New labs. What we thinking now? Any input? - Thyroid UK

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New labs. What we thinking now? Any input?

Meanbeannyc profile image

FT4: 1.41 (0.76-1.46)

FT3: 2.29 (2.11-4)

TSH: 0.841

RT3: 28 (8-25)

I’m in so much pain. Nothing is working!!

82 Replies
SlowDragon profile image
SlowDragonAdministrator

What thyroid hormones are you currently taking

What vitamin supplements

Please add most recent vitamin results too

Magnesium: 2 (1.4-2.2)

Vit D: 30 (20-50)

B12: 459 (211-911)

Folate: 15.3 (normal >5.4)

Iron: 97 (40-150)

TIBC: 375 (250-450)

Iron sat: 26 (11-46)

Ferritin: 28 (8-252)

112 Synthroid 5 cytomel

Just got rx for 125 Synthroid

SlowDragon profile image
SlowDragonAdministrator in reply to Meanbeannyc

What vitamin supplements are you currently taking

Vitamin levels are low because you are under medicated/poor conversion of Ft4 to Ft3

Low Ft3 results in low vitamin levels

Low vitamin levels tend to result in poor conversion

Optimal vitamin levels are

Vitamin D at least 40ng/ml (100nmol in U.K. units)

B12 at least over 500

Ferritin is obviously terrible

Are you vegetarian or vegan

Look at increasing iron rich foods in diet

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

Day before test split T3 into 2 doses and taking last 2.5mcg 8-12 hours before test

Most people when adequately treated will have Ft3 at least 60% through range

Your Ft4 is already high

You probably need increase in T3 not levothyroxine

Adding 2nd 5mcg dose T3 approx 10-12 hours after waking dose T3

I would agree with DippyDame …..try reducing levothyroxine to 100mcg and increase T3

I felt awful on 100 T4. I’m too scared to drop

SlowDragon profile image
SlowDragonAdministrator in reply to Meanbeannyc

Ok ….so just add 5mcg more T3

Retest in 6-8 weeks

Day before test take last 5mcg dose at 9pm

Or split 2nd 5mcg dose into 2 x 2.5mcg …..taking 2.5mcg mid afternoon and 2.5mcg at 9pm evening before test

Likely to eventually need 3 x 5mcg T3

What about the weather? It’s starting to get cold here and I feel bad in the cold

SlowDragon profile image
SlowDragonAdministrator in reply to Meanbeannyc

Another reason to increase T3

And keep warm

SlowDragon profile image
SlowDragonAdministrator in reply to Meanbeannyc

Essential to maintain OPTIMAL vitamin levels

Are you on strictly gluten free diet

Not vegetarian or vegan.

Been trying to increase D, and have done so successfully pretty quickly.

Weather is getting cold here. I think I need more of something in the cold

SlowDragon profile image
SlowDragonAdministrator in reply to Meanbeannyc

Are you on gluten free diet…no wheat, barley or rye

I am not gluten free no.

What does that even help with? I can switch to tirosint for better absorption of T4 if that’s an issue

Your T4 to T3 conversion is poor caused by high FT4 compared to miserably low FT3thyroidpatients.ca/2019/01/...

For good health T3 is is required by every cell in the body in a constant and adequate supply.

Your FT3 is 9.52% through the reference range it should be close to 75% so no wonder you are struggling

First you need to ensure vit B12, vit D, folate and ferritin are optimal

SlowDragon gives excellent on nutrients.

I would suggest that 112mcg Synthroid (T4)with 5mcg Cytomel ( T3) is the wrong combo....you need more T3.

The extra Synthroid (125mcg) you have been prescribed is unlikely to do much to raise your FT3 ( at least not enough to see any improvement) which is what you are aiming to do...your GP should see this. They don't really understand T3, it looks as if he is dosing by TSH which is wrong!

thyroidpatients.ca/2019/09/...

In your shoes I would change to 100mcg T4 with 10mcg T3 while you work on the nutrients then retest after 6/8 weeks and review the situation. Further increases will be needed but one step at a time for now. We are told to change only one thing at a time but I'd be inclined to be the rebel here since you are only dropping 12mcg T4.

It will take time and you will probably need to do a bit of trial and error to reach the dose that makes you feel better....it took me many months but I kept focusing on the fact that things would improve. And they did thanks to support from members...if interested you can read about my thyroid journey in my profile.

As your FT3 level rises the pain should ease....mine did.

