Blood Results

[KS2020]

Hi Everyone

I have been on the same dose of levothyoxine for a year and a half and all of a sudden started feeling jittery. They said i was over medicated and reduced my tabs to 100 from 125. Please see blood results below. I still dont feel right and dont understand why it all of a sudden changed. Has this happened to anybody else. I had my thyroid removed over 2 years ago due to graves and a toxic nodule.

May 2022

TSH 0.1 Range 0.55 - 4.78

T3 4.9 Range 3.5 - 6.5

T4 18.2 Range 10.00 - 20.00

Vit D 67 Range 50 - 374

B12 268 Range 211 - 911

Folate 5.74 Range 3.38 - 23.9

Aug 2022

TSH 0.11 Range 0.55 - 4.78

T3 4.3 Range 3.5 - 6.5

T4 19.9 Range 10.00 - 20.00

Vit D 57 Range 50 - 374

B12 216 Range 211 - 911

Folate 7.63 Range 3.38 - 23.9

Sept 2022

TSH 0.87 Range 0.55 - 4.78

T3 3.5 Range 3.5 - 6.5

T4 18.5 Range 10.00 - 20.00

Vit D 77 Range 50 - 374

B12 260 Range 211 - 911

Folate 6.74 Range 3.38 - 23.9

[PurpleNails Administrator]

At what stage was levo reduced? After sept test or was it on this last test or august?

Was there a 6 weeks between dose change retesting.

Do you test as recommended on forum? 

Do you have same brand of Levo? 

Those of us that have been hyper previously can have a down regulated TSH.  your TSH stays low even when FT4 & FT3 in range & not over range.

Your latest results (sept) show high FT4 but very poor FT3. 

 Doctor likely satisfied as levels in range especially the TSH.  

By lowering levo - FT3 is now only just in range.  You likely feel hypothyroid. Symptoms can be deceiving.

Your nutrients are in range so acceptable to doctors but you need optimal levels for levo to work well & need then higher. 

You also need to ferritin tested.  

[KS2020 in reply to PurpleNails]

Hi

Thankyou for replying. End of July is when they told me to reduce to 100. Yes i use the same brand mercury pharma, no change.

[humanbean]

When thyroid hormone levels are reduced to too low a level, your adrenal glands will produce more cortisol as a (poor) substitute to keep you going. Some people can't produce more cortisol and their levels end up low.

Both low cortisol and high cortisol have several symptoms in common, including getting jittery.

Unfortunately for us, doctors think being jittery is always evidence of over-medication and reduce levels of thyroid hormones even further if they are given the chance. Resist this as hard as you can.

In May your Free T4 and Free T3 were in range so you weren't over-medicated, but your Free T4 was high in range (82%) and your Free T3 was below mid-range (47% through the range). Many people on the forum would feel best with a slightly lower T4 and a higher T3. BUT - you might need the T4 to be as high as it is because your conversion of T4 to T3 is so poor.

By reducing your T4 your doctor has just made your thyroid results worse. In the September results your Free T3 is bottom of the range and your Free T4 is 85% through the range which would make anyone feel terrible.

One thing you could do without involving your doctor is to try and improve your conversion by improving your nutrient levels. But in reality, with no thyroid, you might never be able to get your Free T3 high enough to feel well by conversion alone and will always need to take some T3 with your Levo. Alternatively you might do well with NDT but that is getting harder and harder to get hold of.

Vit D 77 Range 50 - 374

B12 260 Range 211 - 911

Folate 6.74 Range 3.38 - 23.9

Your vitamin D is within range but it isn't optimal. You should be aiming for roughly 100 - 150 nmol/L. There have been some suggestions that 125 nmol/L is optimal. Personally I feel fine with a level of 100, but others like to have a result of 150 - experimentations is essential.

Your Vitamin B12 and folate levels are dreadful. Have you ever been tested for Pernicious Anaemia (PA)? If you haven't been you should ask to be tested for it. There are various opinions on what an optimal B12 level is, so you need to experiment to find what works for you.

1) Minimum of 500.

2) Upper half of range.

3) Top of range.

4) Over 1000.

I wrote a lot about B12 and folate for someone else with low levels yesterday. You can read that reply here :

healthunlocked.com/thyroidu...

...

