Latest Bloods

[AleB]

Hi All

I have tried since 26th October 2022 to increase my T3 with Liothyronine. A very tiny amount of 1.25mcg at night, it seemed to be working fine until 2 days after my blood test - high heart rate and increased sweating at night, feeling too hot during the day, despite the weather being so cold.

I currently take 2 days of 100 mcg levo and 5 days of 87.5 mcg levo along with 1.25mcg lio at 6.15am, 2pm and 10pm. I also changed taking my levo at night to see if this made a difference, granted I should have changed only one thing, but I was desperate.

Bloods from 11th Jan 2023 - fasting, changed the timing of the levo and lio to time with blood draw.

CRP <0.3 mg/L (Range 0 - 5)

Ferritin 83.8 ug/L (Range 13 -150)

Folate - Serum 24.42 ug/L (Range > 3.89)

Vitamin B12 Active >150 (Range 37.5 - 150)

Vitamin D 100 (Range 50 - 200)

TSH 7.76 (Range 0.27 - 4.2)

Free T3 4.23 (Range 3.1 - 6.8)

Free T4 17.7 (Range 12 - 22)

TgA 13 IU/mL (Range <115)

TPA 69 (Range <34)

GP Bloods 26th October 2022 - This was when I was taking levo in the mornings not at night.

The T4 rose slightly from my last test 15.6 (range 12 - 22)

TSH 8.9 (Range 0.27 - 4.2)

T3 3.2 (Range 3.1 - 6.8)

Apart from trying to increase my ferritin again, I have been off Iron tablets for some 2 months, and yet looking back at previous blood results my ferritin has been 132 and yet I still feel like death.

I have removed the bedtime dose of T3 1.25 mcg, although I sleep a bit longer I feel knackered all the time, stiff neck, stiff shoulder, burning in right hip. Dizzy and lacking focus or concentration. Every time I try to slightly increase the T3 I feel like I'm doing ok, then it comes to a point where it's too much... too hot, high heart rate, sweating, tremour. When I was taking 5mcg of T3 during the day, and on 87.5 mcg levo, my legs were shattered, still sleeping during the day. Also, I have not had a period since November, usually every 3 weeks 3 days, but now nothing. I had sex hormones tested on 5th August 2022 to see if this was part of my problem ... I was informed they were fine, I have a print out of them, but cannot really be sure if it's ok for my age (48), the prolactin level was 316 mu/L (Range <700)

I don't know what to do now, do I stick with what I have reduced to and suffer the pain and sleeping during the day again, or try to increase the T3 and reduce the T4 ... either way I'm going to suffer because the TSH will drop before the T3 increases. Or, can I try to increase the T4 by a small amount of 12.5 over the week - these really are small adjustments, is it too small? I would really appreciate some help as I am doing this alone.

[GlowCoach Administrator]

Free T4 (fT4) 17.7 pmol/L (12 - 22) 57.0%

Free T3 (fT3) 4.23 pmol/L (3.1 - 6.8) 30.5%

Your FT4 isn't too bad, just FT3 is struggling. I do wonder if when you increase you are hitting a seam of hypo symptoms that might vanish if you continue with that dose? I have personally had the most terrible hyper type symptoms when under replaced.

Perhaps going 'all in' with a 5mcg increase might help long term?

[AleB in reply to GlowCoach]

Hi Jaydee, if I go in at 5mcg it's too much... I had to drop T3 by half to 2.5mcg per day as I was jittery, sweating and shaking back in January 2022Results were:

TSH. 1.92 (range 0.27 - 4.2)

T3 4.25.(range 3.1 - 6.8)

T4.16.8.(range 12 - 22)

I can't seem to handle more than 8 weeks on a T3 increase. I'm no better than a year ago, it's really starting to affect me.

[GlowCoach Administrator in reply to AleB]

Free T4 (fT4) 16.8 pmol/L (12 - 22) 48.0%

Free T3 (fT3) 4.25 pmol/L (3.1 - 6.8) 31.1%

You do realise that jittery, sweating and shaking are hypo symptoms? You do seem to be just undermedicated.

Have you tried lactose free Levo? That helped me so much.

[AleB in reply to GlowCoach]

But why does my heart rate go so high, and what about the feeling of being too hot all the time? I understand that T3 lowers T4, but my heart rate is just too high and I lose too much weight.

