What on Earth's going on?

[Puddleperson]

How can an increased dose of NDT result in an increased TSH! Like most on here I wouldn’t normally worry too much about TSH but I’m consulting a private endo and he clearly does think it’s relevant so I need to respect that. Also, I’m decidedly not as well as I was before the dose increase/decrease in November and certainly not as good as I was back in 2020 or indeed the previous 10 years.

TSH 0.35 – 4.5 FT3 3.9 – 6.8 FT4 11-24

Sep 20 0.005 6.59 6.9

May 21 0.005 7.3 6.1

Jan 22 .89 5.23 0.5

Sep 22 .33 5.39 0.5

Oct 22 .26 4.1 3.6

Jan 23 2.02 2.8 5.4

Is it as simple as I need to increase my T3 dose back nearer to where it was last year? I have taken the DIO2 gene test and it was negative. Are there other things that can inhibit T4-T3 conversion?

Here’s some background:-

I have had hypo symptoms since 1993 immediately following a hysterectomy. By 2009 I was too unwell to live a normal life so consulted GP. Blood test showed Autoimmune Thyroid Disease and TSH of 3.24 but GP said everything was fine, so no treatment needed and no advice offered.

I consulted Dr P, a month later, in 2009, he said everything was not fine and suggested OTC thyroid and adrenal supplements plus T3. My health then improved considerably, not everything perfect but good enough. At the end of 2020 the thyroid and adrenal supplements were discontinued. I did not replace them but monitored temperature and heart rate for a while to see if I could detect any deterioration. Nothing was obvious.

During 2021 I started to gain weight and feel the cold more than I should, then the brain fog came back along with the feeling tired and lack of energy etc. etc..

I consulted a Hashimotos specialist nutritionist last year to ensure I had the right diet and supplements so am pretty confident that part of my jigsaw is OK. In Sept last year I consulted a private endocrinologist who was recommended. He prescribed Erfa 30mg and reduced T3 to 25mcg (I had been taking 37.5mcg before but with no other meds). The brain fog lifted and I started to feel better, though not completely, after 6 weeks dosages were changed to 45mg Erfa and 12mcg T3.

I’m now not feeling so good, but seeing the endo again at the end of this week, what should I be asking/telling him?

[tattybogle]

30mg Erfa / 25mcg T3

changed to:

45mg Erfa /12mcg T3

THE TSH went up because this was an overall decrease in dose.

Erfa :

30 mg tablet contains: 17.5mcg T4 ... and 4mcg T3

so 45 mg Erfa contains: 26.25 mcg T4 ..and 6mcg T3

But T3 dose was reduced by 12.5 mcg .. so an overall reduction in T3 of 10.5mcg

and the increase of 8.75mcg T4 does not make up for the loss of 10mcg T3

because T3 is about 3 or 4 times as strong 'in it's effect' as T4 is .

~~~~~~~~~~~~~~~~~~~~~~~

(to make up for the loss of 10.5mcg T3 and keep the overall ' strength' of the dose the same , he would have needed to add about 30 or 40 mcg T4 , but he added 8.75 ... so you had a dose reduction not a dose increase )

p.s that is purely the 'maths' answer ... you'd better let someone else come along and answer what do actually 'do' about your doses , as i don't take NDT or T3

... but it looks to me like he reduced the T3 in half purely to try and get the TSH up ~ when aside from the TSH level there was no 'real' reason to reduce it anymore than he already had done , as fT3 was already fairly low at 4.1 [ 3.9-6.8] in October and fT4 was also extremely low.

[Puddleperson in reply to tattybogle]

Thank you so much Tattybogle for explaining it so clearly. That will be extremely helpful when I see the man next week. Given how I'm feeling now and and how I was in Sep 20 it seems pretty clear to me what needs to change and where the numbers need to be. Hopefully the endo won't argue with that but if he does at least the T3 is under my control as I have a decent stock of that!