Brief intro - am ‘induced’ hypo (2 radioactive iodine tests) to break down nodules. Been on thyroxine for 20+ years (fluctuate between 75mcg/100mcg daily) - currently Levo.
Moved to Spain a few years ago but been complacent with tests (self medicating at 100mcg). Have been feeling a bit ‘edgy/anxious’ about silly things and not sleeping well so recently tested.
Two results - 100mcg then reduced to 75mcg.
Oct 2021 results: @100mcg/daily
TSH: 0.0083 (0.3 - 4.2)
T4: 7.5 (5.5 -11)
T3: 0.8 (0.7-2)
Ferritine Low: 10 (11 - 307)
Dec 2021 results: @75mcg/daily
TSH: 0.34 (0.3 - 4.2)
T4L: 0.88 (0.7 - 1.48)
T3L 2.40 (2.1 - 4.4)
New doc would like to reduce to 50mcg daily but am hesitant as have never been that Low on Levo.
Any advise would be highly appreciated - thanks!
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Mikico
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Yes - am taking 75mcg/ daily but it’s true that am not so consistent at times. Great idea - will also get a weekly pill dispenser.
Have been doing some research on Armour Thyroid as I think the addition of T3 would help me. However, not sure if I can get it in Spain. Will be asking my Endocrynologist.
Hello SlowDragon - have been re-reading your response intricately to let it all go in.
It is all starting to make sense to me - especially the T4 to T3 conversion. Am currently working on increasing my ferritin but unfortunately my other iron levels are in good/high range - so have just ordered Ferritin specific iron supplements in order to avoid ‘over’ medicating my iron levels.
However, you indicated that in my December results - am even more under medicated. What do you mean by that? Am only concerned that by increasing it to 100mcg/daily again, that my TSH will drop drastically. Do you think I should look into adding T3? Am currently looking for a new Endo but really appreciate/trust this forum more than any endo at the moment.
Increase levothyroxine dose so that Ft4 is at least 50-60% through range ….always test as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test
TSH is frequently low when adequately treated…..as long as Ft3 is not over range, and you feel well, you’re not over medicated
You will see many members have TSH below range when adequately treated
At moment you’re vitamin levels are too poor and Ft4 is too low ….to consider adding T3 yet
Taking almost any dose of T3 or NDT will suppress TSH….typically 0.01-0.03
Just for reference since you have had RAI thyroid ablation :
RAI induced primary hypothyroidism is more difficult to treat :
RAI is known to trash vitamins and minerals :
RAI is a slow burn, and it takes it's time, burning out your thyroid function in situ :
RAI is known to be taken up, to a lesser degree, by other glands and organs within the body :
If you want to know more I'd suggest you dip into the Elaine Moore Graves Disease Foundation website as Elaine went through RAI thyroid ablation and finding no help with her continued ill health started researching everything thyroid related and now has several published books and a world following through her website which is Stateside.
T4 - Levothyroxine is a storage hormone and needs to be converted by your body into T3 the active hormone that runs the body :
Conversion of T4 into T3 can be compromised by low vitamins and minerals especially those of ferritin, folate, B12 and vitamin D - and read in most papers that ferritin needs to be at least over 70 for T4 thyroid hormone replacement to work.
A fully functioning working thyroid would be supporting you on a daily basis with trace elements of T1. T2. and calcitonin plus a measure of T3 at around 10 mcg plus a measure of T4 at around 100 mcg.
T3 is said to be around 4 times more powerful than T4 and the active hormone that runs the body with the average person needing to find and convert around 50 T3 daily just to function.
Some people can get by on T4 only :
Some people find they need to add a little T3 to their T4 and make a T3/T4 combo at some point in time :
Some people can't tolerate T4 and take T3 - Liothyronine - only :
Some people feel at their best on Natural Desiccated Thyroid which contains all the same known hormones as that of the human thyroid gland and made from pig thyroid, dried and ground down into tablets and referred to as grains.
