Hypothyroidism over-corrected by switching brands?

[ceramo]

I have followed this invaluable site for years but am living in France where only THS is counted.So I haven’t had enough data to be able to ask for help. I am 79 and have increasingly disabling ME/CFS as well as a hereditary tendence to hypothyroidism.

It is only now that I have got more differentiated readings from a functional doctor, following a difficult but graduated switch from several years of Erfa to an equivalent dosage of Euthyral by Merck. My tabs are 100mcg levo with 20mcg liothyronine, and I have been taking approx 3/4 tab for a good 2 months.

Here are my readings: TSH 0.13 (below ref range);

T3L 3.4 pmol /l, 2.2 ng/l; T4L 12.0 pmol/l, 9.32 ng/dl; Parathormone intacte 3.19 pmol/l, 30.1 ng/l (something to do with vitD I think ) (all within ref range).

I find my whole system stressed and sleep is ever less refreshing (I take benzodiazipines at night, longn term). I get trembly when exhausted.The summer heatwave here lasted 4 months and made me feel really ill. Now it is cool, but I pay for every little thing with post exertional malaise. It is important to get the thyroid right!

I will try to reduce my 3/4 tab by a small fragment to see what happens but would really welcome advice/comment please.

[SeasideSusie Remembering]

ceramo

TSH 0.13 (below ref range);

T3L 3.4 pmol /l, 2.2 ng/l; .. T4L 12.0 pmol/l, 9.32 ng/dl .. (all within ref range)

I will try to reduce my 3/4 tab by a small fragment to see what happens but would really welcome advice/comment please.

What are the ranges please, these vary from lab to lab so we need to see your ranges. We need to know where in the ranges your FT3 and FT4 lie even though you say they're within range.

TSH is not a marker of thyroid health, TSH is useful for diagnosis but once on thyroid hormone replacement it is not useful. Also, because you take a medication that contains Levo plus T3 then the T3 is going to lower your TSH and it often suppresses it, so your TSH result is to be expected.

I will try to reduce my 3/4 tab by a small fragment to see what happens but would really welcome advice/comment please.

There is no need. Presumably you are saying this due to the low TSH. Look at the FT3 and FT4, you say these are within range so there is no need to lower your medication, all you will do is lower your FT4 and FT3 levels. Depending on where in range your FT4 and FT3 lie you might even need an increase in dose, hence we need to see the ranges.

[ceramo in reply to SeasideSusie]

Thank you Seaside Susie, it is so complicated! I have photographed the relevant parts of my bloodtests but should add that they note off to the side that my last TSH reading, from Jan this year, was 0.90 (I was still on Erfa then).

extract from bloodtest results

[SeasideSusie Remembering in reply to ceramo]

ceramo

I forgot to mention last time that when on NDT the last dose should be taken 8-12 hours before a thyroid blood test - splitting the dose the day before. When taking Levo plus T3 (separately) then last dose of Levo should be 24 hours before test and last dose of T3 should be 8-12 hours before the test (splitting T3 dose the day before). So this then causes a bit of a conundrum when taking a combined Levo plus T3 tablet because if you take it 24 hours before the test it would tend to give a false low FT3 result. I don't know what the answer is because we don't have combined tablets here in the UK but I would have thought to treat it like NDT to get a more accurate FT3 level, FT3 being the most important test.

So we have

TSH: 0.13 (0.35-4.94)

T3L (FT3): 3.4 (2.4-6)pmol/L = 27.78% through range

T4L (FT4): 12 (9-19.2)pmol/L = 29.70% through range

I have used the pmol/L units of measurement rather than the ng/L ones purely because that's what we're used to here in the UK.

As mentioned above when on any thyroid medication that is or contains T3 then TSH is going to be low and very likely suppressed, that is just what T3 does, plus TSH is not a marker of thyroid health, only FT4 and FT3 tell us that, so we can basically ignore your TSH result and concentrate on your FT4 and FT3.

As you can see, your FT4 is only 29.7% through it's range and your FT3 is only 27.78% through it's range. Both of these are very low and suggest undermedication. Rather than reduce your dose these results suggest that you should increase it. When T3 is in the mix it's often the case that the patient feels best when FT3 is in the upper part of it's range so the aim would be to get it over 50% and then see how you feel.

could there be a connection between time of taking thyroid and difficulty sleeping? I take my tab before breakfast and sleep particularly badly from 3 or 4 am onwards.

Everyone is different so only experimenting with time of taking your tablet will tell you when is the best time for you to take your thyroid meds. Some people take it at bedtime and find it suits them better, some are happy taking it in the morning.

As you take benzodiazipines then you already have an existing sleep problem and your timing of the thyroid tablet may or may not have some bearing on your sleep.

[ceramo in reply to SeasideSusie]

Oh, that is really interesting. Something has to change. I had no idea and will now gradually build up dose. It would be so much more convenient to end up taking 1 complete tab rather than 3/4! Thank you so much for your advice.

[ceramo]

I forgot to ask, could there be a connection between time of taking thyroid and difficulty sleeping? I take my tab before breakfast and sleep particularly badly from 3 or 4 am onwards.