Just for interest, I managed to improve my conversion a huge amount with improving nutrients. (I do still have my thyroid, and I've never been hyperthyroid.) Before and after can be seen here :

healthunlocked.com/thyroidu...

[KS2020 in reply to humanbean]

thank you for your help , very helpful.

[pennyannie]

Hey there again KS2020 :

Once on any form of thyroid hormone replacement and especially since you have Graves and have had a thyroidectomy you must be dosed on your T3 and T4 readings and dose adjusted to keep both these vital hormones balanced at around a 1/4 ratio T3/T4.

Your T3 and T4 were always in the ranges and I'm afraid I think that you are being dosed and monitored on your TSH reading which is a totally unreliable measure of anything once on any form of thyroid hormone medication.

T4 - Levothyroxine is a storage hormone, a prohormone, and needs to be converted by the body into T3 the active hormone that runs the body and said to be around 4 x more powerful than T4.

We tend to feel at our best when the T4 is in the top quadrant- or sometimes a little over range - as this should in theory convert to good level of T3 as it is T3 that runs the body.

Your ability to convert the T4 into T3 can be compromised by non optimal levels of ferritin, folate, B12 and vitamin D and also inflammation, physiological stress ( emotional or physical ) depression, dieting and ageing can all play a part in compromising conversion of theT4 into T3, but maybe some of these a little more difficult to have any control over.

Your ferritin was very low 3 years ago and I can't see a result - do you have a current one ?

I now aim for a ferritin at around 100 : folate 20 : B12 serum 500++ and vitamin D at 100:

So you need to do some work here and supplement accordingly.

The accepted conversion ratio when taking T4 only medication is said to be 1 / 3.50 - 4.50 T3/T4 with most people feeling at their best when they come into this range at around 4 or a little under.:

To find your conversion ratio you simply divide your T3 into your T4 :

and we see your conversion ratio falling dramatically from a very good reading in

May of 3.71 to July at 4.62 and in September well out of range at 5.28

and you must be feeling very unwell - compared to where you were back in May :

Your T4 has systematically been reduced down which has resulted in a dramatically reduced T3 reading which has fallen through the range from 4.91 to 4.30 to 3.50 -

and now at the bottom of the range and your metabolism virtually nonexistent.

Is there another doctor you can see as you need your dose of T4 - Levothyroxine re-instated?

[KS2020 in reply to pennyannie]

thank you for your reply, I will be speaking to my doctor as you have confirmed what I was thinking.

[pennyannie in reply to KS2020]

Good morning to you ;

The issue is if your doctor only knows how to treat primary hypothyroidism going by a TSH reading you will likely be hitting your head against that brick wall :

If there isn't another doctor there with a better understanding of thyroid health ask for a referral to endocrinology - keep us in the loop - you can't carry on like this.

[pennyannie in reply to KS2020]

A fully functioning thyroid would have been supporting you on a daily basis with trace elements of T1. T2 and calcitonin + a measure of T3 at around 10 mcg + a measure of T4 at around 100 mcg.

Some people can get by on T4 only :

Some people find that after a while T4 seems to not work as well as it once did and need to add in a small dose of T3 to rebalance T3/T4 levels to restore their health and well being - especially when they haven't a functioning thyroid and after a thyroidectomy or RAI thyroid ablation as in the case of Graves patients :

Some people can't tolerate T4 and need to take T3 - Liothyronine only :

Whilst other people find their health restored better by taking Natural Desiccated Thyroid which contains all the same known hormones as the of the thyroid gland and derived from pig thyroids dried and ground down into tablets and referred to as grains.

NDT was the original successful treatment for hypothyroidism for over 100 years and on which Big Pharma launched T3 and T4 thyroid hormone replacement medications.

You seemed to be doing ok when on T4 monotherapy - when prescribed enough T4 :

I was ok on T4 when prescribed enough - but at 65 it was as though a draw bridge came down and my dose cut back to 100 mcg and I fell into an ever increasing circle of unwellness and called a conundrum.

I managed a referral to an endocrinologist but refused both NDT and T3 and told I was over medicated as my TSH had all but disappeared :

I then decided to self medicate as the stress of challenging the system simply exacerbated my symptoms and now in my 4th year taking NDT and much improved.

I am with Graves Disease and post RAI thyroid ablation in 2005 - a treatment I deeply regret - details on my profile page.