Help with thyroid results please

[Rock_chick1]

Hi, I have Hashimotos. I'm on 35 liothyronine and 50 levo. I'm still battling with severe fatigue and worsening palps, skipped beats, waking at night and anxiety, shakiness and sweats. So looking at these results my t3 could do with reducing but what is happening? It doesn't seem like the T3 is getting to my cells? My vits seem to be ok. Any advice please

[SeasideSusie Remembering]

Rock_chick1

My reply is based on my own personal experience, it's not necessarily going to be the same for everyone, but there are others on the forum the same as me.

I am on a combination of Levo plus T3. It has taken a very long time (years) to find the right combination to feel optimally medicated and give me FT4 and FT3 at a suitable level within their ranges, and a suppressed TSH is usually par for the course when T3 is being used.

Your results would have me bed bound. Yes you have plenty of FT3 showing, but your FT4 is way below range. I need both FT4 and FT3 fairly well balanced around 70%ish through range.

Everyone is different, we all have our own individual needs as to where each hormone level should be. Some are fine with a low FT4 as long as FT3 is in the upper part of it's range. Some of us need a good level of FT4 as well as FT3. We just need to take our time to find our own sweet spot.

Have you ever had a higher FT4 level with FT3 in range?

I would be looking to increase your Levo and reduce your T3. It can be a long and frustrating road to get the balance right. You can't do both at once so I would first of all reduce T3 by 5mcg then after a couple of weeks add, say, 25mcg Levo or if you'd rather be more cautious add an extra 12.5mcg. I would then wait 8 weeks (the least amount of time I need for levels to finally settle) and retest, seeing how you feel when levels have stabilised, then decide on the next step.

Adding Levo will increase your FT4 and it should also increase your FT3 to some extent depending on how much natural conversion you have. So lots of tweaking as your FT3 will probably remain high as you are adding Levo. You should eventually get to the right balance but you may need to take it very slowly, only change T3 dose by 5mcg at a time.

[Rock_chick1 in reply to SeasideSusie]

Thank you. I am severely wiped out but with the banging heart, anxiety and sweating. The pressure around my heart feels horrible. Im no stranger to that though. They never find anything. It feels like I am both hyper and hypo at the same time. In 2016 I couldn't tolerate levo at all and got left untreated. Then Last Oct I started on T3 only. That didn't do anything for me so I dared to try with Levo again and didn't react too badly taking it very slowly. I still haven't got better however so I'm hoping that changing the dosages will help. When I was unmedicated my T4 was always just a little below their range it was about 11 in a range from 12-22. My last test was when I had been on liothyronine only and the FT4 was even lower at 1.45 and the Ft3 wasn't in the upper third (see photo) Thank you for you advice. I will keep at it!

Test results

[SlowDragon Administrator]

I would agree completely with SeasideSusie ….for me that dose T3 would be far too high and levothyroxine dose far, far too low

How are you taking your T3

as 3 smaller doses spread through day?

Or a single dose?

Which brand of levothyroxine are you currently taking

Do you always get same brand levothyroxine at each prescription

Do you normally take levothyroxine waking or bedtime

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

And day before test, splitting T3 into 3 doses…..Last 10mcg dose T3 approx 8-12 hours before test

Exactly what vitamin supplements are you currently taking

What was ferritin result

As you have Hashimoto’s…..

Are you on absolutely strictly gluten free diet?

And/or dairy free diet

Going forward

Suggest you lower T3 by 5mcg to 30mcg and also increase levothyroxine by 12.5mcg up to 67.5mcg

Taking as 3 smaller doses of 10mcg T3 at approx 7am, 3pm and 11pm

Initially for first few days likely to feel odd, until Levothyroxine starts to improve

Hold at that for 6-8 weeks before retesting

Come back with new post once you get results

May need to repeat this small 5mcg dose reduction in T3 again, down to 25mcg per day

and further 12.5mcg increase in levothyroxine again after next blood test up to 75mcg