Whatever thyroid hormone replacement you choose to take you do need to work on getting your core strength strong and solid as no thyroid hormone replacement works well until your ferritin, folate, B12 and vitamin D are all maintained at optimal levels.
Hi - thanks for your feedback. It is very in depth and I will definitely look into the Elaine Moore books. Am so happy to have found such a helpful forum with great insight!! 👍
Ok then - personally I found her book - the first one - Graves Disease - A Practical Guide - too medical to comprehend but then, she wasn't writing for joe public as she is by trade a medical technologist in the States.
Her website which evolved later is much easier to comprehend and you'll just need to be selective on what you read - as you haven't Graves - but you have had RAI and you have now, likely no thyroid production of your own.
Thyroid UK - the charity who support this forum has a list of reading materials you might like to consider :
My goto book now is Your Thyroid and How To Keep It Healthy written by a doctor who has hypothyroidism Barry Durrant-Peatfield.
The title of his book may sound counterintuitive as we haven't our thyroids but we do need to know all that this tiny but oh so important major gland is meant to do so we can try and compensate accordingly.
Research into the long term consequences of RAI is hard to find but this was published as few years ago in the Thyroid UK newsletter :
Would you be able to recommend any NDT Brand’s? Am keen to try it out as believe am a poor converter. However, when I Google Armour Thyroid or other NDT Brand’s - I keep finding that they are discontinued.
Not sure - apparently he wants my TSH level to be around 2.8/2.9 (range 0.3 -4.2). However, I have been sceptical and therefore have not reduced my thyroxine yet. Am going to try get my vitamin levels to optimal range first. Then retest T3 and T4 👍
" NHS consultant endocrinologists may start a trial of combination levothyroxine and liothyronine in circumstances where all other treatment options have been exhausted.
1. Where symptoms of hypothyroidism persist despite optimal dosage with levothyroxine.
(TSH 0.4-1.5mU/L)
2. Where alternative causes of symptoms have been excluded, see box 1 below"
This one ..... from PULSE magazine for GP's... The article is available from ThyroidUK
If you want a copy of the article then email tukadmin@thyroidUK.org
and ask for a copy of the Dr Toft article in Pulse magazine. The quote is in answer to question 6.
Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine:
"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.
In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l.
Most patients will feel well in that circumstance.
But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.
This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."
"Replacement therapy with levothyroxine should be initiated in all patients to achieve a TSH level of 0.5-2.0pmol/L." Written for GP's by "Dr Iqbal is a specialist registrar in endocrinology and Dr Krishnan is a specialist registrar in cardiology, Liverpool".
* NOTE this one also clearly states that raised cholesterol is caused by hypothyroidism *
"The goal of treatment is to make the patient feel better and this tends to correspond with a TSH in the lower half of the reference range (0.4–2.5 mU/l).
If a patient feels perfectly well with TSH between 2.5 and 5 mU/l there is no need to adjust the dosage" .
"Given the complexity of pathways that govern TH action at tissue and cellular levels, it is not surprising that some patients receiving exogenous thyroid hormone replacement therapy report on-going symptoms despite optimal thyroid function tests (e.g. normal T4 and T3 with TSH <2 mU/L in primary hypothyroidism).
“According to the current TSH reference interval, hypothyroidism was not diagnosed in about 50% of the cases in the afternoon.”
“Further analysis demonstrated inadequate compensation of hypothyroidism, which was defined in 45.5% of the morning samples and in 9% of the afternoon samples”
TSH levels showed a statistically significant decline postprandially in comparison to fasting values. This may have clinical implications in the diagnosis and management of hypothyroidism, especially SCH.
You’re terrible vitamin levels directly linked to being on too low a dose levothyroxine …..and/or poor conversion of Ft4 to Ft3
Guidelines on dose levothyroxine by weight is approx 1.6mcg per kilo of your weight per day
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