Don't worry about RT3

See comments by greygoose here

healthunlocked.com/thyroidu...

Hope you feel better soon

I was on 100 T4 a while back and felt AWFUL

Your FT3 was still too low which would make you feel awful... and which is why I suggested increasing T3 as you reduced T4..I see SlowDragon agreed with me on this.

There is no quick fix (think headache/paracetamol) you may need quite a bit more T3 before you feel better.

But why would I lower my overall dose if I still don’t feel well

why would I lower my overall dose if I still don’t feel well ?

but changing from :112 mcg levo + 5 mcg T3

to:

100mcg Levo + 10mcg T3 ....isn't 'lowering your overall dose'

it's probably about the same 'effect' overall .. might even be 'more' since T3 so much more active than T4 .

greygoose advised to only lower T4 if it’s really high and mine isnt(?)

Why are you quoting me now when you ignored everything I told you, and explained to you, at the time? These people are only repeating what I've said to you a hundred times. When I said about only reducing your T4 if it was really high, it wasn't really high. Now it is. And, your rT3 is high. Reduce your levo and you'll reduce your rT3. But, you have to increase your T3. It's low T3 that causes symptoms, not rT3, probably not T4, but you have to keep things balanced.

Guess at this point it doesn’t even matter no matter how much or how little I take I never feel better

Well, that can hardly be true because you haven't really tried. I know you think you have! But you haven't done it in a systematic way: you haven't optimised all your nuutrients; you haven't investigated your adrenals; you haven't had your sex hormones tested... All these things need doing and sorting out to feel well. And, you've been told all this before, I know. So, why aren't you doing anything about it?

I have new cortisolAnd sex hormone results… and vitamin d has been improving

So, where are these cortisol and sex hormone results? Vit D may have been improving but what about ferritin/iron? B12 and folate? Zinc/copper?

Magnesium: 2 (1.4-2.2)

Vit D: 30 (20-50)

B12: 459 (211-911)

Folate: 15.3 (normal >5.4)

Iron: 97 (40-150)

TIBC: 375 (250-450)

Iron sat: 26 (11-46)

Ferritin: 28 (8-252)

No zinc or copper…

Will update sex hormones in a second. Going to take me a while to write them down with ranges.

SlowDragon profile image
SlowDragonAdministrator in reply to Meanbeannyc

Low ferritin

Look at increasing iron rich foods in diet

Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption

List of iron rich foods

dailyiron.net

Links about iron and ferritin

irondisorders.org/too-littl...

davidg170.sg-host.com/wp-co...

Great in-depth article on low ferritin

oatext.com/iron-deficiency-...

drhedberg.com/ferritin-hypo...

This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.

Thyroid disease is as much about optimising vitamins as thyroid hormones

healthunlocked.com/thyroidu...

restartmed.com/hypothyroidi...

Post discussing just how long it can take to raise low ferritin

healthunlocked.com/thyroidu...

Never supplement iron without doing full iron panel test for anaemia first

Iron and thyroid link

healthunlocked.com/thyroidu...

Posts discussing why important to do full iron panel test

healthunlocked.com/thyroidu...

So, SlowDragon has talked to you about your ferritin - a talk we had over a year ago!

Magnesium tests aren't reliable, just take some.

Personally, I'd want my B12 higher than that - at least over 550. So, I would be taking a B complex that contains methylcobalamin and methylfolate.

I have methylcobalamin jabs at home, I just didn’t wanna jab myself with b12 lol

Methylcobalamin is B12.

Yes I have the injections. I did not want to inject myself with b12

Why not?

Estradiol: 193.3 (follicular phase: 21.4-164.8, mid cycle phase: 49.9-367.2, luteal phase: 40.2-259)

Total testosterone: 26 (premenopausal female: 21-60 years old 9-48, post menopausal >45 years old: <7-46)

SHBG: 93 (premenopausal female 21-60 years old: 11- >180, post menopausal >45 years old: 23-159)

Free testosterone index: 0.97 (premenopausal female 21-60 years old 0.27-7.64, post menopausal >45 years old <0.17-4.15)

I have luteinizing hormone and FSH too. These were all taken last week.

Well, none of that seems quite right. But I'm not an expert on sex hormones. radd ?

Why doesn’t it seem right?

Free testosterone index: 0.97 (premenopausal female 21-60 years old 0.27-7.64, post menopausal >45 years old <0.17-4.15)

This, for a start. It's very low.

During which phase was your Estradiol done?

