Please advise me on big change in Lab results after going from levo only to T3/T4 combo in June

[Koola]

I’ve listed below two levo only lab results in April & May, then the first after doing the combo for 5 weeks. Not much change.

Then a total first for me, yesterday after 12 weeks on combo: TSH extremely low and FT3 above range! Only FT4 hasn’t changed.

Theoretically I should be feeling much better. In fact, generally I’ve not seen any improvement on combo, except slightly less joint pain that has now returned with colder weather. And now I’ve been feeling terrible for the past week, exhaustion and increase of all symptoms, on top of high BP and tachycardia that started a few weeks ago.

A few days ago I was wondering if I should do T3 only then maybe back to levo only, or tweak the combo, and basically I haven’t a clue! Help much needed and appreciated.

Last four labs were:

On Levo only, 88 T4 alternating with 94 T4 - 7 April & 18 May:

TSH (Range: 0.20 – 5.00 ) : 7 Apr.: 2.81 / 18 May: 7.24

FT3 (1.8 – 4.5) : 7 Apr.: 2.50 / 18 May: 2.64

FT4 (7.0 – 20.0 ) : 7 Apr.: 11.2 / 18 May: 10.01

After 5-week T4/T3 combo: (a week on 50T4 then 62/69 T4 and 12.50 T3 twice a day ) – 7 July

TSH: (Range: 0.20 – 5.00 ): 7.July.: 5.36

FT3: (1.8 – 4.5) : 7 July: 2.77

FT4: (7.0 – 20.0): 7 July: 9.33

--------------------------------------------------------------------------------

-8 October, after another 12 week T4/T3 combo on 62/69 T4 and 12.50 T3 twice a day except for 3 weeks in August on 75/ 88 T4 and 12.50 T3 twice a day.

TSH: (Range: 0.20 – 5.00 ) 8 Oct: 0,80

FT3: (1.8 – 4.5) : 8 Oct : 5,64

FT4: (7.0 – 20.0): 8 Oct.: 9,42

[SlowDragon Administrator]

So currently taking 25mcg T3 daily as 2 x 12.5mcg is that correct

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

Ideally day before test split into 3 doses

12.5mcg waking, 6.25mcg mid afternoon and at 9pm

Last 6.25mcg dose T3 approx 8-12 hours before test

Essential to regularly retest vitamin D, folate, ferritin and B12

When were these last tested

[Koola in reply to SlowDragon]

-I’m taking half of that: 12.50 T3 daily as 2x 6,25 mcg. Plus 62/69 T4

- Yes, latest test done 7:30 am, only water, split 2nd 6.25 day before to take 3,12 T3 at 11 pm

I was going to do vits but had forgotten not to take B 12 and iron a week before. Last vit D test in July was a third of range, B, was good and ferritin could be a little higher in range. Folacin was done earlier in the year but is always very good. (Don’t have lab recent results, lab forgot to send them. am testing vit. next week.)

Can you please explain why FT4 hasn’t budged whereas TSH went down so much with FT3 over range?

Do I stay on combo or reduce T3 or T4 or go back to levo only or on to T3 only?

For what it’s worth, after test on 8.10 and yesterday I only took 6,25 T3 and finally feel more relaxed than I have in the past 3 months…

[SlowDragon Administrator in reply to Koola]

Taking almost any dose of T3 will always significantly reduce (or suppress) TSH…..that’s just what T3 does

Hence so essential to always test Ft4 and Ft3

Every person is different as to what levels Ft4 and Ft3 suits them

What’s the highest dose levothyroxine you were on before T3 was added?

On Levo only,

88 T4 alternating with 94

T4 - 7 April & 18 May:

TSH (Range: 0.20 – 5.00 ) : 7 Apr.: 2.81 / 18 May: 7.24

FT3 (1.8 – 4.5) : 7 Apr.: 2.50 / 18 May: 2.64

FT4 (7.0 – 20.0 ) : 7 Apr.: 11.2 / 18 May: 10.01

Both April and May results clearly showed you were under medicated

Ft4 far too low

On levothyroxine alone most people need Ft4 at least 60-70% through range

Typically dose needs to be at least 1.6mcg per kilo per day

Approx how much do you weigh in kilo?

