Latest bloods - increase T3 or T4?

[AleB]

Hi all

It's been a while since my last post ... currently feeling pretty rubbish again. I wonder if anyone can advise what to increase, I feel I should try a bit of T3 added to the morning dose of 1.25 mcg say to 2.5 mcg lio to levo. Feeling cold, not sleeping well, heart palps, vision disturbance, off balance, breathless. Folate has halved since the 21st April bloods, yet my b-complex x 4 per week (Thorne basic b) remains unchanged. Should I increase to x 7 days per week to increase folate level? Antibodies have doubled since the last blood test - is that because I am undermedicated? Trouble is when I add extra T3 my heart rate goes to 90, currently around 77.

Bloods 20th June:

5 x days at 87.5 mcg levothyroxine and 1.25mcg liothyronine x 2 per day

2 x days at 100 mcg levothyroxine and 1.25 mcg liothyronine x 2 per day

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

Ferritin 106.0 ug/L (Range 13 - 150)

Folate - Serum 11.26 ug/L (Range > 3.89)

Vitamin B12 - Active >150 pmol/L (Range 37.5 - 150)

Vitamin D 99 nmol/L >75 - 200 (optimal range)

TSH 3.76 mU/L (Range 0.27 - 4.2)

FT3 3.51 pmol/L (Range 3.1 - 6.8)

FT4 16.9 pmol/L (Range 12 -22)

Thyroglobulin Antibodies 12IU/mL (Range <115)

Thyroid Peroxidase Antibodies 75 IU/mL (Range <34)

Bloods 21st April 2022

87.5 mcg levothyroxine x 6 plus 1.25 mcg liothyronine x 2 per day

100 mcg levothyroxine x 1 plus 1.25 mcg liothyronine x 2 per day

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

Ferritin 105.0 ug/L (Range > 3.89)

Vitamin B12 Active >150 pmol/L (Range 37.5 - 150)

Vitamin D 106 nmol/L (optimal range 75 - 200)

TSH 2.93 mU/L (Range 0.27 - 4.2)

FT3 3.63 pmol/L (Range 3.1 - 6.8)

FT4 14.8 pmoll/L (Range 12 -22)

TgA 12 IU/mL (Range <115)

TPA 32 IU/mL (Range <34)

Both tests were fasting, last thyroid meds taken 10pm night before tests done at 8.35am and 8.37am respectively.

Iron and B-Complex not taken for approximately 9 days prior to these tests.

I have Hashi's and am also a poor converter!

I really would appreciate some advice.

Thank you. x

[SlowDragon Administrator]

Your only taking a tiny dose of T3

Is your T3 prescribed by endocrinologist

Could they offer beta blocker to steady heart?

Suggest you increase to 5mcg T3 waking

Hold at that dose for 2-4 weeks…..then try increase afternoon dose T3 to 5mcg

Retest 6-8 weeks later

Alternatively….can you add a third dose 1.25mcg T3 - taking every 8 hours

And possibly a fourth dose

[AleB in reply to SlowDragon]

Hi Slow Dragon

Thanks for your response, I do get the T3 from an Endo. I am slightly cautious to add in 5mcg, initially when I started this back in October 2021, I reduced the levo by 25mcg per day from 110 to 85 mcg levo and added in 2.5mcg lio and a further 2.5mcg lio 2 weeks later, held for 8 weeks. Unfortunately in January 2022 I had increased sweating, high heart rate and shaking. I'll try to add a further 1.25mcg at 10pm, if it keeps me awake I'll add it to the morning dose. I really don't want to start with Beta Blockers if I can help it.

[SlowDragon Administrator in reply to AleB]

Unfortunately in January 2022 I had increased sweating, high heart rate and shaking.

That doesn’t necessarily mean over medicated….it could be due to being under medicated

Suggest you try increasing morning dose T3 initially.

[AleB in reply to SlowDragon]

I was doing great on the T3, actually it was early February that I was sweating and shaking as I remember walking to the dentist absolutely blathered, yet it was a freezing cold frosty morning. I recall my heart pounding so loudly and my legs were too fast for my body!! It's another option of trying a bit extra T3 in the morning, I may have change the T4 and split this too as I think it may be too much alongside the increased T3.

[greygoose]

Antibodies have doubled since the last blood test - is that because I am undermedicated?

Nope. Antibody levels have nothing to do with your dose. Antibodies fluctuate all the time, but tend to be highest just after an immune system attack on the thyroid.

[AleB in reply to greygoose]

Hello GreyGooseThank you for your response. Maybe just a Hashi flare, will monitor until things settle somewhat!

🙂

[greygoose in reply to AleB]

Not with those results, no. TSH would be 0.000. You are under-medicated.

[AleB in reply to greygoose]

Thank you, I will try and increase the T3 adding a small amount to the morning dose. Will see how that goes before retesting, or if evening is better suited! Thanks again for your help.

[greygoose in reply to AleB]

You're welcome.

[Kandahar]

I have no medical knowledge but I have been very successful at only taking T3 So I hope my comments help. 1 Are you sure that taking any thyroid meds as late as 10pm is a good idea when you have blood taken before 9am? The usual advice is stop levo 24 hours before a test.

2 I finally found that the dose I need of T3 is 72.25mcg, split into three doses a day! That does make my heart rate go up to 100bpm if I’m exercising, but if I reduce it, I start to lose energy and I’m all muzzy. But you’ve got a long way to go and, by standards on here, your tsh is too high.

3 Do you need levo? And is your endo happy for to keep changing your dosing? I think that the recommendation on this site (and from my endo) is to try one dose for at least six weeks and then retest to see how your body is reacting.

4 I’ve found that during those weeks, my body can show a range of different reactions, so you have to stick to it. I know it can be hell, but it’s worth it in the end. However, don’t expect that happy state to stay constant. You may have to start experimenting again because it seems our bodies change.

Sorry! Lynn