Total testosterone: 26 (premenopausal female: 21-60 years old 9-48, post menopausal >45 years old: <7-46)

Presumably you're premenopausal? So, your total testosterone is also low.

SHBG: 93 (premenopausal female 21-60 years old: 11- >180

Don't understand the range, there. You can't have a range of 11 to more than 180, that doesn't make sense. Why not just say 'more than 11', if that's the case.

I am premenopausal yes.

Maybe I wrote down greater than rather than less than .

Still wouldn't make sense for a range.

The first day of my last period was 11/12/21, so I guess during follicular phase?

radd profile image
radd in reply to Meanbeannyc

Mb,

Post LH & FSH.

If your cycles are still regular what day was the test done on?

Meanbeannyc profile image
Meanbeannyc in reply to radd

LH: 7.4

Follicular: 1.9-12.8

Mid cycle peak: 22.8-76.1

Luteal: 0.6- 13.5

FSH: 2.8

Follicular: 2.3-12.6

Mid cycle peak: 5.2-17.5

Luteal: 1.7-9.5

First day of my last period was 11/12/2021.

My periods are always 28-30 days apart.

Cortisol now 11.4 (5.3-22.5)

Cortisol last month: 20.3

What time of day were those tests done? Saliva or blood?

Blood. Afternoon.

And that range is specific to afternoon cortisol? Although, frankly, just taking one reading in the afternoon doesn't tell us very much!

So, was it saliva or blood?

Blood. Afternoon.

Previous reading was 20.

Useless.

Why?

Because for one thing, blood tests are not reliable, and if you have to do them they should be between 8 and 9 am. Secondly, it's not the afternoon the most important. You want to know what your cortisol is like between 8 and 9 am, then see how it pans out through the day, and the next most important reading is in the evening.

As I've said to you many times, what you need is a 24 hour saliva cortisol test, with DHEA.

I had dhea blood done. 127 (35-430)

SlowDragon profile image
SlowDragonAdministrator in reply to Meanbeannyc

You really need a saliva Cortisol and DHEA diurnal test

Like this one

regeneruslabs.com/products/...

cdn.shopify.com/s/files/1/0...

You’re in USA?

Found this one

Might be others

zrtlab.com/test-specialties...

I did saliva cortisol a while back. Didn’t show anything exciting. If I recall correctly

Well, that's pretty low, I think. SeasideSusie?

SeasideSusie profile image
SeasideSusieAdministrator in reply to greygoose

I don't know anything about blood adrenal tests I'm afraid, it looks low but I have no idea what is an optimal level.

Meanbeannyc You have to recognise that T3 is the active thyroid hormone and FT3 the most important reading.

Every cell in your body needs to be saturated with T3 and the cells need a constant and adequate supply

T4 is the storage hormone that ( all being well) converts to T3

Your FT4 is already close to top of ref range and it's still not enough to produce a decent level of T3

So T4 is the problem and ìt has to be reduced and replaced with T3

Your T4 to T3 conversion is poor so T4 is producing very little essential T3

As a result your FT3 is low

So T4 is not helping much but it did, by conversion, provide a trickle of T3...

But totally inadequate T3.

When you reduced your T4 previously that in turn reduced the already abysmally low T3 in the nuclei of your body's cells

Result - you felt AWFUL!

But if we start reducing T4 while introducing more T3 this will gradually raise your T3 level and you will slowly improve.

At this stage we can't tell how much T3 you need but I guess it could be in the region of 20 - 30mcg. You have to carefully experiment with the dose

It's not quantity that's important but quality!

At the moment T4 is the quantity ( too much) but T3 is the quality ( too little)

It will take quite a long time to resolve this but it will resolve as I found out!

Also vital to optimise those nutrients!

After 20 years on T4, I was barely able to function, doctors had no idea what to do but by great fortune I found the cause and the solution with support from experienced and knowlegeable members here

Some of us need T3-only ( myself included on 87.5mcg) though that is the very last resort....and rare.

Sorry, this a ramble but I hope it helps explain why you need to lower your T4 dose even if you still don’t feel well.....and add more T3

It's worth trying 100mcg T4 with 10mcg T3 it won't immediately make a difference but patience and determination will get you there.

Never venture, never win!

I’m scared to reduce anything especially because it’s getting cold out.

You would not be reducing your hormone intake as I, and others, explained above.

You said below, " I am deteriorating and don’t know what to do".

We have offered our experiences.... and a way forward.

