Can you help me get back on track please ?

[Confide55]

Hello lovely people I hope you are doing ok today. I haven't posted for quite a while as a lot has been happening, but I now have time to focus back on my thyroid. I Just need to fill you in on some info :-

Visited GP Nov 2021 - Blood test - T3 below range - Refferel to Endo at hospital at my request. I was taking 100/125 mcgs Levo alternate days but feeling very tired.

Endo Appt Feb 2022 - Agreed to a 3 month trial of 20mcg and reduced Levo to 75mcgs.

Follow up Endo Appt May 2022 - Endo agreed T3 at 20mcgs could continue but Levo to reduce to 50mcgs following blood test and wrote to GP.

Follow up Endo Appt August 2022 - Following TSH blood test Levo reduced to 25mcgs and T3 contunued at 20mcgs and wrote to GP and signed off from Endo.

Self referred myself back to Endo October 2022 - TSH only blood test allowed which showed as 1.61 which she thought was perfect ! Persuaded her to increase Levo to 25mcg/50mcg she wrote to GP to confirm this. Basically she was not at all interested in how I felt only in the TSH figure. Very disappointed as she is the head of endo at the hospital and initially seemed very interested in helping me. I finally thought I was getting somewhere so was keen to follow her advice !!

Fast forward I am now taking 50mcgs per day along with 20mcgs of T3 and have done for the past 7 weeks so plan to increase to 75/50mcgs. However before I contact my GP for an increase in prescription can I ask for advice please. I have listed below my most recent blood test.

MEDICHECKS - 22 SEP 2022

TSH - 3.20 (range 0.27-4.2)

Free T3 - 4.75 (range 3.1 - 6.8)

Free T4 - 8.3 (range 12-22)

CRP HS 0.40 (range 0 - 5)

Ferritin 61.8 ug/l (range 13 - 150)

Folate 14.48 ug/l (range 3.89 - 19.45)

Vitamin B12 Active - 109omo/l (37.5 - 150)

Vitamin D - 66 nmol/L (50-200)

Thyroglobulin Antibodies - 14 iu/ml (Rang <115)

Thyroid Peroxidase Antibodies <9.0 IU/ml (Range <34)

ENDO Appt - OCT 2022

TSH 1.69 (0.35 - 4.94)

MONITOR MY HEALTH - 14 NOV 2022

TSH 1.26 (0.27 - 4.2)

FT3 - 4.7 (3.1 - 6.8)

FT4 - 9.6 ( 12- 22)

GP - 08 DEC 2022

TSH 1.61 (0.35 - 4.94)

FT3 - 4.9 (2.4 - 6.0)

FT4 - 7.6 (9 - 19.1)

Vitamin D - 103 nmol/L (50.0 - 120.0)

Ferritin - 69ug/l (23.0 - 300.0)

Vitamin B12 - 569 ng/l (187.0 - 883.0)

Folate 13.9 ug/l (3.1 - 20.5)

MONITOR MY HEALTH - 08/02/22

TSH - 0.32 (0.27-4.2)

FT3 - 5.2 (3.1-6.8)

FT4 - 10.4 (12-22)

My recent blood test shows my FT3 and FT4 have improved but for some reason my TSH has changed drastically. Does anybody know why this would happen ? How can I improve my T4, is it just a matter of increasing my Levo dose ? Should I be increasing or decreasing my T3 dose along with increasing my Levo dose ? My goal is to get 50% through range on T4 and 75% through range on T3 , do you think this is a good plan ? So many questions I know my GP wont be able to answer them !! I am currently taking Vit B Complex, Vitamin D with Vit K, Magnesium and Vit C which do help with tiredness. Basically I need to go back to my GP to get an increased Levothyroxine precription so any advice you can give would be most appreciated so I don't get fobbed off as being just another neurotic/menopausal woman in her 50's !!

[Regenallotment]

amazing post, good for you! I think you know the answer 😊 well done advocating for yourself.

What was that Endo thinking reducing your Levo so much, awful.

I’m sure more experienced members will be along to reassure you, I just wanted to say 👏👏👏 for knowing yourself 🌱

[Confide55 in reply to Regenallotment]

Thank you Regenallotment, unfortunately we put our trust in Endos and GP's but we all need to inform ourselves and make our own informed decisions.

[Jaydee1507 Administrator]

So your Endo seems to have reduced your Levo by so much to get your TSH into the normal range that you became deficient in T4. Amazing, what a surprise! Also not unusual for them to completely disregard any symptoms you have. Some of them really only good at treating bits of paper.

Free T4 (fT4) 10.4 pmol/L (12 - 22) -16.0%

Free T3 (fT3) 5.2 pmol/L (3.1 - 6.8) 56.8%

There's now quite a disparity in your free numbers so it will take a bit of juggling to get them matching up better. It is said here that FT4 & FT3 need t be around 60-70%. Raising Levo will also raise FT3. So you may well need to drop a bit of T3 to be able to raise T4 comfortably.

Then you will need to be dealing with your GP and possibly Endo panicking about your suppressed TSH but we can deal with that when the time comes.

There's a little bit of room for improvement with your Ferritin. 90-100 is said to be when thyroid hormone is best used.

[Confide55 in reply to Jaydee1507]

Hi Jaydee Thank you for your reply. My Endo has signed me off to my GP so no longer interested so no problem there ! I just need to persuade my GP to increase my Levo. Increasing my Ferritin is proving difficult as I don't want to take iron supplements so trying to get it through foods. I will increase Levo by 12.5 and see what effect this has and then see if I need to reduce T3 to balance the two, I think that's a good plan !

[SlowDragon Administrator]

Were all tests done as recommended

Early morning, ideally just before 9am

Last dose levothyroxine 24 hours before test

Day before test do you always split your T3 as 3 smaller doses spread through the day and last 5mcg dose approximately 8-12 hours before test

Do you split dose T3 everyday

Endo was obviously a nightmare

Suggest you reduce T3 by 5mcg and increase levothyroxine initially by 12.5mcg……

Retest after 6-8 weeks

and most likely get up to 75mcg daily

Which brand levothyroxine do you take

[Confide55 in reply to SlowDragon]

Hello Slow Dragon thank you for replying. I am splitting my T3 10, 5 & 5. I am using Mercury Pharma which seems to be ok. I followed all the protocols for blood testing. Do you think the TSH was just a rogue result ? I am thinking of taking another MMH test to see what TSH I get. I will increase Levo by 12.5 mg then check again. As you say it's going to be trial and error trying to balance T3 & T4. Thank you for your help, I just needed reassurance that I was moving in the right direction.