I agree with Witchinghour in that you need to raise those FT3 levels. However, it is not only about good thyroid hormones labs as you have previously found out.
Reasons why you may find raising T3 difficult;
Low iron levels - A very common reason & also one that can cause the breathlessness & air hunger that increases the higher you try to raise T3 levels. Your ferritin was low but you previously indicated adequate serum iron. You do not need high ferritin levels to raise T3 (ferritin is not iron but a storage protein) but if you don't, it is absolutely essential to have adequate serum iron levels. You recently indicated to SlowDragon you were having a complete iron panel. Can you post these results?
Adrenal issues - We briefly discussed your low DHEA levels which are being addressed with your naturopath. Think of how much T3 speeds up the metabolism and if adrenals are flagging they simply can not immediately keep up. This has caused me feelings of vertigo & derealisation as well as the breathlessness seen with the low iron levels above. You may find 6 months with adrenal supports allows a better T3 introduction. Medicating T3 can actually raise blood sugars significantly but balanced cortisol/DHEA will encourage good blood glucose levels which are required for T3 uptake into the cells to do its thing.
Sex hormones - I previously mentioned raised testosterone but you indicated it wasn’t possible because you are small in stature. If you are peri-menopausal, then possible raised oestrogen will encourage more binding carriers that risk binding thyroid hormone. If you are menopausal, poor adrenal reserve might mean a deficiency in both O & P & elevated testosterone such as I had myself & I am quite small in stature also. Any sex hormone imbalance will prevent thyroid hormones from working effectively on some level.
I am not sure if low VitD would have a direct impact on T3 being tolerated but it will inhibit other good actions. Yours was previously low. Is this being addressed?
Protein - It is great you previously said you eat clean, and lots of protein. I don’t particularly like meat but eat a little because have noticed the significant differences protein makes to how my thyroid meds work & in particular T3. I also use pea protein in smoothies.
I also think you need to slow down in your pursuit of well-being because hormones can takes months & months to re-regulate themselves. All systems are connected and it may be that by addressing all of the above T4 conversion improves enough that you don’t even need to medicate T3. I have a small DIO2 impairment myself and so need to medicate a tiny bit of T3 but concentrate on getting the rest by good T4 conversion as believe the conversion process contributes a lot to longer term homeostasis.
An iron panel can be tricky to read. How high was serum iron in range & was TIBG corresponding? These levels are important because you don’t have adequate ferritin.
These results can also indicate the necessity for further investigation into possible conditions like anaemia or early onset RBC issues. Both a possibility given your poor ferritin & Vit D levels indicating poor gut absorption on some level. Roughly 20% of thyroid hormone will be converted in the gut if conditions are healthy.
Being on the same thyroid hormone dose for a year means nothing if you aren’t addressing the barriers that are preventing it from working well. ‘Slowing down’ related to keeping your focus on the required cofactors for encouraging your body to accept additional thyroid hormone and being able to utilise it well. The longer we remain under-medicated the further factors will need eliminating from enquiry in both number & depth.
Otherwise I guess it’s waiting until adrenal issues are more balanced. Hope your naturist is helpful 😊
Well maybe I should switch to a liquid levo like tirosint or tiro sol if I’m having an absorption issue… but FT4 goes up with increases. So I don’t think absorption is an issue.
Vitamin D is being addressed with D3/K2.
Haven’t had an iron and TIBC in a while. But had a ferritin 2 weeks ago. Results as follows:
So vitamin D is far too low…looking at improving to 40ng/ml (that’s around 100nmol in U.K. units)
But had a ferritin 2 weeks ago. Results as follows:
36 (8-252)
Ferritin also low.look at increasing iron rich foods in diet. Looking for ferritin to improve to at least around 70.
