I have been experiencing symptoms of what looks like to be subclinical hypothyroidism for quite a while now and decided to try thyroid medication on my own as i am tired of feeling unwell and my GP is useless and just blows me off as a hypochondriac or says its anxiety etc...
So i've just got my bloods back after being on 25mg levo T4 (eltroxin) and 6.25 T3 (Cytomel) for approx 7 weeks and these are the results compaired to my previous results before starting medication:
TSH: 08/07/2021 - 3.21 mU/L and 02/09/2021 - 1.86 mU/L
T4: 08/07/2021 - 16.6 pmol/L and 02/09/2021 - 13.3 pmol/L
T3: 08/07/2021 - 4.1 pmol/L and 02/09/2021 - 3.89 pmol/L
As you can see these results are very strange, i would expect my t4 and t3 levels to be increased not decreased... only my TSH has gone down a little for some reason. Could this be due to being underdosed?
Would appriciate any help with understanding these results or hear from someone with similar experience that might be able to shed some light on this situation.
Thanks
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FranklinSaint
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I'm afraid we're going to need a bit more detail before anyone can understand what's going on with your results:
* were you put on T4 + T3 at diagnosis? (If so, were do you live? Because it's rare to get diagnosed with a TSH of 3.21 in most countries. And even rarer to be started on a T4/T3 combo without tryint T4 only first.)
* if not, what were you taking, and how much, before adding T3?
* what time of day was the blood draw? Was it done fasting? How long was the gap between the levo and the blood draw, and the T3 and the blood draw?
* do you always take your levo and T3 on an empty stomach, leaving at least one hour before eating or drinking anything other than water; and at least two hours before other medication/supplements?
* have you had your nutrients tested: vit D, vit B12, folate, ferritin?
I appologize for not clearifying correctly in my original post but i live in the UK and also i sourced these mediciations myself through a pharmacy that is located here.
I have tried T4 only at 25mg before starting this but did remember i felt way worse than when i was on nothing so that is why i decided to try adding a low dosage of T3 as i read somewhere that alot of people do better on NDT or T4 + T3 combo...
Bloods were drawn at 09:00am and was done fasted, i did not take any levo or t3 prior to doing this blood test in the morning.
I usually took the T4+T3 with just water at around 04:00am-05:00am as that was when i woke up to go to use the toilet before going back to sleep again, waking up at 08:00am-09:00am.
Yes i have done extensive testing on nutrients and also other vitamins and health markers, everything else other than my 4 point saliva cortisol test (came back low am and also afternoon) and thyroid came back perfect or well within range...
The way I read your post is that you are in the UK (as you've had a Medichecks test), couldn't get a diagnosis/prescription from your GP so you went ahead and bought your own Levothyroxine and T3?
I'm afraid you've rather jumped the gun.
Did you have a full thyroid panel to include thyroid antibodies, and did you have the test which also tests the key nutrients as well - Vit D, B12, Folate and Ferritin?
Was your 8/7/21 test with Medichecks? If so then the reference ranges will be (we always need reference ranges to be able to interpret results as these vary from lab to lab):
TSH: 3.21 mU/L (0.276-4.2)
T4: 16.6 pmol/L (12-22)
T3: 4.1 pmol/L (3.1-6.8)
A normal, healthy person would have a TSH of no more than 2, often around 1, with FT4 around mid-range-ish. Unfortunately none of us are tested for a baseline in health so we don't know what is normal for us.
With those results you are not even "subclinical" - that would be over range TSH with normal FT4.
It's very likely that your TSH may be your normal (remote possibility) or it may be higher than normal due to a non-thyroidal illness. Doctors will always want to see two abnormal TSH results before diagnosis because they need to rule out non-thyroid illness which can elevate TSH.
On 2/9/21 your new results after 7 weeks of 25mcg Levo plus 6.25mcg T3 were:
TSH: 1.86 mU/L (0.27-4.2)
T4: 13.3 pmol/L (12-22)
T3: 3.89 pmol/L (3.1-6.8)
Did you do both tests as we always advise:
* Blood draw no later than 9am. This is because TSH is highest early morning and lowers throughout the day. If looking for a diagnosis of hypothyroidism, an increase in dose of Levo or to avoid a reduction then we need the highest possible TSH
* Nothing to eat or drink except water before the blood draw. This is because eating can lower TSH and coffee can affect TSH.
