T3/T4 - I don't understand blood results, any thoughts? and next steps

[jsy_girl]

Hi all, i am refining T4/T3 combo treatment. I would say I do feel slightly better now than I did but my overriding feeling is I need more. More T3 and more T4. I think my blood results support that. Not sure what they are doing to be honest as the results seem to go down each time, I have gained a bit of weight too.

I think my Endo though (private, respected, recommended on here) will not be happy with increasing T3 again (as he told me as such last time) but I am going to email him today and set out my reasons why I think I need it - I'm not sure if he will "recognise" some of the reasons but any thoughts on things that might persuade him will be appreciated. If he doesn't support I can increase my T4 levels myself.

Dear Professor X,

I have seen my last blood results and I wanted to write to you ahead of our appointment. I am pleased with the improvement with symptoms from the last time we spoke, when we increased T3 to 20mcg. I am starting to see improvements in pain, pins and neeedles, anxiety and depression symptoms and finally some small improvements in fatigue.

These don't seem born out in my blood results which, as you can see, still positions me low in range for both fT3 and fT4 (less than 25% through range) which I think would suggest I could accomodate an increase in both T4 and T3.

As i think this treatment is working and I am seeing improvements I would really like to try a 5mcg increase in T3 next time and hope you would be supportive.

I have been noticing ahead of the third dose of the day some hypo symptoms returning similar to what I noticed last time ahead of the second dose.

To reassure you about a further increase, as I know we have never met face to face, I am a very tall (5'8") woman, I am curvy (and have gained weight since last time) - so physically I might expect to need a higher dose than average; furthermore I am very conscious that I do not want to be hyperactive - I had hyperactive graves disease for many years -and so if at any point I was feeling this way I would be telling you that so that we could address it.

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What do you reckon.... will this work? any idea why my T4 (and T3 to a lesser extent) levels would have fallen off like this too? I guess I should recheck vitamin levels - they were fine in April though.

Last few blood results attached.

[Yeswithasmile]

Hi jsy_girl

I notice your predicament with the endo and not having been successful in getting over75/20 t4/3 I can’t be much help I am afraid although I do wish you the very best of luck with it and your letter. You can but try. 🤞🏻🤞🏻🤞🏻

I am no use with your other question either really but I wanted you to know that I am thinking of you. It’s all so confusing isn’t it? I have read several members posts that seem to fluctuate so you aren’t alone there

The one thing I would say is my results when on levo were different after 12 weeks rather than 8 so maybe it is just a period of adjustment plus another 5mg levo on your last test and that’s why your t4 is reduced. The t3 I imagine would flutuate depending on day/time of test etc and it’s minimal. My endo told me that exactly the same sample but the same on at the same time oils read differently so 🤷‍♀️ . As for tsh I expect the same there too as well as your body having more time to adjust to the doses.

I suppose other factors have an effect as in female hormones, cortisol, etc. If you feel nothing has changed in that respect I would be raising but I hope so clever bod says which one as I don’t know!! Maybe levo as the more t3 you take seems to not being doing much apart from suppressing your t4.

You obviously want to increase t3?

I have read this back but I seem to be more confused than any on here!! Apologies!!

[jsy_girl in reply to Yeswithasmile]

Thank you for your message Yeswithasmile

And thanks for the luck. I guess I have nothing to lose so to speak.

I am quite confused by the fluctuations but I guess regardless they are quite low so either way it indicates there is room to increase.

And yes prefer to increase T3 first. But I really don’t expect he will agree to!

[Yeswithasmile in reply to jsy_girl]

It’s strange. I have raised t3 and have a number of improvements but more aches. Time will tell as to blood results but whilst you think things will improve more quickly on t3, the more I read the more I wonder whether it’s worth going higher levo first. Even as a poor converter? Tsh is invariably low/surpressed on t3 which is why we have t3 but why not allow us to try more t4 if tsh is going to drop anyway?

Anyway I hope your letter works. It is a very well written letter x.

[jsy_girl in reply to Yeswithasmile]

Thank you. I will try it. Nothing to lose really. Yes I know what you mean. I think I just want to secure the T3 first as I can up the T4 separately and more easily myself if he doesn’t agree.

Fingers crossed.

[CBDB]

This seems to look fairly similar to my stats, so I thought I’d send you the link to my post and the resulting discussion about how to adjust T4/T3.

I ended up deciding I should increase T4 first and then see if I need more T3.

healthunlocked.com/thyroidu...

[jsy_girl in reply to CBDB]

Thank you! Yes they are similar and I do what you do and take all at once in morning but the day before my blood i did move it so that i took 10mcg at 7am, 5 and 3.30pm and 5 at 9.40pm for a 9am test so my ft3 shouldnt be a false low.

I think reading the responses I would be inclined to continue what I am doing and ask for more T3. If i can get my ft3 above 50% i will then relook at fT4 and add more levo at that point.

Thanks again, that was helpful!