Meanwhile getting full iron panel test for anaemia. Never take iron supplements unless full iron panel test shows low iron. It’s possible to have low ferritin and high iron
Low vitamin levels suggests your under medicated for thyroid
Being under medicated for thyroid results in low stomach acid and poor nutrient absorption and low vitamin levels as direct result
Low vitamin levels leads to poor conversion of Ft4 to Ft3
Taking a daily vitamin B complex will help maintain optimal B vitamins including folate and B12
Remember to stop taking vitamin B complex a week before all blood tests as contains biotin and biotin can falsely affect test results
Suggest you work on improving low vitamin levels for 6 weeks
Then retest thyroid correctly
Testing as early as possible in morning before eating or drinking anything other than water. Last dose levothyroxine 24 hours before test
Are you currently taking taking T3
Day before test split T3 into 2 or 3 doses roughly equal 8 hour intervals. Last 1/3rd of daily dose T3 approx 8-12 hours before test
Typically when taking T3 alongside levothyroxine, dose is 2 x 5mcg or 3 x 5mcg per day
As you have/had Graves’ disease it’s ALWAYS worth trying absolutely strictly gluten free diet
Get coeliac blood test done BEFORE cutting gluten out
If you test positive for coeliac, will need to remain on gluten rich diet until endoscopy
If result is negative can consider trialing strictly gluten free diet for 3-6 months. Likely to see benefits. Can take many months for brain fog to lift.
If no obvious improvement, reintroduce gluten see if symptoms get worse.
I just looked up high gluten foods. I don’t think I eat very much gluten daily. eggs, Turkey, chicken, oatmeal, fruit, yogurt. That’s my usual daily intake. Then 2 days a week pizza, fast food, candy, etc.
OK, so you have a false low FT3, there. And your TSH isn't as high as it would be if you'd had the blood draw before 9 am. So, frankly, those labs don't tell us very much.
No, as I've told you before, it doesn't work like that. But, even if it did, and 9 am was your noon, you're still having the blood draw too late in the day. You're not having it when the TSH is at its highest. You'd have to have the blood draw around 6 in the morning.
I saw a different doctor and he’s sending me for a bunch of tests, he REALLY wants me to switch to armour after preparing my body for the higher T3 levels. We’ll see what he says when he gets my results.
I can understand why. So, when are you going to stop talking about increasing your T3 and actually doing it? You posted this question 20 days ago and you still haven't done anything about it.
So do a lot of other hypos. Which just means that in the cold, you need more T3 because your FT3 is too low. That does not mean that 'the weather is messing with your dose'. It just means that you don't have sufficient T3 in your system to heat your body when the weather turns cold.
Well, thousands of other hypos manage it! But, first, you have to optimise your dose in winter, and you are a long way off doing that. You need to increase your T3 by 5 mcg.
Increasing your T4 - as I've explained many times - will take your FT4 over-range but won't do much to raise your FT3. T4 is the storage hormone, T3 is the active hormone, so it's T3 that you need to raise.
As I've said before, no point in testing magnesium. The results might look good but you could still be deficient. And, taking vit D uses up your magnesium, so you always need to take them together.
I've no idea what Mg tissue salts are. Sounds weird to me.
Yes, vit D has improved, but could still be higher, so don't stop supplementing yet.
Insufficient levels of iron/ferritin is very common on the forum. Having an iron panel offers info on how iron mechanisms are working as well as the amounts. Sometimes the more thyroid hormone levels are tried to be optimised, the more the manifestations of iron deficiency are exposed because thyroid hormones increase the rate of RBC formation (erythropoiesis) and iron requirements increase.
Your serum iron is half way through range. TIBC should correlate but is slightly higher. AS TIBC shows the amount of transferrin proteins available for binding iron, higher amounts than serum iron levels is a good indicator of (early onset) iron deficiency, ie your body is trying to carry more iron for utilising by the liver creating more transporters, but insufficient iron amounts mean these transporters remain unbound.
A calculation of these two results shows iron saturation at 26% is low. The ideal is anywhere between 35 - 45%. And lastly your ferritin is just 8.20 % through range.
Because your results are a little ambiguous you need to combine them with a recent blood count. If results showed healthy RBC's (shape, size, number) and adequate haemoglobin levels, iron mechanisms are working ok and you could probably raise levels by eating iron rich foods and being mindful of what encourages/discourages good absorption. Also, if you have gut issues & low stomach acid supplementing Betaine helps enormously with absorption.
However, if results showed low haemoglobin levels and/or struggling RBC’s, you are heading towards full blown anaemia. Supplementing a low dose of iron will raise levels quicker but would need to be retested after several weeks, and ferritin may not raise for a while until thyroid hormones are optimised and other iron mechanisms are more normalised.
I had a bunch of labs done today. I do have a CBCD with H&H and RBC. No indication of any abnormal RBC morphology. I can post those results along with thyroid panel as well from today.
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You posted this question 20 days ago and you still haven't done anything about it. 
Is decreasing a dose slowly as important as increasing?
what's my T4 \"problem\"
which one would you increase?
Frustrated by thyroid
