So here's my recent blood test results - TSH <0.02 (0.27-4.20), ft4 22.4 (10.8-25.5), ft3 5.7 (3.1-6.8). On 125mcg levo and 10mcg lio.
I still have hypo symptoms although with each increase of dose I feel an improvement and I'm definitely on the right track but I still have lingering symptoms like cognitive issues and balance issues
So my question is could it be at all possible that I do better when my ft4 is above reference range and when Dr Toft says 'some need a higher dose of levothyroxine to suppress serum TSH' as you can see my TSH is suppressed and results look favourable but is there a slight chance that I may do better on a higher dose of levo.
My Endo has agreed to trial increasing levo to 150mcg and decreasing lio to 5mcg
Any thoughts... Hoping this is my sweet spot
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Handsome14
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Dr Toft is talking about patients who are on Levo only.
When you take Levo plus T3 it's a whole other ball game. You have to find out yourself where your own personal sweet spot is. You may be fine with a low FT4 as long as FT3 is in the upper part of it's range. You may be like some of us who need both FT4 and FT3 in the upper part of their ranges when on combination hormone replacement.
Your TSH is going to be low or suppressed because you take T3.
Your FT4 is 78.91% through it's range.
Your FT3 is 70.27% through it's range.
By increasing your Levo and reducing your T3 then your FT3 level will lower. By adding more Levo your FT4 will rise and, depending on how much natural conversion you have it may increase your FT3, but it's unlikely to give the same result you had with 10mcg T3.
By the way, both should never be changed at the same time, you change one and see what difference it makes, change the other later, when levels have settled from the first change, and see what difference it makes, change them both together and you wont know which dose adjustment has made whatever difference you experience.
If that was me, and I self source/medicate T3, then I would be perhaps reducing Levo by 12.5mcg, see where that takes my levels and how I feel. I'd wait 8 weeks for levels to settle before retesting and make any further changes. Then, depending on results and how I feel, the next change would be to increase the dose of T3. Tweaking doses is long winded and should be done with small adjustments of one of the hormones at a time, be patient and wait for levels to settle before making any other change. I have found that the smallest adjustment can make a big difference.
And you mentioned that he said if FT4 was below 18 he'd increase Levo and lower T3, yet your FT4 above is 22.4 (10.8-25.5) yet he's still increased your Levo???
Why would you reduce levoBtw my Endo prescribes T3
Yes I understood your endo prescribes T3.
I mentioned that I self source/medicate with T3 so I can do whatever I like, I don't have to follow an endo's instructions.
Having used T3 with Levo since 2015, I am basing my comments on my own personal experience, that's all anyone can do - pass on their own experience.
As I said, when on combination hormone replacement, it's very individual where one needs both their FT4 and FT3, what applies to me doesn't necessarily apply to anyone else, and what might apply to you may not apply to anyone else. We each have to find what is right for us by trial and error and fine tweaking of doses.
Generally, many people on combination meds do fine with a lower in range FT4 as long as FT3 is in the upper part of it's range. Some of us need FT4 higher in range as well as FT3. It's unsual to have FT4 at the top of the range and higher than FT3 is in it's range, your FT4 is 78.91% through it's range and your FT3 is 70.27% through it's range. Most people on combo meds would need those the other way round, FT4 lower than FT3. That is why I said I would reduce Levo slightly to start with and see what that brings.
I asked if I could increase levo and he says he's listening to me and my symptoms so agreed to increase levo but decrease lioI'm very confused
If you increase your Levo when your FT4 is already high in range at 22.4 (10.8-25.5) then adding another 25mcg is very likely to take your FT4 over range. Reducing your T3 is going to reduce your FT3 level.
You said in your post 2 days ago:
Endo seems focused on TSH
He's literally saying all the things I've read about on this forum - TSH suppressed (0.07 - range 0.27- 4.20), wouldn't want to go much lower as causes heart issues, hypothyroid sufferers seem to blame all symptoms on thyroid, not looking at ft4 (14.8- range 10.8-25.5) or ft3 (4.5 - range 3.1-6.8) results, saying doesn't matter if hashimotos as treated same as hypothyroidism, can't explain why ft4 and ft3 are low end of range.
I'm feeling like he doesn't understand condition but obviously can't quite say that.
You have doubted him yourself. I think your endo doesn't know much about how to treat with T3, he is very likely a diabetes specialist like most of them. If he is prescribing T3 and is focussed on TSH then he definitely doesn't know that taking T3 lowers TSH often to the point of suppression. So is he really the best person to be treating you?
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