results advice and Adding T3

Good Afternoon, I have just got back from finally seeing my old Endo who has been off ill I saw his registrar last time who I was not happy with he lowered my Levo to 75 from a 100 even suggested I come off Levo for 3months as well I ended up taking just under I didn't drop 25mcg from 100 my tsh has come up into range for the first time in a year but my t4 n t3 has dropped a lot and I don't feel too good hairloss worse nails all broke I thought maybe it was diet related or iron? But have had a lot of stress and bereavements my Endo now says go back on T3 5mcg with 75mcg but he says these results are spot on can anyone tell me if I look like I have iron problem? Low iron Thank You!

[Hidden]

So Sorry its not clear I took it off his computer

[SlowDragon Administrator]

Was test done early morning, ideally before 9am and last dose levothyroxine 24 hours before test

Do you always get same brand levothyroxine at each prescription

FT4: 13.2 pmol/l (Range 7.9 - 16)

Ft4 65.43% through range

FT3: 4.6 pmol/l (Range 3.8 - 6)

Ft3 36.36% through range

Helpful calculator for working out percentage through range

thyroid.dopiaza.org

Assuming test done as recommended….shows poor conversion

When were vitamin D and folate levels last tested

What vitamin supplements are you currently taking apart from B12

SeasideSusie or humanbean might comment on iron levels

Looking like you need to increase iron rich foods in your diet

Are you vegetarian or vegan?

Are you on gluten free diet?

[Hidden in reply to SlowDragon]

Yes always get same MP Levo when I was on 100 Levo very low Tsh top of range T3 T4 always but stupid Registrar cut me down at the hospital while my Endo was off sick I do convert ok but because tsh was low stupid man lowered my Levo so these results are because Levo lowered Endo now says 75 levo with 5 mcg T3 I'm inclined to think the same as SeasideSusie 100mcg with 5 T3 I always get bloods done at before 9am gluten n caffeine free except 1 cup of caffeine on rising but I'm concerned about my iron SeasideSusie has given me some good replies but do I get iron supplements my ferritin had been up n down all year last year

[SlowDragon Administrator in reply to Hidden]

Taking any dose of T3 will almost always lower or suppress TSH

So if endocrinologist is TSH obsessed….they will then want to reduce levothyroxine even further (and inappropriately)

If you were ok on 100mcg ….just go back to 100mcg

If GP/endo says " I have to reduce your dose because the guidelines say i can't let you have a below range TSH" .....

The first paragraph in the NICE (NHS) Thyroid Disease, Assessment and Management guidelines says :

nice.org.uk/guidance/ng145

"Your responsibility

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian. "

What were Thyroid results on 100mcg ?

[Hidden in reply to SlowDragon]

They were very good top of range always but tsh was always low so that silly registrar dropped my Levo 3 months ago said your tsh needs to come up I did argue but he sent my GP a letter well my Tsh did come up and t4 t3 down he said try coming off Levo for 3 months I've not been myself fir a while now so only today I've started to speak up but my Endo doesn't like you many questions infact he said you can always go elsewhere for a 2nd opinion wish I knew a decent one that doesn't keep looking at numbers n your OK had morning cortisol done but he says all normal what's normal if you don't feel it

[SlowDragon Administrator in reply to Hidden]

2 months ago

TSH 0.04

Ft4 16.1 (7.9-16)

Ft3 5.8 (3.8-6.0)

That was presumably on 100mcg levothyroxine?

How did you feel at that dose?

Reducing levothyroxine by 25mcg per day was far too big a reduction…..

you could have tried just reducing by 25mcg per week

…..retesting after 6-8 weeks

T4 therapy

ncbi.nlm.nih.gov/labs/pmc/a...

In a study evaluating tissue function tests before total thyroidectomy and at 1 year postoperatively when using LT4, it was found that peripheral tissue function tests indicated mild hyperthyroidism at TSH <0.03 mU/L and mild hypothyroidism at TSH 0.3 to 5.0 mU/L; the tissues were closest to euthyroidism at TSH 0.03 to 0.3 mU/L [48]. A normal serum TSH level consequently does not necessarily indicate a euthyroid state at the tissue level.

[Hidden in reply to SlowDragon]

I've never really felt good on Levo at any doses

[SlowDragon Administrator in reply to Hidden]

Ok, so try adding 5mcg T3

[Hidden in reply to SlowDragon]

My vit d folate were very good top of range I'm going to start up b complex again not sure best one to get I found Thorne basic b not to my liking and your right duet rich in iron also protein

[SeasideSusie Remembering]

GSD2011

Ferritin: 100 (15-300)

Serum Iron: 12.7 (10-30)

Transferrin: 2.24 (2-3.6)

Saturation %: 23% (15-45)

When discussing iron panels we usually quote the following:

Optimal iron panel levels according to rt3-adrenals.org/Iron_test_... are:

Serum iron: 55 to 70% of the range, higher end for men - yours is 13.5% through range which is very low.

Saturation: optimal is 35 to 45%, higher end for men - yours is 23% which is low.

Total Iron Binding Capacity (TIBC) or Transferrin: Low in range indicates lack of capacity for additional iron, High in range indicates body's need for supplemental iron - yours is 13.75% through range which is low.

Ferritin: Low level virtually always indicates need for iron supplementation; High level with low serum iron/low saturation indicates inflammation or infection.

Your results are mixed, your serum iron and saturation % suggest a problem, your transferrin and ferritin don't necessarily suggest a problem. However, Ferritin can be raised when inflammation is present and it's possible that is the situation with you. I don't suppose an inflammation marker test was done, eg CRP?