* For the 2/9/21 test when taking thyroid hormone replacement, last dose of Levo should be 24 hours before blood draw, if taking NDT or T3 then last dose should be 8-12 hours before blood draw. Adjust timing the day before if necessary. This avoids measuring hormone levels at their peak after ingestion of hormone replacement. Take your thyroid meds after the blood draw. Taking your dose too close to the blood draw will give false high results, leaving any longer gap will give false low results.
* If you take Biotin or a B Complex containing Biotin (B7), leave this off for 7 days before any blood test. This is because if Biotin is used in the testing procedure it can give false results (most labs use biotin).
These are patient to patient tips which we don't discuss with phlebotomists or doctors.
If so then we can consider both sets of results are accurate.
As you can see these results are very strange, i would expect my t4 and t3 levels to be increased not decreased... only my TSH has gone down a little for some reason.
Your TSH has decreased because you are taking thyroid replacement hormone. That's what it is supposed to do. TSH is a signal from the pituitary to tell the thyroid to make hormone if it detects there's not enough. Your pituitary is detecting there is now exogenous thyroid hormone so it has reacted by lowering your TSH.
Because we don't know when you took your last doses of Levo and T3 before the test it's difficult to comment but if you took them at the advised times then the following probably applies:
Your FT4 has decreased because you are takingT3, that's just what it does.
Your FT3 is minimally different from your previous result, nothing is static so don't read too much into this at the moment. It may be slightly lower because your FT4 is lower so there is less T4 to convert to T3 regardless of the fact that you are taking a small dose of T3.
Could this be due to being underdosed?
That's debatable. You should have started on Levo only, not a combination of Levo plus T3 - why did you do that?
The way we should treat hypothyroidism is to start on Levo, get the TSH down to 1 or below which gives the highest possible FT4, then we look at the FT4 and FT3 together, if FT4 is high and FT3 is low then that shows poor conversion and that's when we consider whether adding T3 would be beneficial.
However, before adding T3 we need optimal nutrient levels so we need to test
Vit D
B12
Folate
Ferritin
If any are low or deficient we address this before starting T3.
Thank you SeasideSusie for your indepth and thourough comment on my post.
I've commented on greygoose's comment earlier on as he asked some of the same questions as you but i've done a alot of different blood tests to test nutrition and also view my health markers and everything but my AM/afternoon cortiso(both very low in the range) and thyroid came back better than normal, atleast from what i can see..
I have my thyroid labs dating all the way back from 2013 to 2019 showing my TSH hovering between 1.2 and 1.4 at the highest, this is suppousoudly before i started noticing the strange symptoms such as joint pain, cold intolerance, throat pressure, brain fog, muscle fatigue, shortness of breath and poor memory.
Do you suggest i try a higher dosage of just T4 then? such as 50mg for atleast 8 weeks?
I appologize if my writing is a mess as English is not my first language and my mind is a bit foggy at the moment, once again thank you.
I appologize if my writing is a mess as English is not my first language and my mind is a bit foggy at the moment, once again thank you.
Don't apologise, your English is excellent and I wouldn't have guessed it's not your first language
Do you suggest i try a higher dosage of just T4 then? such as 50mg for atleast 8 weeks?
Certainly I would suggest you drop the T3 and only take T4 at this stage, but I would want to see your nutrient results/ranges. Some low levels/deficiencies can have symptoms which overlap with symptoms of hypothyroidism so before taking any thyroid hormone I would suggest that all key nutrients are optimised.
Joint pain may be low Vit D.
Shortness of breath may be low ferritin or low iron.
Throat pressure - have you had thyroid antibodies tested? If not I would do that.
They're not too bad. What are you supplementing with, if anything?
Vit D is recommended to be 100-150nmol by the Vit D Society and Grassroots Health, with a recent blog post on Grassroots Health recommending at least 125nmol.
