I have had moderate CFS for the last few years. I trialled T3/T4 titering up to 50mcg of T4 and 40mcg of T3, a year a go but didn't notice any difference in my fatigue so the Dr told me I should just come off the meds. I just got my recent thyroid results and it seems the T4 and T3 are low, or at least lower than optimal. Someone mentioned to me that "those doses arent high enough for the vast majority".
So I'd be grateful if anyone could provide some advice, on my current results and if it's worth perhaps trying T3/4 again but going up to a higher dosage than before?
TIA!
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Mowgyi
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Generally, when a Hypo patient is on Levo only, most tend to feel best when TSH is below 1 with FT4 and FT3 in the upper part of their reference ranges. Going by that generalisation, your results show that your TSH is too high and your FT4 is too low. It might be an idea to increase your Levo, aiming for a TSH below 1 to see how high your FT4 goes then look at the FT3 to see how well you convert T4 to T3. That should then help the decision as to whether to trial T4/T3 combination again.
Your ferritin level is rather high.
Have you got any results for B12, Folate and Vit D?
Many thanks for the valuable input. I'm not on any meds at the moment. When I was on the T3/4 my TSH did drop below 1 (0.46), but I still didn't notice any difference. Given my current bloods and symptoms do you think another trial is worth looking into? I had a bad case of covid a few months ago and that may have driven the ferritin up (usually sits around 130). B12, folate and vit D are all okay (see attached), although my platelet count is consistently low which apparently points to a possible B12, folic acid or iron problem.
Your serum iron is slightly low at 40% through range, it's recommended to be 55-70% through range, with the higher end for men. Maybe look at eating more iron rich foods. Your ferritin could be high due to inflammation or infection.
Your B12 is good but your folate is low at just 17% through it's range and folate is recommended to be at least half way through range. Maybe ensure you eat lots of folate rich foods and a good quality B Complex such as Thorne Basic B might be worth considering.
Vit D is pretty good, the Vit D Society and Grassroots Health recommend a level of 100-150nmol/L, with a recent blog post on Grassroots Health mentioning a study which recommends over 125nmol/L.
As for your thyroid results, your TSH is actually where a normal healthy person's TSH is generally - no more than 2 but often nearer 1, although your FT4 is very low in range, it would normally be around mid-range-ish in a healthy person.
Did you do your test no later than 9am with nothing to eat or drink except water before the test? This ensures the highest possible TSH.
Hi Susie,Thanks again for all the info. You seem to know an awful lot. When I decided to go on the meds a year ago my TSH was much higher at 4 something. My test was done fasting, but was done at 11am. Would such a low T4 be strong enough to consider t3/4 meds again in your opinion? I'm wary of using limited energy resource going down this route again if it's unlikely to help with my fatigue issues so just trying to get a feel for if its worth it. Many tahnks.
SeasideSusie Hi Susie, thanks again for your input. Here's my summary of my thyroid results over the last few years. I was on t3/4 Jan, Feb & March 2021 but not since or before then.
I'd seen those above, it was the other results I was wondering about the ranges. I was wondering if any of your results were out of range, specifically FT4 below range or on the very bottom of the range. That would show Central Hypothyroidism, but I don't think any of those results suggest that as your FT4 results all look pretty well in range.
Although 2017/18/20 results show a TSH level higher than one would expect for a normal healthy person, none of them appear to be over range with a low FT4 which would be suggestive of your doctor maybe suspecting hypothyroidism and trialling Levo.
Looking at your February results when you were taking T4/T3 (was this Thyroid-S?), this took your FT3 over range and your FT4 was quite low in range (assuming same range as recent test).
Taking your current results on no thyroid meds, if you had done your test at 9am your TSH would have been higher, I expect over 2 as your historic TSH results have always been. This, together with your low FT4, makes me think that if you are going to self medicate then get some Levo and just take that, forget about NDT or T3 at this stage. See what the Levo does. It should reduce your TSH and increase your FT4 level which in turn should increase your FT3 level. Once your TSH is below 1 (following our advice on how to do test) see where your FT4 and FT3 lie to see what your T4 to T3 conversion is like. If FT4 and FT3 are fairly well balanced then you wont need T3 you would just need to find the dose of Levo that is right for you.
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