Advice on Results Please

[FAB-jellybean]

Hello, I've been trying to find my sweet spot since starting HRT and discovering I was undermedicated. I've just had my latest test results back although I keep having issues with the blood samples for Medichecks so some tests have been redone and other are missing. Anyone else have issues with this and have you managed to find a solution?

Results from GP 6/6/22 on 100mcgT4 and 20mcgT3 (24 hrs since both T4 and T3 - wrong I know):

TSH 4.76 (0.27-4.2)

fT4 9.1 (10-22)

fT3 2.9 (3.1-6.8) I realise this is falsely low and is around the same levels as it was when I took T4 alone.

My T4 was increased from 100mcg to 125mcg and T3 stayed the same at 20mcg.

Results on 125mcg T4 and 20mcg T3 24/8/22: Bloods taken 8.45am fasting, 24 hrs since T4 and 12 hrs since last T3. No supplements for 8 weeks.

TSH 0.02 (0.27-4.2) -6.36%

fT4 14.9 (10-22) 29%

fT3 4.52 (3.1-6.8) 38.38%

Results from 136mcg T4 and 20mcg T3: 7/11/22 I've been taking 125mcg T4 4 days a week and 150mcg T4 3 days a week along with 20mcg T3. I split my doses and take T4 4 times a day and T3 3 times.

TSH - no result - problem with sample

fT4 - 14 pmol/l (Range 12 - 22) 20.00%

fT3 - 5.1 pmol/l (Range 3.1 - 6.8) 54.05%

Thyroglobulin Antibodies (2/11/22) 67.8 kIU/L (0 - 115) (9/11/22) 70.6 kIU/L

Thyroid Peroxidase Antibodies (2/11/22) 9.8 kIU/L (0 - 34) (9/11/22) 10.5 kIU/L

I'm still having symptoms, albeit mild and I'm not sure if that's just because it takes me a while to adjust or if I need to increase a little more. I'm think I need to increase my dose a little, the question is should I increase my T4 to 150 mcg every day (so a 100mcg increase in a week) or just increase a couple of days so 50mcg increase a week. I have no idea if my antibodies were tested when I was first diagnosed 20 years ago. I'm waiting to receive my GP and hospital records to see.

These are the results from other tests.

24/8/22 (after 8 weeks without any additional supplements).

MCV and MCH slightly above normal range and could apparently be macrocytic anaemia (common in thyroid disease) but needs to be considered along with B12 and folate.

Active B12 79.7 pmol/L (37.5-150)

Folate 17.47 ug/L (>3.89)

Vit D is flagged as low normal 69nmol/L (50-200)

Magnesium too low 0.67 mmol/L (0.7-1)

Female hormones (follicular stage)

LH too high 17.5 iu/L (2.4-12.6)

Oestradiol too high 1139 pmol/L (45.4-854)

Iron 20.1 umol/L (5.8-34.5) and Ferritin 72.1ug/L (13-150) but need to redo the TIBC and transferrin saturation as there was a problem with the sample.

Cholesterol also too high

Total 5.02 mmol/L (0-5)

LDL 3.05 mmol/L (<3)

Non HDL 3.54 mmol/L (<4)

HDL 1.48 mmol/L (>1.2)

Total: HDL ratio 3.39 (<4)

Trigylcerides 1.07 mmol/L (<1.7)

There was still a problem with the sample when repeated so didn't get the TIBC and transferrin saturation but Iron had increased to 23.5 umol/L (5.8-34.5) on 23/9/22 with supplementation.

Results from 2nd Nov and 9th Nov 22 as there was a problem with the sample.

Albumin (2/11/22) 36 g/L (35 - 50) (9/11/22) 38 g/L

SBGH (2/11/22) 111 nmol/L (9/11/22) 114 nmol/L (27.1 - 128)

FSH (9/11/22) 19.2 IU/L no range as taking HRT (Evorel Conti) that prevents menstruation

LH (9/11/22) 29.9 IU/L no range

Oestradiol (2/11/22) 1,051 pmol/L no range (9/11/22) 1,660 pmol/L no range

Testosterone (2/11/22) 0.97 (0.29 - 1.67) (9/11/22) 2.23 nmol/L

Free Androgen Index (2/11/22) 0.9% (0.2 - 7.1) (9/11/22) 2 %

Prolactin (2/11/22) 1370 mIU/L (9/11/22) 858 mIU/L (102 - 496)

I supplement with Magnesium Glycinate, Zinc, Selenium, Vit D3, K2-MK7, methylated B complex, Iron, Vit C, Omega 3 fish oil, Glucosamine, Full spectrum amino acids, Co-enzyme Q10, Ashwaganda and a probiotic. All taken with the correct times apart from each other and T3 & T4.

