Seeking Advice Regarding a Dosage Change

[imnotyouranti]

Hello, I have been a lurker on this forum for a couple of months but have yet to ask for advice directly. Even though I am only 18 years old, I have been dealing with hypothyroidism since a sudden onset of symptoms in March 2020. Since then, I have been put on levothyroxine, yet my symptoms have never been resolved. I noticed a marked improvement with the addition of 5mg of T3 in September 2021, but I have yet to feel as I did before the onset of hypothyroidism.

My pediatric endocrinologist suspected I have central hypothyroidism while this OBGYN believes I am poor converter of T4 to T3.

I re-tested my thyroid last week, fasted, before 9am, and last dose 24hrs before. Given my results, an OBGYN wishes to reduce my levothyroxine from 112mg to 75mg and increase my dosage of T3 from 5mg to 25mg.

As the fatigue, brain fog, and depression I experienced on lower dosages drastically interfered with my ability to function, I'm reluctant to embark on such a drastic dose change. She mentioned that I will feel off for a few weeks which did not alleviate my concern. Given my most recent test results (provided below), does this dosage change appear reasonable?

Results from 7/27/22:

T3 REVERSE -- 45 (range  8-25 ng/dL) H

T3, FREE -- 2.1 (3.0-4.7 pg/mL) L

TSH -- <0.01 (0.50-4.30) L

T4, FREE -- 1.5 (0.8-1.4 ng/dL) H

T3 UPTAKE -- 32% (22-35%)

IODINE, SERUM/PLASMA -- 89 (52-109 mcg/L)

IRON, TOTAL -- 70 (27-164 mcg/dL)

IRON BINDING CAPACITY -- 378 (271-448 mcg/dL)

% SATURATION -- 19 (15-45%)

FERRITIN -- 25 (6-67 ng/mL)

THYROGLOBULIN ANTIBODIES -- <1 (< or = 1 IU/mL)

[greygoose]

Hi imnotyouranti, welcome to the forum.

My pediatric endocrinologist suspected I have central hypothyroidism while this OBGYN believes I am poor converter of T4 to T3.

Could be both. One does not exclude the other. Looking at your results, you do appear to be a poor converter, but can't comment on the Central Hypo without seeing your results from diagnosis.

I re-tested my thyroid last week, fasted, before 9am, and last dose 24hrs before. Given my results, an OBGYN wishes to reduce my levothyroxine from 112mg to 75mg and increase my dosage of T3 from 5mg to 25mg.

She's an idiot. You can't do that. Levo should only be increased/decreased by 25 mcg every six weeks. Reducing by so much certainly would be a shock to the system and make you feel unwell. And, T3 should be increased by maximum 5 mcg every two weeks, and never change both at the same time! I don't think this woman knows the first thing about treating hypo, so be very wary of her. You may be feeling bad at the moment, but treating hormones like aspirin is only going to make you feel worse. You have to go slowly to give your body time to adjust.

[SeasideSusie Remembering]

imnotyouranti

My pediatric endocrinologist suspected I have central hypothyroidism

Do you have results/ranges from when first diagnosed? Central hypothyroidism is suggested by normal, low or minimally elevated TSH with a low/below range FT4?

while this OBGYN believes I am poor converter of T4 to T3.

Do you have results/ranges from when on Levo only that show high FT4 and low FT3 which would suggest poor conversion?

an OBGYN wishes to reduce my levothyroxine from 112mg to 75mg and increase my dosage of T3 from 5mg to 25mg.

Did you do your test as always advised here:

* no later than 9am

* water only before test

* last dose of Levo 24 hours before test

* last dose of T3 8-12 hours before test (splitting dose the day before into 2 or 3 and taking last dose 8-12 hours before test).

If you took last dose of T3 24 hours before test then you have a false low FT3 result.

It's possible that what your OBGYN is suggesting might be your ultimate dosing regime, but you shouldn't make such a drastic change all at once, it must be done gradually. Levo no more than 25mcg change (even 12.5mcg or 6.25mcg when fine tuning dose), T3 no more than 5mcg change, at a time. Also, don't change both at the same time. Change one, wait 6 weeks to see what difference it's made then decide what next change should be. Tedious and requires a lot of patience and gradual tweaking but in the long run this ensures you don't overshoot your sweet spot. Do it too quickly or change both at once and you may find you'll never find your optimal doses, or you may have to go back to square one and start again. Slow and steady wins the race here!

If you reduce your Levo this will reduce your FT4 level but may also reduce your FT3 level, so maybe reduce FT4, wait 6 weeks then test then next step would probably be to increase T3 dose by 5mcg then wait and see what happens. This should increase your FT3 level and might reduce your FT4 level. Next step might be to add another 5mcg T3 so again wait 6 weeks and see what happens, T3 should increase again and FT4 might reduce again.

[SlowDragon Administrator]

You need vitamin D, folate and B12 levels tested

Ferritin is too low

But iron is ok so iron supplements NOT recommended

Look at increasing iron rich foods in your diet

Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption

List of iron rich foods

dailyiron.net

[eeng]

I can fully understand why your doctor wants to increase your T3 dose - your FT4 is clearly under range. However I don't know why he/she wants to decrease your T4 dose - your FT4 is right at the bottom of the range. I do understand why she thinks you have central hypothyroidism - you have low levels of both FT3 and FT4 but your TSH is near zero. If it was me I would probably take the increased dose of T3, but increase slowly over a few weeks, maybe 5mg each week or two. Then once your symptoms begin to improve and you have had another test you could consider dropping some of your T4.

However if you look at posts on here you will see that it's not uncommon for people to be taking 125mcg of Levothyroxine and 25mg of T3 as a permanent dose, particularly if they have had a thyroidectomy.

I hope you find a dose that really suits you before too long so that you can get on with your life.