Your results from May Ft4 was only 23% through range

Dose should have been increased to 100mcg daily and bloods retested 6-8 weeks later

TSH was way over range clearly showing you needed dose increase

Why wasn’t dose levothyroxine increased?

Looking like you possibly never needed T3 ….as Ft3 is now too high

When on levothyroxine plus T3 with only small dose T3 many members find they need Ft4 and Ft3 roughly 50-60% through range minimum

Your Ft4 is only 19% through range

Helpful calculator for working out percentage through range

chorobytarczycy.eu/kalkulator

Most people would find that too low a dose levothyroxine

Perhaps reduce T3 to 3.25mcg twice day and increase levothyroxine

Suggest you increase levothyroxine to 75mcg daily and retest in 6-8 weeks

Which brand of levothyroxine are you currently taking

Do you always get same brand levothyroxine at each prescription

[Koola in reply to SlowDragon]

Thank you very much for your advice, Slow Dragon. I will answer your questions and then ask you to explain raising Levo, because I still don’t understand how it works.

- My highest dose levothyroxine was alternating between 94 and 88. About increasing the dose to 100, well yes, I was often advised to do so since end of 2019 and – I kept trying! Just couldn’t do it. (Least of symptoms being laid out flat as a pancake all day and since I live alone, not possible to maintain for any length of time…)

- I haven’t checked weight in many months, will do. Could be anywhere between 60 and 65 Kilos. (I was up to 70, until this winter when I lost 10 kilos).

- I take Euthyrox. T3 is Unipharma only here. T4 Euthyrox felt smoother than T4 Unipharma, that I used many years previously. Was told here that it didn’t matter to take T4 and T3 from different brands. (?)

- You said “Perhaps reduce T3 to 3.25mcg twice day and increase levothyroxine

Suggest you increase levothyroxine to 75mcg daily and retest in 6-8 weeks”.

- I have a question about increasing to 75 mcg T4 (from 62,50/69mcg): I understand that having added T3 suppressed my TSH – and therefore didn't raise my FT4? However, since TSH & FT4 are low, shouldn’t I take less T4? Or do I take more so as to raise FT4? Will that not raise TSH again?

[SlowDragon Administrator in reply to Koola]

Taking T3 reduces TSH ….just because it’s the active hormone

It’s all trial and error what suits each person

The fact you couldn’t increase levothyroxine up to 100mcg…..means you might want to cautiously increase levothyroxine to 75mcg

Alternatively stay as you are and retest again in 6-8 weeks

Increasing levothyroxine won’t increase TSH …..it’s more likely it would reduce TSH

It would/should increase Ft4 (and ft3 slightly)

You might want to try 3 smaller doses T3 - 3.25mcg three times a day

[Koola in reply to SlowDragon]

Okay for trial and error - and caution - which will hopefully become trial and Bingo! some day, hitting that famous sweet spot.

So recap: I’d always read that low TSH indicates to take less T4 to raise it and the other way around.

But why FT4 reacts the opposite way i.e. a low FT4 indicates take more to get higher (which is less counterintuitive) I still don’t get. But I trust your advice and will up levo and reduce lio and see what happens.

More recently I found out that a very low TSH (I’m now 0.80 on scale 0,20 – 5,00) is okay and I can go down further.

I’d been wondering about T3-only because of not doing well on levo and trying to raise it but you seem to dismiss this option entirely. NDT you didn’t mention. I did a 5-day trial which was very unsuccessful but I wasn’t used to T3 at all then. If you have any thoughts on the subject please let me know. As it would be nice to know there’s an alternative if this combo doesn’t work out.

Always grateful for your time and patience. As many have said, where would we without the Forum and people like you?

(six-feet under, is my opinion!)

Wish you a pleasant day

[SlowDragon Administrator in reply to Koola]

Obviously there’s lots of options to try

Going from least to most …..

Just levothyroxine

Levothyroxine plus small dose T3

Less levothyroxine and higher T3

NDT

NDT plus levothyroxine

NDT plus T3

T3 only

And things change over time as we get older etc

So many people start on just levothyroxine, but, over time and especially post menopause find they need T3 added or NDT

[Koola in reply to SlowDragon]

Thanks!

Editing the above to add a caveat that if one has to wait 6 weeks between trying each possible change and combo, we might need many lifetimes over..

Hopefully there's a Saint Thyroid somewhere to light the way !