate time gap since adding T3 you can post the new results/ranges, tell us how you feel and it could very well be that that is a better treatment regime for you, we are all different and not everyone does well with Levo.
Sorry, yes I appreciate your advice on that I was just more letting you know I had tried the increase because I hadn’t mentioned it before so it was just incase you had any more advice after knowing that.
Sorry not the best at describing it so may come across blunt but not intended. I do appreciate any feed back given.
With Hashimoto’s it’s extremely important to regularly retest vitamin D, folate, ferritin and B12
What vitamin supplements are you currently taking
When were vitamin levels last tested
Have you had coeliac blood test done
Are you on strictly gluten free diet?
Bloods should only be tested after 6-8 weeks on unchanging dose levothyroxine (and T3 if on T3)
All thyroid tests should be done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test
Day before test split T3 into three smaller doses at approx 8 hour intervals, with last dose approx 8-12 hours before test
Only vitamin I’m taking at the moment is vitamin D. I intend to get my vitamins rest after 6 weeks at the next test. Always do the test first thing in the morning before I take anything or eat or drink anything. I have been strict gluten free for 3 years now. They tell me I have to eat gluten for 6 weeks for celiacs test to confirm if I have it or not but in all honestly it’s not worth it for me because if I have any gluten it affects me quite badly and I would end up ill for weeks if I done it.
Hello, just reading this blog now, did you ever get your thyroid levels sorted out. I am not surprised at how you were feeling as your THS ( thyroid stimulating hormone) is totally over active. This is what you have all the symptoms.
I also have hashimotos and my thyroid flipped from under active to over active 2 months after having covid. It’s a result of viral infection. It returns to under active again a few months after: I was taken off thyroxine while this happened.
If your THS is low this means you have become over active - mine went to 0.01 and I had a thyroid storm. Not something they warn us about.
Unfortunately many doctors are not educated in this area and think that low TSH means more thyroxine but actually it’s the total opposite.
Hi AbiKat1 your reply shows you have some misunderstandings regarding some aspects of thyroid testing and treatment. Purple dog's TSH did not mean she had gone overactive . I won't try to explain why here on Purple_dog's post because it's an old post , as it's not relevant to her, but she'd keep getting alerts which could be annoying .
But if you start a new post of your own with any question you have , people will be able to clarify your misunderstandings .
I’d be happy to hear your comments in this. Thank you.
I do believe however if the stimulating hormone is 0.0 something - then that is in the lower range which indicates a suppressed stimulating hormone which would cause over activity. I think that is the part I am focusing in on.
As this is an old post AbiKat1 . your questions can be better answered of you write a new post of your own. otherwise we'll just annoy Purple_dog with alerts (assuming she's still around, she may not be after 2 yrs)
To write a post of your own where replies will be notified to you ...either look for the blue "WRITE" box .... (top right of page on laptop , not sure where it is on other devices) .. or Click on "My Feed" and write new post in box at top of page marked "What your Question ?"
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