Help with blood test results - Is there room to increase T4? - On Levothyroxine only

[BreifneKing]

Hi all, hoping someone can offer some advice on whether I have room to increase my T4 dose - currently taking 237.5mcg - given that my FT3 level is not over range.

Also, is a 12.5mcg increase in T4 likely to make much difference to my FT3 level seeing as it only increased by 0.2 despite an increase of 25mcg (from November 2021 to March 2022 and actually decreased in January 2022)?

And if this is due to a down regulation of deiodinase enzymes how do I increase FT3 without taking T3?

My last four blood test results are as follows:

September 2021 - 200mcg Levothyroxine:

TSH - <0.01 (0.27 - 4.20)

FT4 - 14.10 (9.00 - 19.00) 51% of range

FT3 - 4.60 (2.4 - 6.0) 61.11% of range

November 2021 - 212.5mcg Levothyroxine:

TSH - <0.01 (0.27 - 4.20)

FT4 - 16.00 (9.00 - 19.00) 70% of range

FT3 - 5.00 (2.4 - 6.0) 72.22% of range

January 2022 - 225mcg Levothyroxine:

TSH - <0.01 (0.27 - 4.20)

FT4 - 17.10 (9.00 - 19.00) 81% of range

FT3 - 4.90 (2.4 - 6.0) 69.44% of range

March 2022 - 237.5mcg Levothyroxine:

TSH - <0.01 (0.27 - 4.20)

FT4 - 19.00 (9.00 - 19.00) 100% of range

FT3 - 5.20 (2.4 - 6.0) 77.78% of range

[pennyannie]

Hello BreifneKing :

There are some people who need their T4 slightly over range in order to get a good level of T3 that resolves symptoms.

I haven't the link to hand but this has been stated by Professor Toft the eminent, now retired endocrinologist.

However getting the NHS to allow you to experiment, and considering your TSH is suppressed which generally sees the NHS reducing T4 medication I doubt you get supported through the conventional channels.

No thyroid hormone works optimally until your ferritin, folate, B12 and vitamin D are up and maintained at optimal levels - do you have any results and ranges of these core strength vitamins and minerals.

Looking back I see you didn't find NDT a help but you results on a T4/NDT mix looked ok and left room for further adjustments, but guess this didn't work out for you either.

P.S. Just seen you have Hashimoto's and thinking absorption issues, leaky gut as detailed in the research of Dr Izabella Went on Hashimoto's - have you looked at food intolerances such as gluten, dairy, wheat - I know it's a minefield ?

[BreifneKing in reply to pennyannie]

Thanks for your response.My vitamin and mineral levels tend to be pretty consistent, with the exception of ferritin, and are currently as follows:Ferritin - 90 (15 - 275)Folate - 14.9 (3.1 - 20.5)

B12 - 758 (187 - 883)

Vitamin D - 79.5 (> 49.9)

If there was an absorption issue then surely my FT4 level be low?

I don't have an issue with trying a dose increase, if it is likely to increase my FT3 level, so the question is whether it is likely to increase the level sufficiently, or whether there are other factors at work that will prevent it from doing so? This is purely based on the fact that a 12.5mcg increase in T4 resulted in a 0.4 increase in the FT3 level, from September 2021 to November 2021, but an increase of 25mcg (from November 2021 to March 2022 and actually decreased in January 2022) only increased the FT3 level by 0.2.

I suppose, in some ways, the question is whether conversion plateaus, or drops off, at some point? And, if that is the case, how can FT3 levels be continually increased on just Levothyroxine?

[pennyannie in reply to BreifneKing]

Well some people can achieve a 100% through the range T4 on just half the dose you are taking :

Yes. I believe there is a fine balance where increasing T4 further doesn't reflect in a higher T3 :

All you can do is try and see for yourself where your optimum dose is. :

And yes of course, if you want to stay in the ranges as recommended the logical answer is to adjust manually both T3 and T4 thyroid hormones when running T4 heavy :

It's also suggested by jimh111 that we should try and not run with a high T4 which therefore would require the likely addition of T3 - Liothyronine to restore well being.

P.S. They can't !!!

[BreifneKing in reply to pennyannie]

Can ‘streaky gastritis’ be a potential cause for absorption issues?I found a letter to my GP in my medical record that says I have streaky gastritis, although when I actually had the gastroscopy my GP told me there was nothing of any significance in the consultants report.

I also did a ‘burp test' yesterday and did a tiny burp almost 4 minutes later. I assume this means I have low stomach acid but can’t increase it using Betaine (due to the gastritis)?

I’ve been down the T3 and NDT roads before and just felt worse so would be reluctant to go there again.

[pennyannie in reply to BreifneKing]

No idea - sorry I've only ever heard of that term in relation to bacon.

Yes, low stomach acid goes hand in hand with hypothyroidism:

I waited 10 minutes - nothing - did it twice - thought I must have done it wrong !!!

However if you have tried all the options I do wonder what's going on and now think vitamins and minerals - though back up this screen see your ferritin, folate, B12 and vitamin D look ok and presumed maintained at optimal levels ?

Have you ever tried liquid T4 ?

[Hidden]

I don´t think you should worry so much about your dose. After all, it´s just a number. Most important of all: how do you feel???

In Europe, 200 mcg seems to be the highest dose available. However, in the US, there are 300 mcg pills. Which means some people need that.

Ever since I was diagnosed with Hashimoto´s over 20 years ago, I have been told by various doctors - and thyroid forums, not this one - that "you should not take more than X mcg daily". Which is of course impossible to tell since we are all different. We need what we need.

Some people need high doses of levo rather than NDT or T3+T4.

I guess there could be some thyroid resistance since you need a high dose of levo but your FTs increase with every dose increase. In that case, you just need more levo. I have read about thyroid hormone resistant people needing up to 10 grains of NDT daily, and some on T3 only take over 100 mcg daily.