Help with Results going into to endo meeting next week

[TiredNRetired]

I am on NDT 60mg taking it divided 2 x per day, and overall I am feeling pretty good as it pertains to my hypothyroidism though there may be some times later in the evening I may feel the T3 wearing off. Here are my most recent labs:

TSH 1.31 0.40--4.50

FREE T4 1.0 0.80-1.8

FREE T3 4.0 2.3-4.2

Vit D 60 Optimal >30

B12 1086 (no ref range)

Folate 17.2 >5.4

No Iron taken! I can't seem to get the docs to do Iron on my lab for some reason.

It's important to note that the lab draw was done 2 hours after my AM dose of 30mg of Armour as the endo insists on doing it this way even though we all know T3 will be much higher in this time frame then it would he hours later.

These values are fairly identical to ones I did 4 weeks earlier when I was on 45 mg of Armour, so the 15mg bump didn't really do anything lab wise or clinically.

My question is since the T4 is on the lower side of opitmal, TSH is ok but could be even lower still, and the T3 value is transiently higher due to the 2 hour post med lab draw, should I either suggest yet another 15 mg Armour increase, or suggest supplement with a small dose of Levo (boosting T4 mostly) or just leave it all alone since I feel okay for the most part?

Appreciate your thoughts!

[Lalatoot]

With your ft3 just .2 under the top of the range it is unlikely that the endo will agree to an increase.This is why we go with the 8hours for last dose T3 prior to test. It gives us the chance of getting an increase because of lower levels.

Also what is measured 2 hours after a dose is the peak and not what is more typically circulating.

I know what your endo says and I have had endos from the hosp team tell me to do the same. But do I do it? Nope. It at least gives me some control of my dose.

[TiredNRetired in reply to Lalatoot]

Thank you. Much appreciated.

[greygoose]

T3 doesn't 'wear off'. It's not an aspirin. The half-life of T3 in the blood is about 24 hours, but what gets into the cells stays there for about 3 days, during which time you've taken more doses, so there is always some in the cells.

Given your TSH of over 1, I would say that your FT3 is probably a lot lower than that in the general run of things. We expect TSH to be in the lower part of the range - or under-range - when taking T3. So, I think it's pretty certain that you do need an increase, yes.

[TiredNRetired in reply to greygoose]

I hear you. Thank you very much.

[greygoose in reply to TiredNRetired]

You're welcome.

[Heloise]

I think I'd wait before making any change since it's only been a month. The results seem good and two grains of NDT is a common dose and you are feeling well on it. I think a low FT4 is not that consequential when T3 is included. This talks about T3 fluctuations.thyroidpatients.ca/resource...

[TiredNRetired]

Good thought and very interesting article. I think waiting another 4 weeks and insisting on a blood draw 12 hours after my last dose would be helpful if I can get the endo to go along with it. Thank you!