Symptoms of iron deficiency include:

◾Persistent fatigue

◾Pale skin

◾Shortness of breath

◾Headaches

◾Dizziness

◾Heart palpitations

◾Dry skin

◾Brittle hair and hair loss

◾Swelling or soreness of the tongue or mouth

◾Restless legs

◾Brittle or ridged nails

Are any of these familiar?

I think you need to discuss these results with your doctor.

TSH: 1.38 (0.3-5.0)

FT4: 13.2 (7.9-16) = 65.43%

FT3: 4.6 (3.8-6.0) = 36.36%

but he says these results are spot on

Hardly! TSH over 1, FT4 and FT3 would be much better balanced if the results were "spot on". However, you now have T3 added back so that is a good start. I don't think you need to reduce Levo to 75mcg, your FT4 is only 65.43% through range, taking T3 is going to lower it and reducing Levo will lower it even more. It would have been better to just add the T3 to your current dose of Levo and see what that produces.

Retest 8 weeks after this dose change and see what your results are like.

[Hidden in reply to SeasideSusie]

So do I need to supplement iron? My ferritin has been up n down all last year more up than down it didn't reflect the iron panel results I just don't understand what's going on I have a lot of the symptoms above definetly as for my thyroid Endo Sat's spot on I told him they arnt my t3 gone down a lot and t4 and tsh has gone from very low to over 1 in 3 months so looks like you mean takec100 Levo and the 5 mcg T3? The hairloss is weird it's receding only from the front and just thinner no bald patches on crown thank goodness I actually feel not in control now of what to do next My Gp says all fine too my iron panel isn't fine

[SeasideSusie Remembering in reply to Hidden]

Gsd2011

So do I need to supplement iron?

Because iron is complicated and because I'm not medically trained, I can't advise whether you should supplement, all I can do is point out what your results show and suggest that you discuss with your doctor emphasising the symptoms you recognise that may be due to iron deficiency and the low serum iron.

My ferritin has been up n down all last year more up than down it didn't reflect the iron panel results I just don't understand what's going on

As I said, ferritin can be raised when inflammation is present. You have Hashi's and Hashi's causes inflammation. Your Hashi's might be the reason for your fluctuation ferritin results.

looks like you mean takec100 Levo and the 5 mcg T3?

Yes, certainly don't reduce to 75mcg.

[Hidden in reply to SeasideSusie]

Thank You so much !

[CosmicGirl61 in reply to Hidden]

The hairloss is weird it's receding only from the front and just thinner no bald patches on crown thank goodness

Hi Gsd2011, my thinning hair is exactly same from the front so can't have a fringe, which suits me 🥺 and has been thinner ever since I had low iron results.. must be 15 years ago (thyroid removed 20 years ago) and my nails are so weak. Remember telling GP all this AND for years now from memory remember result was 12!!! Yes only 12. GP said I was within range so all was fine. Maybe a year or so later I asked for another test.. (never ever been given vitamin tests along with thyroid) AND results were only slightly better. Maybe 16!! He still played it down saying I could buy iron and take but it would probably only have a placebo effect!!!!! I remember my daughter having issues with low iron when she was 16 going through exams and feeling so tired, looking pale, thinning hair.. and her result was low around 16 and she had same awful response! It's terrible. Only now I've discovered patients can access results on line, and found my old iron results which was 12 at my lowest!! I've been having hair extensions put in for years now which makes appear fuller but if had proper doctor this wouldn't happen. I'm now, taking supplements, since being on this wonderful forum and seeing my latest results. I'm going to be more assertive in future with the doctors. I'm at a group practice and the one who didn't think my low iron was an issue and in past reduced my dose of levo twice making me feel worse, I don't use him now. However, the woman I've been "seeing" (only telephone appointments) had seemed good to start but it was her (and endo) who also were obsessed with low TSH!!! 🙄 They're all the same which very frustrating ! Anyway after my amazing response to my last post on here, I felt very fired up and I insisted my dose was put back up, stating my body needed good levels of T3 to function.. I felt exhausted after the call. I felt like I'm having to have a crash course in understanding treatment for thyroid.. what the doctors should know! Hope you start feeling much better 🙏

[Hidden in reply to CosmicGirl61]

I've seen a well know triologist twice who said I had CTE hairloss due to diet stress and thyroid correct all these and it will come back i went back on the 2nd time she said I had Seborrheic dermatitis go to see a Dermatologist I saw a good one 200 pounds who said you certainly don't have it all you have is a dry scalp she said could see lots of hair growth but not actually growing at hairline as such then I saw a professor triologist he thinks possible some sort of traction alopecia but still no positive diagnosis so I live in hope it will come back but not as thick but I think diet n iron as well protein so working on it just wish these specialist actually know after paying out if I could find a good Endo and pay I would but with out the help and advice on here I would know nothing at all

[CosmicGirl61 in reply to Hidden]

The help on here is AMAZING 🙏😊 I'm thinking the dry scalp diagnosis could've been the right one. If thyroid was say a bit under and symptoms is dry skin.. and of course effects hair.. 🤔 Just wondering ...

[theminiaturist]

We're your T3 and T4 tests done through the NHS? My GP says that only TSH test is done through the NHS and if that is OK then nothing else needs to be done.

[Hidden in reply to theminiaturist]

Yes NHS Endocrine

[Happyfairy09]

My ft4 range is between 11-22, are you in the UK ?

[Hidden in reply to Happyfairy09]

Yes in UK

[Happyfairy09 in reply to Hidden]

Wow what a difference with lad range.