I know how hard it is, it took me nearly 3 years, and some very dark days, to find the answers that had evaded me for decades

Be strong!!

We're all here for you.

Thanks for the support @dippydame those words mean a lot, and people don’t truly understand how awful you can really feel. And how easily the hormone replacement can change based on weather and exercise, absorption, etc.

I honestly feel okay on 112 if I’m in the hot weather and not active. It’s when I become really active (work days, exercise) or when I go into a very cold environment (AC, or supermarket) is when I feel very bad. I honestly feel like I’m on just enough thyroid hormone to keep me alive if that makes sense. If I stay completely still in a hot room, I feel OKAY. lol. If tsh does make you feel something, and most people feel better <1, I think I just don’t have a large enough buffer at the moment. Or I’m just close enough on my T3 to keep me alive

My FT3 was much lower on lower doses of T4. So it is increasing somewhat

One time I was on 15 T3 and that was too much Bc I raged out and had sob on exertion.

Looking at some of your previous posts you have also been advised for some time to increase T3... Increase must be low and slow.

It can take a very long time to settle into your body and changes in mood can happen along the way....I've been there!

You have also been advised to optimise your nutrients....and why.

Until you get all your ducks in a row ( get organised, with all the preparation correct) you will continue to struggle to swim smoothly!!

You seem determined to fall at the first hurdles. There is no magic solution....just a steep learning curve with patience and determination needed to beat this awful disease, and a recognition that the journey will be long and bumpy.

You need to change your mind set and think positively instead of continually pouring out negative thoughts....I understand that can be a challenge, I've been in some very dark places along the way. Like others here I've had to overcome that too, but if you want to feel better you have to work dammed hard at it.

Had I not carefully followed advice from the highly knowledgeable and experienced members here, and made mistakes along the way, and read extensively to educate myself about thyroid disease then I would still be struggling to function (or worse) because of low cellular T3.

Sorry if this sounds uncomfortable but sometimes a good dose of harsh reality is needed to push us forward out of our uncertainty.

I've probably said far more than enough so I'll leave you to digest what we've all been saying and hope you find your way forward using the advice you have to hand.

Then come back and let us know how the journey is progressing.

Good luck

DDx

Thanks dippy dame. Will take everything into consideration.

Meanbeannyc,

Ouch, no wonder meds aren’t working well with over range RT3! I have just replied to another post about testing RT3.

As RT3 is the result of an overactive enzyme that causes hypo symptoms, the advantage of testing RT3 when TFT's are adequate is it plainly gives reason for meds not working (although not what that reason is), so encourages considerations of other causations other than the med or dose itself. Make sense?

It is also reminds us that in cases of an adequate thyroid hormone dose increasing thyroid hormone levels risks raising RT3 levels further until the cause of enzyme overactivity is addressed.

Causes of RT3 are numerous and multifactorial but a common cause on this forum is inadequate iron levels in combo with thyroid meds. Your iron & ferritin levels are still too low.

Meanbeannyc profile image
Meanbeannyc in reply to radd

greygoose says to not worry about rT3

radd profile image
radd in reply to Meanbeannyc

Mb,

That's because RT3 isn't the direct cause but it is indicative of why your meds aren't working. It is the result of the cause but as influenced by so many factors it is difficult to interpret so left alone, not worried about.

However, when an adequate dose continually fails to alleviate any symptoms we need to look outside of the box, stop making dose adjustments that haven't relieved you of your symptoms one jot.

In fact you sound as if you are deteriorating and if you are that is because it becomes a vicious circle as pain (inflammation) will encourage further RT3 just as elevated RT3 can encourage pain.

Anyway, this is irrelevant in the sense that if low iron is responsible for RT3 happening, then getting it higher will eventually reduce RT3 levels and that would be your aim.

Meanbeannyc profile image
Meanbeannyc in reply to radd

I am deteriorating and don’t know what to do

Meanbeannyc profile image
Meanbeannyc in reply to radd

What’s an “adequate dose”. I know people who are on 200mcg + Synthroid

radd profile image
radd in reply to Meanbeannyc

One that makes us well ... our very own sweet spot. And who knows what that dose might be until meds working effectively allow us to find it 😊.

Mb, you posted an elevated RT3 result so I responded because in spite of numerous dose changes, you remain symptomatic and yet appear to still be using dose changes as your main strategy for alleviating symptoms.

Your elevated RT3 suggests more complexity and other strategies may be required such as efforts to raise iron. This is simplifying as elevated RT3 is never down to just one causation, and other common reasons on this forum are elevated cortisol and autoimmune issues.