Ferritin is recommended to be half way through range so maybe make sure you include iron rich foods in your diet regularly, eg liver, liver pate, black pudding, etc.
Folate would be better on double figures.
B12 is recommended to be at the top of its range.
I think you may benefit from supplementing with a good quality, bioavailable B Complex such as Thorne Basic B this would help improve both Folate and B12 levels.
B Complex should be left off for 3-7 days before any blood test as it contains biotin which causes false results when biotin is used in the testing procedure (which most labs do).
Currently i am Only supplementing vit d, zinc, vit c and Magnesium but i do have a Unopened liquid vitamin b complex that i havent tried yet, i will start it tommorow aswell as push my gp to do another vit d test to check My levels as my last one was done a few months back
Make sure that you take Vit D 4 hours away from thyroid meds, also magnesium needs to be take 4 hours away. Others 2 hours away.
Come back with new results.
Dose of Vit D needs to be tailored to current level with a view to achieving the recommended level and I can help with that. Also, when taking Vit D, as well as magnesium there is another important cofactor - Vit K2-mk7. D3 aids absorption of calcium from food and Vit K2-mk7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissue where it can be deposited and cause problems.
Noted! Once again thank you so much for your help Susie, I will write all this down and try me best to do this for the next 8 weeks and hopefully we should see some improvement in my well-being
Oh really? Is the finger prick test accurate enough?? The more you know I wanted to ask you another question Susie, I took my first 50mg Levo dose today and have been feeling quite lathergic with a splitting head ache all day, do you think this is normal? Maybe my body needs to adjust to the dosage?
Oh really? Is the finger prick test accurate enough??
Yes. I do a fingerprick blood spot test once a year with that lab and I also do a blood sample full thyroid/vitamin test that includes Vit D once a year with a different lab. The Vit D results are what I expect to see with my level of supplementing and they are always very close so I have no reason to think the blood spot test is not accurate.
I took my first 50mg Levo dose today and have been feeling quite lathergic with a splitting head ache all day, do you think this is normal?
Who makes the Eltroxin you are taking? If it was prescribed it would be Advanz (Mercury Pharma) but you have bought without prescription so it wont be that brand. It could very well be GlaxoSmithKline and headaches are mentioned as a side effect. I think headaches are listed as a possible side effect of any brand of Levo.
Maybe cut the tablets in half, start with 25mcg for a week or two so that your body gets used to it, some people do need to introduce Levo slowly. If all is OK on lower dose then increase.
It could be fillers and you are reacting to one of those.
Thanks for the quick reply Susie the tablets are indeed made by GSK, I didn’t know people react to the fillers… do you think the side effect could possibly lessen with time?
It just could be a case of taking it slowly and getting used to it. Some people can jump right in with a big dose, no problem, others need to take it more slowly. So maybe drop down to 25mcg for a week or so and then try 50mcg again.
Not trying to hijack, but this is the first time I have seen B12 needs to be near the top of range. My last test was 799 pg/mL (232 - 1,245 pg/mL). That's only 56% through range. Is that enough? I do take Igennus Super B-Complex. But I only take 1 tablet.
According to an extract from the book, "Could it be B12?" by Sally M. Pacholok:
"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".
"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."
Obviously ranges differ and there are different units of measurement.
If you take your result it's pretty good but using the above quote they'd recommend it to be a bit higher, especially in older people.
I do take Igennus Super B-Complex. But I only take 1 tablet.
It's worth pointing out that Igennus Super B contains Vit C and this can keep the body from using B12, they should be taken 2 hours apart according to this - see slide 3 here:
I left a question on the Igennus web site and just received this reply via email:
Dear Elaine
Thanks for your enquiry. That's indeed an interesting question. This article is quite useful on the topic: b12-vitamin.com/vitamin-c/
While all the reports mention 'large doses of vitamin C' - I don't think that the modest dose of 80mg vitamin C in each tablet of Super B-Complex (160mg in 2 tablets) would have much influence.
However, if you wish to be completely sure we have just launched a sublingual B12 1000mcg consisting of methylcobalamin, adenosylcobalamin and hydroxocobalamin - have a look at it here, it's a tub of 180 tablets (6 month supply): igennus.com/products/super-...
