Bloods and reduced T3

[AleB]

Hi all

Since my last post, I had felt overcooked on T3. Endo suggested reduction of T3 from 2.5mcg along with T4 87.5mcg levo in the morning and 2.5mcg reduction in the afternoon. I decided to hold the T4 at 87.5mcg, and whilst the T3 reduction stopped the adrenals from throbbing and the hip from burning, I am going through an almighty crash. I have been bed bound for 2 weeks, last 2 days waking up at 4am again, oddly the last 2 days not sleeping in the day but complete zombie by 6pm!

I noticed that my ferritin and folate and vit d has dropped quite considerably from my bloods of the 13th December 2021. I took a basic thyroid panel test on the 7th Jan 2021 which looked ok on paper, but literally days later I was feeling very overcooked!

Bloods on 87.5mcg levo (from 20/01/2022) and reduced T3 of 2.5mcg per day (from 29/01/2022), as follows:

CRP <0.3 mg/L (Range 0 -5)

Ferritin 65.90 ug/L (Range 13 - 150)

Folate 16.02 ug/L (Range >3.89)

B12 Active >150 (Range 37.5 - 188)

Vitamin D 95.90 nmol/L

TSH 5.14 (Range 0.27 - 4.2)

Free T3 3.40pmol/L (Range 3.1 -6.8)

Free T4 15.700 pmol/L (Range 12 - 22)

TgA 11.00 IU/mL (Range <115)

TPA 11.10 (Range <34)

I started T3 on 30/10/21 carefully reduced my levo leaving off it for approx 1 week, reintroduced the levo back at 100/100/75/75/100/100/75 I felt that with the addition of T3 I was getting alot of highs and lows, so went to 87.5 every day. Kept the T3 at 2.5mcg liothy am along with levo dose of 87.5mcg and 2.5mcg liothy at 2pm. This was from 20/01/22 and as I mentioned the T4 has not changed, just the T3 reduced. I am barely functioning, cold, especially hands and feet, really dry skin, dizzy, muscle aches not sleeping well, low mood. Endo hasn't seen this blood test of 8th Feb 2022, he said to reduce levo to 75mcg at 2.5mcg lio and 1.25 lio at 2pm. Only last time an endo suggested to go down to 75 and add T3 I really suffered, FT4 14.7, TSH 12.6 and FT3 3.76 (ranges as above - all medichecks). My question is, should I go for the endo's suggestion and also I know I need to get back on the iron and B-complex again. My only bug bear is the endo wants blood results on the 3 times that I have seen him, this I feel is too soon between dose changes. When I was taking just levo and had to reduce (4 years ago), I rode it out for 12 weeks. Ever since trying to add T3 I seem to be doing this less than every 6 weeks. It's costing me a fortune that I can't afford in blood tests/T3 and endo appointments. I know I need T3, no two way's about it! I seem to have tried to add the T3 to a larger T4 amount, without much success, maybe trying a reduced T4 to T3 is the way to go!? Any thoughts would be really appreciated.

[Lalatoot]

AleB You are undermedicated and need an increase in lio first. Your ft3 is too low in range.It has taken me 2 years of fine adjustments of lio and levo to get to doses and results that I am happy to be at to see the longer term effects.

You should only change lio or levo - one thing at a time - and then wait 8 weeks and do bloods. Each change you make should be small, 12.5mcg for levo and 2.5mcg for lio I would suggest. Though with your FT3 result you could add another 5mcg.

I would not reduce your levo as your ft4 result is nowhere near the top of the range.

Some folks take the doses in one go; others split them throughout the day. That is something you find out again by trial and error.

The symptoms of over medication and under medication are the same. They are not as clear cut as the lists you read online for hyper and hypo. I know this from experience as I was hyper, had RAI treatment and am now hypo.

[AleB in reply to Lalatoot]

Thanks Lalatoot, I was doing OK until I felt overcooked mid January. Maybe I could try 2.5 alongside 87.5mcg levo and 1.25mcg at 2pm... see how I go. I know when I add T4 it does increase FT4 and lower TSH, however barely moves the FT3 level. If I were to increase T4, would that be 12.5 per day or a couple of times per week?

[Lalatoot in reply to AleB]

The amount would be up to you as you know your body . For me it would be daily

[AleB in reply to Lalatoot]

Thanks Lalatoot, and thanks for your posts. It really is a juggling act! Will up the T4 and keep T3 as is for now and retest in 8 weeks!

[Lotika]

I did some research once upon a time - forgive me, I forget my sources - and learned that it takes 6 weeks for fT4 to stabilise and 8 weeks for TSH. With that in mind, depending on your view of the importance of TSH, 6 weeks would be fine… or if you needed an accurate TSH, 8. My endo thought it took 3 weeks for fT3 to stabilise on lio. I am less certain about that, as given time it will impact fT4…

[AleB in reply to Lotika]

Maybe I need to increase levo and keep lio as is?

[Lotika]

Agree that you look worefully under medicated. I feel unwell looking at your results, so I can only imagine how awful you feel ☹️🙁

[AleB in reply to Lotika]

I feel undermedicated, all over the place and my head is really confused. Thanks for your posts.

[Lotika]

I hesitate to advise, but as you reduced the lio for feeling overcooked, it seems like the more obvious option?