I remember you had a thyroidectomy but can’t remember if it was due to cancer or Graves. People with Graves commonly have elevated RT3 because of elevated levels of thyroid hormone, and then further RT3 caused by inflammation from the autoimmune issues. SlowDragon has asked if you are strictly gluten free? I have previously asked you about nutrients, adrenals, sex hormones, etc. Sometimes everything needs to be absolutely optimal, including a clean diet & healthy lifestyle for meds to work effectively.

I used to detest the cold too as it made me hurt so bad and really sympathise. Given your obvious apprehension to impending cold weather, I agree with the others above to increase T3 levels but then hold it whilst you look for ways of making meds work better.

Meanbeannyc profile image
Meanbeannyc in reply to radd

What do u mean making meds work better. Thyroidectomy due to Graves’ disease. I literally cannot enter a supermarket without stopping breathing because it’s too cold in there

SlowDragon profile image
SlowDragonAdministrator in reply to Meanbeannyc

Yes you have Graves’ disease …..so many, many people with Graves’ disease (or Hashimoto’s) find enormous benefit on absolutely strictly gluten free diet

Changing to a strictly gluten free diet may help reduce symptoms, it’s ALWAYS worth trying

Before considering trial on gluten free diet get coeliac blood test done FIRST just to rule it 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.

chriskresser.com/the-gluten...

amymyersmd.com/2018/04/3-re...

Vitamin levels

Taking levothyroxine (and T3) we MUST have optimal vitamin levels

Obviously your vitamin levels are not at good levels

What vitamin supplements are you currently taking?

Tested negative for Celiac.

Never tested H pylori.

Vit D3/K2 only.

SlowDragon profile image
SlowDragonAdministrator in reply to Meanbeannyc

Vast majority of Hashimoto’s and Graves patients are NOT coeliac, but gluten intolerant due to leaky gut

changing to strictly gluten free diet can significantly reduce symptoms……it’s ALWAYS worth trying strictly gluten free diet for 3-6 months…..if it helps (as it frequently does) remain gluten free

SlowDragon profile image
SlowDragonAdministrator in reply to Meanbeannyc

How much vitamin D are you currently taking When did you start supplementing

Aiming for vitamin D at least around 40ng/ml (100nmol in U.K. units)

Might benefit from daily vitamin B complex

supplementing a good quality daily vitamin B complex, one with folate in (not folic acid) may be beneficial. This can help keep all B vitamins in balance and will help improve B12 levels too

Difference between folate and folic acid

chriskresser.com/folate-vs-...

B vitamins best taken after breakfast

Thorne Basic B or Jarrow B Right are recommended options that contains folate, but both are large capsules. (You can tip powder out if can’t swallow capsule)

IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

Meanbeannyc profile image
Meanbeannyc in reply to radd

Isn’t dosage changes the way to relieve symptoms?

radd profile image
radd in reply to Meanbeannyc

Mb,

Yes, it’s usually the first strategy to try alleviating symptoms, together whilst addressing nutrient/iron deficiencies. Have you raised that low T3 yet, because that will help supply an inner warmth? 🤗

+++++++++++++++++++++++++++++++++++++++++++++++++++

Re follicular stage for sex hormones above, estradiol looks high for day 1 of your cycle as is over-range . Elevated oestrogen is usual as progesterone levels start to drop but may encourage more TBG that binds too much thyroid hormone, leaving you symptomatic. (Peri)menopause & hypo symptoms may mimic/magnify each other. However, FSH remains low as opposed to raising that indicates perimenopause. Graves/Hashi often makes our sex hormones volatile.

SHBG is influenced by thyroid hormone levels and therefore commonly low in hypos. Testosterone is also low which is common in hypos as influenced by SHBG and yours is under half way through range. Testosterone starts reducing with age anyway.

This sounds complicated but isn’t that bad. You may need to get progesterone tested & retest oestrogen to evidence level of dominance. If it remained so you could try a liver support to improve clearance, and/or maybe a progesterone transdermal cream to balance levels, etc. The aim is not always focussed to optimise/minimise levels but to balance opposing hormones.

+++++++++++++++++++++++++++++++++++++++++++++++++++++

Iron: 97 (40-150)

TIBC: 375 (250-450)

Iron sat: 26 (11-46)

Ferritin: 28 (8-252)

B12: 459 (211-911)

Your serum iron is 50% through range. However, ferritin is 8% and iron sat just 26%. A healthy saturation is usually between 35-45% and indicates you would quickly head towards iron deficiency/anemia should iron supply become interrupted & levels diminish further.