--
Dr Danielle Crida
Nutritionist
***
But that's just B12, right? I also need a balanced B-complex.
Indeed it is just B12, and for anyone who is intolerant to mannitol it's worth noting that this supplement contains it (so anyone who can't use Teva levothyroxine wont be able to use this B12).
I also need a balanced B-complex.
As I've said, my preference is for Thorne Basic B. It was the original one I tried, tried a few others, but have gone back to Thorne Basic B. Others may have different suggestions.
Reading your knowledgeable response, there are several things I pick up on.... But one in particular is pertinent to me at the moment about needing to be tested by 09.00
Currently trying to help a friend be tested for a full thyroid panel of tests, by Medichecks, with a nurse coming to the house.... The slot she was offered was 17.30 !!
From everything I've read everywhere this time seems to be absurd, as well as useless because Next Day Delivery from the postoffice is collected at 17.00, hence missing the post completely.
So far our experience of Medichecks has been rather poor with much conflicting information. Yes, no doubt the test tube shortage may be an issue but days and weeks of silence with out any call back, to rearrange for a blood draw, to an elderly person whose anxiety levels are sky-high is making her worry that Medichecks are not a professional outfit.
I personally also find their approach not very inspiring, as I called myself & over the phone was told 'it was fine, it didn't matter'!!!!
When I pointed out that the postbag leaves the post office at 17.00 however, they didn't know what to say. .. It's all a bit of a mess..
I have no experience of Medichecks home phlebotomy service, they outsource it I believe so I suppose it's a case of they have so many phlebotomists which cover different areas and they need to work out a route which doesn't require them to go back and forth to the same part so they time the appointments to what else they have that day. This is pure guesswork as I used to be a secretary to a team of surveyors who did building society morgtage surveys, when booking appointments I had to be mindful of grouping them so that they didn't waste time going back to an area they were in earlier in the day.
A few years ago I used Blue Horizon for home phlebotomy. I live in rural North Wales and there were no phlebotomists locally. The one who came to me was from South Wales (at least 2 hours travelling time). I think the time arranged was 10am, it was impossible to book any earlier because of the length of her journey. I did book a second one some time later and the only time offered was 12.30pm, again she travelled from South Wales.
I now do fingerprick tests which, fortunately, I have no problem with.
The other option is to not use Medichecks home phlebotomy service but use an independent one. ThyroidUK has a list here:
Taking any dose of levothyroxine, but especially any dose of T3 will reduce TSH
Typically standard starter dose for hypothyroidism is 50mcg levothyroxine (not adding any T3)
Bloods should be retested 6-8 weeks after each dose increase
Typically dose levothyroxine is increased slowly upwards in 25mcg steps until on around 1.6mcg levothyroxine per kilo of your weight
Only when you get on approx full replacement dose and vitamin D, folate, ferritin and B12 tested and at optimal levels (by supplementing if necessary) will you know if yo7 actually need T3 prescribed as well
It’s MUCH easier to only take levothyroxine, if possible
The problem with starting T3 too early, when only on low dose levothyroxine, is that as soon as you take almost any dose of T3 then TSH drops dramatically ……so your own thyroid output drops significantly, or completely, leaving you more hypothyroid than before you started
As demonstrated so clearly by your current situation
Your low Ft4 shows you need 25mcg dose increase in levothyroxine
Essential to test vitamin D, folate, ferritin and B12 plus both TPO and TG thyroid antibodies
So you suggest i drop the T3 completely atleast for now and try upping my Levo (T4) to 50mg for atleast 6-8 weeks before doing another blood test and going from there??
I have previously done the Thyroid antibodies test through medichecks aswell and both shows negative for hashimotos. Regarding supplements i take vitamin d at 5000iu a day, Magnesium, vitamin c and Zinc.
Levels for all of these have Come back Well in range and i like to think of my diet as for the most part quite healthy mixture of meat, vegetables and grains aswell as minimally prosessed Where possible.
I think i will have to try increasing my levo dosage for now to 50mg and drop the t3 completely..
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