recent results and other help request??

[lauriegraham]

hello

I wonder if anyone has any thoughts or comments?

i have posted before healthunlocked.com/thyroidu...

Since then i have been put on a low dose of levo (50) , and i had the results at bottom of this post

Since those results they have upped levo to 75 and i have also acquired some T3 via Turkey and have started to take 12.5 mcg per day, i am not noticing any difference yet

My temperature whenever i take it remains worrying low. eg 96'ish, often, my heart rate has gone up since the levo from about 50 to mid 50's

I had a salivary cortisol test a while ago, and it was all wrong, low in morning and too high at night. People on here have suggested this is a central hypo issue, possibly pituitary not stimulating thyroid etc ..

Sometimes but not always can feel weak. I eat meat etc for ferritin

I dont have an endo, except one who wants me to take statins, so any advice gratefully received

thank you

Recent results include, from Blue Horizons

T4 72 ( 59-154)

TSH .89 (.27-4.2)

T3 3.6 (3.1-6.8)

Free thyroxine 15.7 (12-22)

Thyroglobulin antibodies 10.1 (0-115)

Thyroid Peroxidase Antibodies <9.0 IU/mL 0 - 34

FERRITIN 83 ug/L 30 - 400

C Reactive protein <0.6 mg/L <5.0

Folate (serum) 12.0 ug/L > 2.9

25 OH Vitamin D 102 nmol/L 50 - 200

Vitamin B12 * 999 pg/ml 197 - 771

REVERSE T3 17 ng/dL 10 - 24

[SlowDragon Administrator]

How much do you weigh in kilo approx

75mcg levothyroxine is only one step up from starter dose

These results from when on 50mcg obviously show you were very under medicated

How long have you been on 75mcg levothyroxine

Which brand of levothyroxine are you currently taking

As soon as you take almost any dose of T3 TSH will become suppressed, switching off your own thyroid output

If not on high enough dose levothyroxine before adding T3, you can get in a pickle

Also any future testing for GP, likely to cause them to want to reduce levothyroxine if TSH is suppressed

So you might need to self supply levothyroxine as well

Ideally you would stay on just 75mcg levothyroxine minimum 6-8 weeks ….gets bloods retested

Get next 25mcg dose increase in levothyroxine up to 100mcg

Repeat until on full replacement dose

Bloods should be retested 6-8 weeks after any dose change or brand change in levothyroxine

Always test as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

Are you currently splitting T3 into 2 doses approx 12 hours apart

Day before test split T3 into two doses and take last 1/4 tablet 8-12 hours before test

Monitor My Health offer just testing TSH, Ft4 and ft3 for £26.10 if order via Thyroid U.K.

[lauriegraham in reply to SlowDragon]

oh dear, thanks Slowdragon, , so perhaps t3 started too early? i thought as i am not a good converter i should add t3 in. started extra 25 a month or so ago, after test50 is mercury? 25 tevia?

[SlowDragon Administrator in reply to lauriegraham]

Well you may need T3 alongside levothyroxine……but as TSH invariably becomes suppressed, you need an endocrinologist who is ok with that

99.9% of GP’s will freak out and reduce/stop levothyroxine prescription if TSH is below range

They seem incapable of reading Ft4 and Ft3 results

Brands of levothyroxine

Teva brand upsets many, many people

Best avoided unless lactose intolerant

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, or Aristo are the only lactose free tablets

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

Mercury Pharma make 25mcg, 50mcg and 100mcg tablets

Accord is also boxed as Almus via Boots, and Northstar 50mcg and 100mcg via Lloyds ....but doesn’t make 25mcg tablets

beware 25mcg Northstar is Teva

List of different brands available in U.K.

thyroiduk.org/if-you-are-hy...

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.

New guidelines for GP if you find it difficult/impossible to change brands

healthunlocked.com/thyroidu...

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, 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

[lauriegraham in reply to SlowDragon]

amazingly helpful, thank you

[SlowDragon Administrator]

Ft4 was only 37% through range Ft3 only 14% through range

Helpful calculator for working out percentage through range

chorobytarczycy.eu/kalkulator

Shows inadequate dose- aiming for Ft4 at least 60% through range, possibly higher

Poor conversion of Ft4 to ft3 as Ft3 is much lower

Exactly what vitamin supplements are you currently taking

Are you on strictly gluten free diet

[lauriegraham in reply to SlowDragon]

hi. thanks again, so helpful, . Rarely have gluten. I take some selenium most days, at night magnesium, sometimes zinc, reishi/lions mane, astaxanthin, nattokinase, occasionally k , c, NAC, a few others, have stopped a few! (eg ala, l-carnosine)

[SlowDragon Administrator in reply to lauriegraham]

Strictly gluten free diet does need to be absolutely strictly gluten free to be effective

If gluten is an issue…….Takes around 4 months to recover from each time it’s eaten