Is it possible to develop secondary hypo whilst treated for hashi's?

[Salphy]

Hi I haven't been on here for a while and sorry its late/early.

I worked really hard getting my thyroid and vitamin deficiencies treated when I was first diagnosed in 2017.

I am currently taking 100mcg levo and 10mcg t3 and have been stable on that dose for a good while. Probably around 3 years+ now.

I was doing really well for about 18months dropped loads of weight etc but now its all going backwards.

I had some medichecks results back today and my t4 has been continuing to drop over the last say 6 months with no change to my meds. My t3 and tsh has stayed around the same.

T4 has gradually dropped from around 19 to 13. Which is what it was when I was first diagnosed as subclinical.

T3 is around 5.8.

Tsh is 0.06.

My antibodies have been in remission since 2018 and no change there either.

My cortisol is raised about 660 but 24hr urine tests normal so they ruled out cushings.

My prolactin fluctuates and has come back at 1948. 2 weeks ago is was 958 and my endo said no further investigation as below 1000 (eventhough it was 1300+ and 1600+ last year) normal is below 500.

All my vitamins are normal. I have b12 injections and take vitamin d and folic acid so no change there either.

I'm just confused how my t4 can drop so much when still on 100mcg levo with little change to my tsh and t3 levels in comparison 🤔

[greygoose]

It's dropped because you're taking T3. That's what happens when you take T3. Absolutely nothing to do with secondary hypo.

[Salphy in reply to greygoose]

Oh really? Why would that happen suddenly when my medication has stayed the same and I still take t4? I've been taking t3 since 2018. It only started dropping from December 2020 when it was 19 and now down to 13.

[greygoose in reply to Salphy]

That's just what T3 does. Nobody seems to know why. There is a theory that taking T3 improves conversion. But, to my mind, the labs don't back that up. I just don't know.

[SlowDragon Administrator]

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

Did you split T3 dose day before test and take last 5mcg dose approx 8-12 hours before test

Do you always get same brand levothyroxine and T3 at each prescription

Many of us who take levothyroxine plus T3 find that we might need to increase levothyroxine dose if Ft4 drops low

Some people are fine with low Ft4, others find it better to increase levothyroxine dose so that Ft4 is approx 50% through range

It’s trial and error what suits each person

You might want to consider trialing small dose increase in levothyroxine. Perhaps to 112.5mcg per day. Retest thyroid levels in 6-8 weeks

Please add actual vitamin results and ranges on folate, ferritin and vitamin D

What vitamin supplements are you currently taking apart from B12 injections

[Salphy in reply to SlowDragon]

Hi yes thanks, you and others helped me learn all this when I was going through it and getting on the right treatment.

Medication was taken before bed and bloods first thing.

Folate is 19+, vit d 125, ferritin 74.

I take folic acid and vit d to maintain these levels.

I have been stable on the same dose of everything since 2019.

I'm just confused why my t4 would suddenly drop but everything else stay the same x

[SlowDragon Administrator in reply to Salphy]

Medication was taken before bed and bloods first thing.

So last dose levothyroxine was only 12 hours before test?

If so you have falsely high Ft4….and it’s actually lower than test result

Do you always get same brand levothyroxine at each prescription

Are you on absolutely strictly gluten free diet

Why do you think secondary hypothyroidism….you probably just need small dose increase in levothyroxine

Either you’re doing more, metabolism improving and needing higher dose or Hashimoto’s has progressed and need higher replacement dose

[Salphy in reply to SlowDragon]

Yes I think I took my t4 the same time that night. I don't normally though.

Yes I'm gluten free.

I just wondered if it could have any link with my very high prolactin and high cortisol.

I would have thought if it was disease progression my t3 would be dropping too and my antibodies would have raised but they've lowered further.

Definitely not metabolism improving. I lost 15kg when first on the right dose. I've regained at least half for no reason