New blood test results – need advice

[Zazbag]

Hello everyone,

I am 35 years old, female with Hashimoto's. I take 150mcg levothyroxine and 25mcg liothyronine. I follow a strictly gluten, dairy and egg free diet and mostly avoid soy except for lecithins and tamari sauce if I have sushi. I take my levo before bed, 2 hours after food. I take my first dose of T3 when I wake up, 30 mins before food and a second dose around 3–5pm but sometimes later depending on when I have eaten (but I always take it 2 hours after food and 30 mins before food).

I had my first blood test in a year last week and my T4 and T3 are both significantly lower than a year ago.

Latest T4: 45.4% through range

One year ago T4 was: 83% through range

Latest T3: 54% through range

One year ago T3 was: 114% through range

In fact, my T3 is back at the level it was when I was on levothyroxine only and feeling really bad. I felt my best when my T3 was at the top of the range or even a bit over range. I've been having thyroid symptoms for the past 4 or 5 months so I'm not that surprised. I've gained about 6–7kg (was 66kg a year ago, now 72–73kg), I'm constantly hungry and overeating, depressed (to the point of suicidal ideation some days), anxious, night sweats, struggling to recover from exercise, irritable, moody, angry, unable to cope with stress and generally just feeling not great.

I have all the supplements I am supposed to take but I don't take them consistently anymore however more recently I have been taking them more often. I take them away from my thyroid meds as I know that can affect absorption.

B vitamin complex (Thorne Basic B)

Ferrous fumarate (I take 410 mg when I remember to take it)

Vitamin D3 + K2 liquid

Magnesium bisglycinate

Selenium

Zinc picolinate

Omega 3 fish oil

My last dose of B complex was Monday and I had my blood test on Friday so I don't know if this had an effect, I know biotin supplements should be stopped 7 days before but unfortunately wasn't able to stick to this on this occasion. My blood test was at 9am, fasted. I skipped my dose of levothyroxine the night before, and took it after my blood test, so my last dose before the test was two nights before. I took my second dose of liothyronine about 12 hours before my blood test. These are the timings I follow for every blood test so they are a consistent comparison to each other.

Here are my latest results:

Serum TSH: <0.01

Serum T4: 15.9 (10.0–23.0)

Serum T3: 5.1 (3.10–6.80)

Serum folate: 7.6 (3.10–20.50)

Serum ferritin: 74 (22–275)

Serum B12: 309 (187.00–883.0)

Serum vitamin D: 93

RBC: 4.28x10^12 (3.95–5.1510)

MCV: 91.0 (80–100)

A year ago (when I felt well and weighed 66kg) they were:

Serum TSH: 0.02 (0.27–4.2)

Serum T4: 18.3 (12.0–22.0) (different range)

Serum T3: 7.3 (3.10–6.80)

Serum folate: 8.54 (2.5–19.50) (different range)

Serum ferritin: 48.0

Serum B12: 396.7 (180.0–900.0) (different range)

Serum vitamin D: 159

RBC: 3.87x10^12 (3.80–5.30) (different range)

MCV: 93.0 (83–100) (different range)

I'm currently abroad with an abundant supply of liothyronine 50mcg tabs and levothyroxine in 100mcg and 50mcg. I won't be returning to the UK for at least one month so this is what I have to work with. What should I increase my doses of each by? I'm thinking of adding a third dose of liothyronine before bed of 12.5mcg so I'm taking a total of 37.5mcg and 25mcg of levothyroxine so I'm taking 175mcg. Would appreciate advice on this. Thank you so much!

[SlowDragon Administrator]

We generally say only increase levothyroxine or T3…..not both at once

Your Ft4 is actually higher than the result shows as last dose was 36 hours before test

Perhaps have room to add 1/4 tablet of T3 (6.25mcg )

Ferritin is improving

Next time, in week before test when you stop vitamin B complex, perhaps consider taking a separate folate and separate B12 ….then these will be higher in test results

[Zazbag in reply to SlowDragon]

Thanks so much for the quick reply. I'm thinking I should increase T3 first then, would you agree that's sensible? And to implement it with 12.5mcg as a third dose before bed?

[SlowDragon Administrator in reply to Zazbag]

I would only increase by 1/4 tablet initially and then retest….

[Zazbag in reply to SlowDragon]

Okay great, 1/4 of the tablets I have is 12.5mcg so that's doable. I'm also wondering about the timing though, I've only taken my liothyronine split into two doses. I'm thinking of adding a third dose because I can't split the 1/4 tab into 1/8 and divide it equally into two doses. But I could just take 12.5mcg and 25mcg instead. Not sure what's best.

[SlowDragon Administrator in reply to Zazbag]

Sorry…I was thinking you had 25mcg tablets…I meant 6.25mcg

you had said they were 50mcg tablets

So you can’t really increase by less than 12.5mcg unless you had some 25mcg tablets

Can you get 25mcg tablets?

[Zazbag in reply to SlowDragon]

Oh, no I only have 50mcg tabs right now

[Zazbag in reply to SlowDragon]

I used to take separate B12 and folate, will get both again.

[SlowDragon Administrator in reply to Zazbag]

Just for the week you have to stop vitamin B complex