If nothing else, these last results show how wildly sex hormones can swing. If anyone has any advice about these I would be very grateful. I wasn't convinced that I needed the HRT so took a month off following the 24/8 results. I was fine for a few weeks but the menopause symptoms all returned by the end of the month so I restarted the patches again before the end of Sept.

Thanks for reading if you've managed to get this far. 🙏

[SlowDragon Ambassador]

Is HRT a patch or tablets you swallow

How much vitamin D are you currently taking

Need to increase dose

Perhaps try different magnesium supplement

Did you stop B complex 5-7 days before test

Are you on gluten free diet or dairy free diet

Do you always get same brand levothyroxine at each prescription

Same brand T3

[FAB-jellybean in reply to SlowDragon]

Thanks SlowDragon , it's a combination HRT patch that I've recently changed to. Been on patches for 2 years, previously 2 weeks oestrogen and progesterone then 2 weeks oestrogen only. Now both oestrogen and progesterone constantly and I have been feeling a bit better, and more balanced since doing that. Bit concerned about the very high prolactin from last week although it has come down significantly this week but still too high. Not sure what the link between high prolactin and hypothyroidism is about though, does that infer I'm still undermedicated? Although the testosterone levels have jumped this week (I weight/strength train, and had just returned to the gym 3 days previously after having a flu type virus, could this be why?), the FAI is till low because my SHBG is quite high (although within range). I'm assuming this is also holding oestrogen too with it being quite high. I'll wait until I've been on these combination patches for another couple of months before thinking about testing sex hormones again but would like to get a handle on what's going on and why.

Taking 4000IU D3 softgels now, I had stopped taking supplements 8 weeks before the vitamin tests just to see where my body was at. Prior to that I was taking 3000IU in tablet form. That Vit D result was after a month in the Moroccan sun. I started the supplements again straight after the test in August. Will retest vitamins again in a few months. Do you think I need more than I'm currently taking?

Magnesium, I had been taking magnesium malate before stopping while I was away and have been taking max dose of glycinate since the test. I get really bad muscle cramps when it's too low. My mum has the same issue (and is also hypothyroid but diagnosed after me) so I'm guessing it's a genetic thing.

Stopped the B complex 3 days before tests as it's not a high dose.

Tested neg for coeliac in Aug 2012 but went GF as I had gastritis (diagnosed by endoscope) and couldn't keep my food down. After almost a year I very gradually reintroduced gluten without issue. I am contemplating trying GF again though. Not tried dairy free.

Always the same brand of T4 (Almus 50mcg tablets) and T3 (Morningside 20mcg tablets) that I use to divide my doses. I don't react well to changes and had to yellow card Teva T3. I can use Mercury T3 (although not as good) if they absolutely can't find Morningside but that hasn't happened for a couple of years now.

Thanks so much for your help and advice, much appreciated. Often I can see what would help other people but it seems to more difficult when it comes to myself.

[SlowDragon Ambassador in reply to FAB-jellybean]

high prolactin pretty common with hypothyroid esp Hashimoto’s

Can’t comment on HRT ….never tried it

Personally I much prefer vitamin D mouth spray. It doesn’t need 4 hours gap between levothyroxine. It’s often better absorbed in mouth than tablets or gels in gut

I use Better You vitamin D with k2

One spray = 1000iu

I find 4 sprays per day in summer and 5 sprays in winter suits me ….but everyone is different

Some people only need one or two sprays per day

Magnesium

I prefer Thorne Magnesium capsules (I tip powder out into small cup water) taken immediately after dinner, min four hours away from levothyroxine

You might find my profile info helpful …

[FAB-jellybean]

SlowDragon what's your advice please for my T4? Do you think I can safely increase to 150mcg every day or only increase another couple of days. I've been taking 150mcg 3 days and 125mcg 4 days along with 20mcg T3 since mid Sept. I had been taking 125 + 20 since mid June prior to that.

[SlowDragon Ambassador in reply to FAB-jellybean]

I would initially try increase to 150mcg 5 days and 125mcg 2 days

Retest in 8-10 weeks

[FAB-jellybean]

Many thanks, that was what I thought myself so very grateful for the confirmation. 🙏