[GlowCoach Administrator in reply to AleB]

What is your normal heart rate and what is a high heart rate on T3?

How much weight did you lose? Do you have weight to lose?

I have definitiely experienced a higher than normal heart rate when undermedicated but luckily it was a passing phase when my dose was increased and it settled. I do have dysautonomia.

[AleB in reply to GlowCoach]

Around 70/75bpm, I lost aroud 6lbs, quite a small frame anyway, but when the weight goes up (usually watercweight), it's incredibly painful and uncomfortable. I had my heartcchecked by two cardiologists one NHS (who were very thorough), one private (not so thorough). I tried NDT about 3 years ago, was ok but never got out of first gear so to speak, endo reduced it, he added in 25mcg of levo... I spent 2 months sweating up, sleeping, GP said my TSH was suppressed, told to come off it and go back on T4... I no longer consult with the GP, he knows less than I do. I can no longer afford to see an endo, and will not see an NHS endo again... they refuse T3 (even though I have Di02 conversion problem) it's T4 and that's it.

[GlowCoach Administrator in reply to AleB]

70/75 isn't a high heart rate. When hypo our Heart rate can drop but when better replaced it will go back to a more normal rate which will be higher.

When going from severely hypo to a more normal metabolism by taking Levo I have experienced heat intolerance/ the feeling of being too hot, despite clearly being very hypo. The body can play tricks on us sometimes.

[AleB in reply to GlowCoach]

So could I reuce the T4 slightly and increase T3 back by 1.25mcg?

[GlowCoach Administrator in reply to AleB]

Reminder of your latest results:

Free T4 (fT4) 16.8 pmol/L (12 - 22) 48.0%

Free T3 (fT3) 4.25 pmol/L (3.1 - 6.8) 31.1%

You actually have acres of room for an increase in either or T4 and T3.

[AleB in reply to GlowCoach]

My latest bloods 11th Jan were T4 17.7 and T3 4. 23.

[GlowCoach Administrator in reply to AleB]

Free T4 (fT4) 17.7 pmol/L (12 - 22) 57.0%

Free T3 (fT3) 4.23 pmol/L (3.1 - 6.8) 30.5%

Baring in mind we are aiming for a FT4 of around 60-70%, same with FT3.

Your TSH is calling for quite a bit more thyroid hormone at 7.76.

[AleB in reply to GlowCoach]

So keep t4 as is and try again with T3, extra 1.25 at night or am.

[GlowCoach Administrator in reply to AleB]

Honestly you really don't need to be reducing anything at all, you need to increase. The longer you are hypo the symptoms are just going to be stacking up. Increasing is going to cause a change in your symptoms and some may get worse before they get better. If you feel jittery then try and go for a walk to get your circulation going.

The timing is up to you as you know when you need a tiny bit extra.

[AleB in reply to GlowCoach]

Morning JaydeeI am going to add back the 1.25mcg of lio at 10pm, I am also going to split the levo to am and pm so it's gentler on my system. Will keep an on pulse etc and symptons. Thank you so much for your help, I really appreciate it. 😊

[SlowDragon Administrator]

which brand on levothyroxine are you currently taking

Do you always get same brand at each prescription

Have you tried splitting levothyroxine dose

Half waking and half at bedtime

Have you tried taking 100mcg levothyroxine everyday?

As you have Hashimoto’s are you on strictly gluten free diet and/or dairy free

[AleB in reply to SlowDragon]

Hi SlowDragonSo it took a while for my body to adjust to the night time dosage, if I go straight in and increase by 12.5 extra over 5 days it may prove too much all at once... I tried to increase 2 day's at 12.5 (so increase of 25mcg overcthe week), initially it was great then by the end of the second week I was sweating up again, heart rate in the 90's, so reduced that and increased T3 cautiously to 1.25mcg lio at bed time to help me sleep. I did sleep initially, but then waking up after 2 hours the 3 hours... averaging 6 hour's broken sleep. Gradually the heat was getting too much for me within 3 hours of taking T3. It seemed the obvious one to reduce. I take the same brand of levo, strictly gluten and dairy free, also very strict about taking supplements away from meds etc, I could try and increase levo by 12.5mcg over a week, or split the doseage as you have described.