New tests, endo appointment next week

[Pearlteapot]

Hi everyone

I changed endo recently. He is or was considering prescribing T3. I have an appointment next week and I wondered what people think of my new test results

A little recent background: I had been taking 112.5 mcg of Levo and my results were

4 October 2022

TSH 2.21,

T4 15.2 (12 -22 )

T3 3.91 (3.1-6.8)

I carry CC alleles for DIO2

My old endo increased the dose to 125mcg on the basis of those results and symptoms (continuing fatigue, burning feet, hair loss, hearing loss . He then retired. I went to a new consultant who, on the basis of the same tests, increased my dose to 150mcg to try to get my TSH below 2 before deciding whether to prescribe T3 or not. To clarify, I was on 125mcg for only 2 weeks before going up to 150mcg which I have been on for 5 weeks.

New test results 18 November 2022

TSH 0.21 (0.27 - 4.2)

T4 23.3 (12-22) 113%

T3 5.1 (3.1-6.8) 54.1%

The first couple of weeks on the 150mcg dose, I was continued to suffer fatigue, hearing loss was getting worse, generally felt good in the mornings and rubbish by late afternoon. Then over the last week things have improved. I can exercise without being wiped out for days and although I still get thyroid headaches and fatigue it is minor compared to before. I don't find this surprising because my T3 is the best it has ever been at 5.1

Now my question: Test shows I am over medicated or at least my GP thinks so. I am worried that if I reduce the Levo my T3 will go down to misery levels again. It looks as if it takes a lot of T4 to get my T3 to a decent level. I'm assuming the first step may be to reduce the levo just a little, to 125/150 for example and then wait and see what happens.

But on these figures should I be pressing for a T3 trial so that I don't have to have such high T4 levels to reach a decent level of T3?

Endo was considering T3 for me before. I'm not sure if these figures support going ahead with a trial or not?

Edited to add: D3 is 128 (50-250), Folate 29.4 (8.83-60.8), B12 89 (37.5-189), Ferritin 135,

Thoughts please?

TIA

[SeasideSusie Remembering]

Pearlteapot

My thoughts:

1) You should have stayed on 125mcg Levo for a full 8 weeks to see how your levels were on that dose.

2) You've tested too soon after increasing to 150mcg, you should leave at least 6-8 weeks for levels to settle.

3) Your FT4 is showing over range so suggests too high a dose of Levo.

4) Looks like poor conversion of T4:T3 but I think you need longer for levels to settle before this decision can be made (but I wouldn't be surprised if T3 would be beneficial and you might not need too much).

[Pearlteapot in reply to SeasideSusie]

I agree with all of that. Do you think I should ask to stick at 150 for a further 3 weeks notwithstanding the current test showing too much T4 or go down to 125/150 and stick there for 6-8 weeks before reviewing the T3 options? I feel mostly okay at the moment on 150mcg despite having too much T4. I weigh 79kg so its somewhat over range on that metric too.

[SeasideSusie Remembering in reply to Pearlteapot]

Can you rearrange your endo appointment?

Not much point in changing dose now if you have to stick to next week's appointment. If you have to go next week discuss options including reducing Levo, waiting a couple of months to reassess results then decide about T3.

But if endo wants to give you T3 on those results I'd go along with it but reduce Levo a bit before adding T3. Endos usually want to reduce Levo by too large an amount.

These really are just my thoughts, I don't have the problem of dealing with endos, I do my own thing

[Lalatoot]

Pearl, there is some evidence that a lower ft4 level is preferable to a very high one.

healthunlocked.com/thyroidu...

If your results settle long-term with needing high ft4 to be able to get a decent level of ft3 then I would consider adding lio t3. We don't always need much lio. Adding 7.5mcg lio brings my ft3 up to 72% (from 16.7%)

[Pearlteapot in reply to Lalatoot]

Hi Lalatoot thanks for the link to the cancer risk study. I remember reading that high t4 is also bad for cardiac health. My feeling is also that I will need a small amount of T3 to bring down the T4. I guess, as SeasideSusie says the question is whether to go to the appointment and see if he wants to do that trial now or defer the appointment and re-test on this level. I think I'll go to the appointment and if he wants to wait longer then fair enough.

Life must feel pretty good on 72% T3?

[Lalatoot in reply to Pearlteapot]

Yes and no! I was wrongly medicated for so long that my body had adapted and switched of non essential features, as it were. So it has been along road even with good hormone levels to get fully functioning again. Still a bit to go but I am so much better.