Endocrinologist report

[Kowbie]

Hello everyone hope your all keeping well, haven’t been on lately, would like your opinion please, endocrinologist is trying me on liothyronine, I was on 200 thyroxine, he put it down to 150 and started me on liothyronine 5 in the morning and 5 later on, my test before starting were TSH 0.57 (0.27-4.2). T4 17.4(12-22) T3. 4.3 (3.1-6.8). Not feeling too good sleeping a lot of the time missed my phone appointment with endocrinologist yesterday as didn’t wake up , he rang me today, said I was over medicated as tsh had gone to 0.7 ranges same as before, i said I’m not as t4 and t3 were nowhere near the top , T4 15.3 T3 4.5 ranges as before, he said I could have a stroke or heart attack do to it being like it is he then said my colestral was high and mentioned statins, I said I didn’t wan to go on them , in the end he agreed to put liothyronine up to 10 twice a day , but said he was writing to dr to say I might have a stroke or heart attack and if I didn’t feel well to. Drop down again, wanted to ask all of you for your opinions please thankyou kowbie

[Jazzw]

This is the same endocrinologist?? That’s quite a contradiction. Your TSH is actually higher now than it was when you started on T3. And any Endo worth his or her salt would know that TSH is not a great indicator of whether you’re on the right dosage.

I wouldn’t raise by 10mcg of T3 all at once—take the prescription (having 20mcg to play with is much better than 10mcg!) but maybe try increasing by 5mcg a day first so that you’re taking 15mcg a day.

I suspect your levothyroxine dose was dropped too much when you started T3–a drop of 25mcg Levo would have been more than enough. Dropping by 50mcg was too big a change all at once.

I fear you may be being set up to fail… but this is still fixable.

Your cholesterol is high because you’re under-medicated—undertreated hypothyroidism reduces the liver’s ability to clear cholesterol from the bloodstream. You’d like to think our eminent doctors and endos would know this stuff but alas they don’t. And cholesterol being high isn’t nearly the problem Big Pharma make it out to be… They’d have us all on statins from birth if they could get away with it.

As for the dramatic “you’ll have a stroke or a heart attack”, pur-leeease. 😩 You aren’t over-medicated.

[Kowbie in reply to Jazzw]

Thankyou for getting back to me, I thought it was a big drop but there you go there supposed to be the experts , I wondered if I did what you said group by 5 for a couple of days then add the other 5 and if in three weeks time was still not feeling great add 25 thyroxine what do you think about that thanks for your help and seasidesusie

[Kowbie in reply to Jazzw]

Hello it’s me again ,my head must be in a fuddle , when tsh was 0.57 and this time is 0.7 , it’s like my head won’t let me see which is the lowest as he didn’t say much last time but he did this time so I’m a bit muddled so I don’t know can you help me , sorry to bother you again x

[Jazzw in reply to Kowbie]

Hi Kowbie

0.57 is lower than 0.7.

The TSH “normal” range for the TSH blood test goes from 0.27 to 4.2 in your laboratory’s reference range.

0.57 is nearer the bottom of that range than 0.7 (I know, it all gets very confusing).

There’s not a lot in it—but (1) both results are within range so your Endo really shouldn’t be troubled at all and (2) your TSH is now higher than it was before he started you on T3–so I’m bewildered as to why he’s saying you’re overmedicated.

[Kowbie in reply to Jazzw]

I’m the same , he knew what the tsh was on starting I think he’s muddled, when he phones again in 6 weeks I’ll tell him about it and say you knew what it was on me starting it thanks a lot for your help x

[SeasideSusie Remembering]

Kowbie

Oh dear, sounds like another doctor who doesn't really know how to dose with Levo plus T3.

he agreed to put liothyronine up to 10 twice a day

T3 should only be increased in 5mcg increments, doubling your dose is asking for trouble.

I was on 200 thyroxine, he put it down to 150 and started me on liothyronine 5 in the morning and 5 later on, my test before starting were TSH 0.57 (0.27-4.2). T4 17.4 (12-22) T3. 4.3 (3.1-6.8).

Well, your Levo should not have been decreased by 50mcg, in fact with your FT4 only 54% through the range there was no need to reduce your Levo at all. Taking T3 will reduce FT4 as well as TSH (it's just what it does).