Many people with Hashimoto’s do well on JUST 15mcg T3 per day as 3 x 5mcg at roughly 8 hour intervals

Levothyroxine dose typically perhaps at 1.6mcg per kilo of your weight, minus 25mcg

So if you weighed 10stone that’s 63 kilo

63 x 1.6mcg = 100mcg

If ONLY taking levothyroxine that 100mcg would be the likely daily dose levothyroxine required

But if ALSO taking T3 alongside as 3 x 5mcg …..then likely to need to reduce levothyroxine by 25mcg …..or possibly a little more

It’s all trial and error

Important to ONLY adjust VERY SLOWLY and cautiously because with completely suppressed TSH, you have zero capacity to make any thyroid hormones yourself

[McPammy]

Sounds like you are over medicated on T3. Why don’t you reduce the T3 slightly and see how you feel. It might take a week to reduce in your system. All what you are describing sounds like over medication and your TSH reflects this also. I wouldn’t change your Levothyroxine dose. If you still feel over medicated after a slight reduction after a week then slightly lower more T3. You may feel not so good during the transition period but it will settle down. It all takes a little time. Once you feel better get your bloods done again and keep methodically to that regimen. Only reduce one medication at a time as you won’t know which one is beneficial or causing issues. Get the T3 down first and feel less anxious etc then after a couple of months if still not quite right increase Levothyroxine but only very slightly. I take my Levothyroxine in split doses twice a day as I had trouble with it. My own theory was my body was trying to convert Levothyroxine but struggled. I have the DIO2 gene and therefore a poor converter. I was only converting 8% of Levothyroxine to active T3. Could you consider the DIO2 gene test through Regenerus Laboratories if you haven’t already. First job is reduced T3 but only by 5mcg snd at least for a week. Do you split your daily dose. I take half twice a day and that seems to work well along with two doses split of Levothyroxine too.

[Hidden]

I have overdosed myself recently, my ft3 was 6.8 in the same range you have, so top of the range. I had waking up at night as well, sweating, shaking, like a sugar crash almost (and other symptoms), I had to keep eating to keep myself stable. I have lowered my dose 5 days ago and just now it starts to feel better. Also agree with comments that maybe your ft4 is a tad too low for you, I need ft4 a bit higher than let's say 30% of range, but not as high as 60% of range to feel well. Whatever you do, try to do only one thing at a time, like lowering t3 slightly and wait out about 3-5 days maybe? I was still feeling quite rough or maybe even worse until day 3-4.

[Rock_chick1 in reply to Hidden]

Thank you, glad to hear I'm not alone! What dose of Liothyronine were you on and come down to? It is day 7 of the reduction and this morning I was sweating and wierd air hunger poundy heart episode first thing but the rest of the day has been fine in that respect so hopefully this is the turning point. Obviously still very fatigued though!

[Hidden in reply to Rock_chick1]

So I mix Armour with t4. I have reduced my dose by about 10 mcg t4 and 1.5 t3, so not a lot, but my levels go down quickly if I reduce by more. How much did you reduce by? I felt breathless, like I had a bra that was too tight, couldn't take a proper deep breath. And yeah tiredness around afternoon.

[Rock_chick1 in reply to Hidden]

Yes, exactly that! . It horrible isn't it and you try and keep the wave of anxiety that seem to come with it down as you know it will make your heart worse. I have dropped the Lio by 5mcg for now as suggested. I'm just hoping that I can manage to raise the levo without problems. I will be chatting to my Thyroid speciast via zoom on Wednesday so will see what he suggests aswell. How is your tiredness now?

[Hidden in reply to Rock_chick1]

Yeah it is, you feel like you can't even process what is around you and everything drives you mad. Yes, breathlessness is distressing, but I try to say, it's okay, I won't stop breathing, it's just a stupid overdose symptom, I will be ok. It is very unpleasant though!My tiredness is okay now, I have a bit of a different issue now, because I think my body is not very happy with either a bit too much Armour or synthetic levo, so I will have to tweak soon.