New Doctor/central hypo

[gabkad]

Hello everyone! I haven't posted my own stuff for a while now. What do you all think of this situation:

The new doctor who took over the practice ordered the tests last week. At our first in person appointment I explained to her the my hypothyroidism is not because my thyroid but my pituitary. I told her that when TSH was 0.9 or 1.0, fT4 was bottom of range and fT3 was below range and I was very disabled. This was on a 112 mcg T4 dose.

Here are the test results: (blood was taken at 7:45 a.m. I did not take Synthroid before the appointment. Dose is 150 mcg T4.)

Thyroid Function

Thyroid Stimulating Hormone [TSH]

LO 0.06 0.32-4.00mIU/L

Thyroxine Free [Free T4]

12 9-19 pmol/L

Triiodothyronine Free [Free T3]

3.5 2.6-5.8 pmol/L

The fT3 has been 4.2 and 4.3 last year and the year before. Not good enough.

The doctor sent me an email yesterday to get in touch.

I took 6.25 mcg T3 from August 2021 to January 2022 but have not been self medicating since. Last night I decided it's time and I've opted to do a split dose of 6.25 mcg at bedtime and 6.25 mcg in the morning along with the 150 mcg T4.

This new doctor is actively listening to me and I will let her know. If she wants, we can test again in 8 weeks.

I don't need to wonder now why my libido has disappeared. 🥵 I need it back. I'm using HRT but that's not enough. Plus I've noticed my energy isn't where I need it to be. Libido was great during March 2020 lockdown but that's partly because I was not using up my energy doing anything at all. Not sure it would work these days even under those circumstances. Low thyroid = no libido.

Looks like I need to take the T3. I don't think taking more T4 is really the way to go.

[Gingernut44]

There was no FT4 result, only the range 🤨 but your FT3 is only 28.3% with the range you’ve given so I think you’re right in assuming you need some Liothyronine

[gabkad in reply to Gingernut44]

It's there: fT4 is 12, range 9 to 19 pmole/L

[Gingernut44 in reply to gabkad]

Sorry, the way it was written looked like a range of 12.9 - 19. Best to put ranges in brackets to save any misunderstanding 🤭Your FT4 is only 30% through the range. Your FT4 and FT3 results are really odd for your TSH of 0.06. Hopefully someone more knowledgeable will come along SeasideSusie or SlowDragon

[SlowDragon Administrator]

Essential to test vitamin D, folate, ferritin and B12

Having stopped T3 in January….likely Vitamin levels have dropped

What vitamin supplements are you currently taking

FT4: 12 pmol/l (Range 9 - 19) 30.00%

FT3: 3.5 pmol/l (Range 2.6 - 5.8) 28.13%

Helpful calculator for working out percentage through range

thyroid.dopiaza.org

Low Ft4 shows you are under medicated and in need of 25mcg dose increase in levothyroxine

Most people when adequately treated on just levothyroxine will have Ft4 at least 60-70% through range

Bloods should be retested 6-8 weeks after each dose increase

Likely to need further increase in levothyroxine after next test

Do you always get same brand levothyroxine at each prescription

[gabkad]

My screen froze just before I was going to reply! ARghhhhhhh.

Ferritin is 79 right now. I'm on a low iron diet so I won't need to donate blood. I can afford to demolish some steaks and maybe eat some liver. It's eggs, dairy, and fish almost exclusively.

Vitamin D level has been checked several times over the past 9 years. I take 8,000 IU every 5 days. In 2021 January it was 114, consistent with previous testing. Now I've been outside all summer so it's for sure fine. (It works out to 48,000 IU per month. Bolus dosing every 5 days is more efficient than taking vitamin D3 every day.)

Every 5 days: high dose B complex, lutein, Jarrow K Right, and three times per week I take zinc with 1 mg copper (Jarrow product also). The only vitamin I don't take is C. I get enough from my diet.

B12 has been checked in the past and it was over 600 (ng/l). I have never had folate checked in my entire life even when I was pregnant so that's kind of negligent. But it's highly unlikely it's low.

Hematology was done as well. Hemoglobin is 152. Oftentimes it's 162 but I guess with restricting iron it's gone down a bit.

The major hypo symptom I have is lack of exercise tolerance. If I walk 5 to 7 km in the morning I'm done for the day. I can't walk like this day in and day out.

I now started on 12.5 mcg T3 before bedtime. I can't be bothered dosing more than once per day.

I take the T4 in the morning because for sure it's on an empty stomach. I'm not informing the M.D. that I am now self medicating. If I feel better then I will just keep on going. I don't see the point of doing more bloodwork seeing as how I have enough data on taking T4 on the day of blood draw .... fT4 was 18 (same range as posted initially), fT3 was 4.8. I have the data for blood draw 24 hours after taking T4 and after 48 hours. After 24 hours, fT4 was 15 and fT3 was 4.3. The most recent test was after 48 hours. fT3 was 3.5! Amazing.