Not feeling too good sleeping a lot of the time missed my phone appointment with endocrinologist yesterday as didn’t wake up , he rang me today, said I was over medicated as tsh had gone to 0.7 ranges same as before, i said I’m not as t4 and t3 were nowhere near the top , T4 15.3 T3 4.5 ranges as before

You are very likely experiencing this fatigue due to your FT4 having dropped from 54% to 33% through range. I am on Levo plus T3 and if my FT4 was that low I'd struggle to get out of bed, I need both FT3 and FT4 reasonably well balanced around the 70% mark through range (although we are all different as to where we need these levels, some are fine with FT4 low as long as FT3 is in the upper part of range).

he said I could have a stroke or heart attack do to it being like it is

Wrong. That is associated with suppressed TSH and high FT3 with hypERthyroidism, he needs to keep up with research.

he then said my colestral was high and mentioned statins,

Wrong again. High cholesterol is a symptom of hypothyroidism, your results show undermedication, get optimally medicated and cholesterol will most likely sort itself out. Statins are not recommended for females, also NHS says

nhs.uk/conditions/statins/c...

If you have an underactive thyroid (hypothyroidism), treatment may be delayed until this problem is treated. This is because having an underactive thyroid can lead to an increased cholesterol level, and treating hypothyroidism may cause your cholesterol level to decrease, without the need for statins. Statins are also more likely to cause muscle damage in people with an underactive thyroid.

in the end he agreed to put liothyronine up to 10 twice a day

I don't believe at this stage this is the correct thing to do. I would increase your Levo by 25mcg now, retest in 8 weeks to see if FT4 has increased, FT3 might increase as well depending on how much natural conversion you have.

Personally I would aim to get FT4 back to roughly where it was originally.

But I wonder if you needed T3 in the first place.

T4 17.4 (12-22) = 54% through range

T3. 4.3 (3.1-6.8) = 32.43% through range

Ratio of T4:T3 - 17.4 divided by 4.3 = 4.05

Good conversion takes place when the ratio is 4:1 or less, and you are so close to that.

What are you nutrient levels like? We need optimal nutrient levels for thyroid hormone to work properly and good conversion, so if you had any low levels these should have been optimised before adding T3.

Maybe you only needed an increase in Levo originally to see where that took you.

[Kowbie in reply to SeasideSusie]

Thank you both for replying to me , I’ll have to go with what he said at the moment as he had put my thyroxine down to 150 , I thought that was a big jump at the time , I thought I would do what he said for three weeks and if I didn’t feel much better add 25 thyroxine in what do you think

[SeasideSusie Remembering in reply to Kowbie]

Personally I would add in the extra Levo, but I don't have to answer to an endo, I do my own thing

[Kowbie in reply to SeasideSusie]

Thanks a lot I might be doing the same , is there a write up by a professor or some one I can quote to him about please , and thanks again

[SeasideSusie Remembering in reply to Kowbie]

Unfortunately Kowbie I don't know of anything that talks about where levels should be on combination thyroid hormone replacement. Dr Anthony Toft (past president of the British Thyroid Association and leading endocrinologist [now retired]) wrote an article about where levels could be on Levo only, but I haven't seen anything about when on combo meds. It could be because no doctors/endos know enough about it (plenty of evidence of that) but also we are all very different where we need the individual hormones to be for us to feel well individually.

On Levo plus T3 I need both FT4 and FT3 fairly well balanced around 70% through range. Others are like me, some others are fine with a low FT4 as long as FT3 is in the upper part of the reference range. Then of course there are those who don't need any T4 and just take T3. So no wonder there's no "guidelines", it's all too complicated for them, they need guidelines to follow because they have lost the ability to listen to the patient and treat on symptoms rather than numbers.

(Oh yes, I'm a cynical grumpy old bird who is very bitter about lack of understanding/optimal treatment from doctors since I originally went with symptoms back in 1973.)

[Kowbie in reply to SeasideSusie]

Well you not the only one to be a grumpy old bird about it I’m you buddy, it’s only taken me 29 to 30 years to get here I wouldn’t have known anything about vitamins or t3 if it hadn’t been for this site and there knowledge, I appreciate you getting back to me thanks again, and bye for now