VitB12 is also too low.

++++++++++++++++++++++++++++++++++++++++++++++++++++

Cortisol/DHEA blood results aren’t terribly useful as an isolated snap shot taken at the wrong time of day but at least tell us you have some 😁. May be consider a saliva adrenal stress test that offers hormone levels & circadian patterns over 24 hour period. This would be useful to assess adequate cortisol required for T3 to be utilised as you seem to hypothyroid on a cellular level.

+++++++++++++++++++++++++++++++++++++++++++++++++++++

If these were all my results I would:

1. Make immediate T3 dose adjustment.

2. Supplement iron under supervision as further regular testing will be required to ensure serum iron doesn’t go too high.

3. Supplement methyl form of Vit B12.

4. Supplement Betaine + Pepsin to help gut absorption difficulties .

5. Retest oestrogen in a few weeks and start an oestrogen reducing protocol if required.

6. Seriously consider SlowDragon's great info on the benefits of a gluten-free diet in the presence of autoimmune disease. Maybe even consider dairy free for a while too.

7. As long as T3 levels are adequate leave further dose changes well alone for several months and then reassess.

8. Do not expect quick miraculous change. It’s taken a while to get into this state so requires time to get out.

🤗

Re RT3 - I agree with greygoose , she taught me a lot about thyroid function and you'd do well to listen to her too.

Hey there again :

I too had high reverse T3 which. if you think about it is logical;

First we have a diagnosis of Graves = High T3 and HighT4 with the high T4 attempting to be processed out of the body through the reverse T3 mechanism :

We are then processed through the system with either a thyroidectomy or RAI thyroid ablation and for all intent and purpose " turned off " and dosed on T4 only which will not effectively convert to T3 for us as we have lost our own T3 supply that kick starts the metabolism and conversion process.

So T4 builds up again and we end up blocked again with an over range T4 and an over range reverse T3 reading as we can't kick start our own conversion as we haven't any natural T3 in our bodies.

As I've said to you before I take NDT and my dose equates to 13.50 mcg T3 + 57 mcg T4 :

My reverse T3 will have reduced way down from where it was when taking 125 mcg T4 and not converting it to T3 and very unwell.

You can live without T4 but you can't live without T3 :

Please look at dropping your T4 - it's not helping you - and slowly adding in some T3 ;

Or try NDT - I switched from 125 mcg T4 over night to 1/2 grain NDT and haven't looked back :

No thyroid hormone replacement works well until you have optimal ferritin, folate, B12 and vitamin D ;

I’m scared to reduce dose because the weather is getting cold. I was just gonna add more T3 to this dose or something idk

But the T4 isn't working and isn't converting to T3 and so of no use being this high in your body :

T4 doesn't keep you warm - T3 does and that's what you need to concentrate on building up not T4 which is inert and of little value if you can't convert it which is what is happening.

As said previously your ferritin needs to be over 70 for any thyroid hormone to be effective and I think this low ferritin is causing it's own set of symptoms within everything else that is going on.

Like what?

What do you mean ?

Symptoms of low ferritin for me were shakiness anxiousness, unable to stand long enough to boil an egg and unable to walk far, giddy standing for any length of time, feeling faint when standing and very breathless on mild exertion.

I don’t have any of that. I just feel undermedicated. Sleepy and cold and tired and swollen. Carpal tunnel and muscle pain.

What was ferritin like? Was that when you were on T4 only or T4 and T3 combo?

100 mcg T4 only - my ferritin came in at 22 in a range of around 15 -300 I think :

It was highlighted at hospital when I was being investigated for Sjogren's Syndrome as I had no saliva and in continual pain : results for SS negative though surgeon who did the mouth biopsy said that it wasn't SS but that she had never seen a case like mine and confused :

Details on profile - referred to as a conundrum by doctor - housebound I purchased Elaine Moore's first book and read of my symptoms experienced by people who had had RAI :

So started my journey back to better health - first off focused on building up my vitamins and minerals and started taking adrenal glandular.

As well as reading Graves Disease A Practical Guide by Elaine Moore I purchased doctor Barry Durrant-Peatfield's book - Your Thyroid and How To Keep It Healthy as though mine was burnt with RAI i needed to learn how the body works and how everything relates to everything else.

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