thyroid test results

[hippy66]

Hi all, long story short, back in December I was put on a trial treatment of Levothyroxine and liothyronine as my T4 was not converting to T3.

I am currently on 100m mcg of Levothyroxine and 20 mcg of Liothyronine.

My recent results have come back as follows

TSH 0.01(0.27-4.2)

T4 19.5(12-22)

T3 10.7(3.1-6.8)

My T4 has never been this good in the past on a higher dose but I am also taking ferrous numerate and vitamin D as they were both low so maybe that is the reason why my T4 levels are better. However, my T3 is way to high so I'm looking for advice on how slowly or quickly can I safely reduce my liothyronine and to what dose do people think I should stop at. I should have been retested after 6 weeks on this trial but luckily the Endo has forgotten about me so I've had time to play around with the dose myself before I see him again(whenever that may be).

Thank you in advance for your advice .

[Jaydee1507 Administrator]

What was the timing of your last dose of Levo and T3 prior to this test?

Did you stop any biotin containing supplements before the test?

Iron should be taken 4 hours away from Levo & T3.

What were your latest vitamin blood results?

T3 is usually adjusted in 5mcg increments so reduce by 5mcgs T3 and retest after 6-8 weeks. That is if you did the recommended test protocol of Levo 24hrs & T3 8-12 hrs before test.

[hippy66 in reply to Jaydee1507]

HI Jaydee,

Thanks for your reply. I had my last dose of thyroid meds the night before I did the blood test. I haven't had my vitamin levels rechecked yet but they're due to be retested anytime now. I am wondering whether I should have not had my thyroid meds the night before I did the blood test but would this cause such a big anomaly?

[Jaydee1507 Administrator in reply to hippy66]

How did you split your dose and how much did you take the night before?

Its a delicate balance finding the stable blood level. If you leave too longer gap you get a false low result. Too shorter gap and a false high. See attached graph with how blood levels change following a dose. 8-12 hours would be about right of 5mcgs last dose.

FT3 dose graph

[hippy66 in reply to Jaydee1507]

I take 100mcg levo and 10mcg liothyrine am then 10mcg liothyrine at around 10pm so there was around a 9 hour gap from my last dose and 24 hours from my first dose.In the past I think I've held off from taking my night meds but can't remember with my hashi brain the endo had put me on 50mcg levothyroxine one day then 75 the next which was a huge drop from the 112.5 I was originally on so I ignored him and listened to you guys and settled on 100mcg levo. I don't want him to stop the T3 because it's too high but suspect he might if I can't get it down before I see him next.

[Jaydee1507 Administrator in reply to hippy66]

That's an unusual split of T3. It has quite a short half life as you can see from the graph above. For 20mcgs T3 I would have recommended splitting 10mcgs morning, 5mcgs late afternoon and then 5mcgs bed time.

Had you done as I mention above your FT3 would have been lower although perhaps still a little too high.

Perhaps try 5mcgs 3x a day.

Your FT4 looks fine.

[Lalatoot in reply to Jaydee1507]

Jaydee there are quite a few unusual splitters here! And some no splitters!I found that it made no difference if I split my dose into 3 times a day or twice a day . So I settled on morning and night leaving the rest of the day clear for supplements.

I take 5mcg lio first thing and 2.5 mcg bedtime.

[Jaydee1507 Administrator in reply to Lalatoot]

Its important to get it right, even if only for the one day prior to a blood test, epsecially if an Endo will determine your final dose by the blood test.

[hippy66 in reply to Jaydee1507]

I do it this way just because I have to take other supplements of iron, vitamin D and B complex and there isn't enough time in between for 3 splits. I'll reduce the Lio by 5mcg and see how I get on with that.

[Lalatoot in reply to hippy66]

Hippy I found 2 splits better than 3 exactly for the reasons you're saying. It is what suits us individually.

[Lalatoot in reply to hippy66]

When to take meds before testing depends on how you dose and what you want to measure. And also what sort of results you want to present to an endo!

If you do bloods 2 - 4 hours after any dose levo lio then you will get the peak levels in your blood. Peak levels are not what we have to run on during most of the day so in general folks tend to avoid doing this. Having peak results also makes it difficult to argue for a dose increase if you are still symptomatic.

To get the lowest results your levels get to you count the longest gap between doses and then leave that gap between dose and blood tests. For folks dosing once per day that is a 24 hour gap.

If you want to measure the average levels in your you take the longest gap between doses and half leaving that gap between dose and test.

However you decide to do your blood tests it is better to follow the same protocol each time so that you can compare like for like. It is important to interpret your blood tests according to the gap you left too. This is so you understand that this is the highest, lowest or average levels of hormones in your blood.

I dose twice per day first thing and bedtime. The longest gap between my doses is 16 hours. I do not need to worry about TSH levels. The protocol I fell into was getting blood tests around 2pm and taking my morning lio at 6am but not taking my morning levo till after the test. This gives me a 16 hour gap for ft4 - levo dose - and an 8 hour gap for ft3 - lio dose. When I look at my results I know that my ft4 at 50% through range is the lowest it gets and my ft3 at 72% is the average I have through the day.

Now re your higher levels. Yes improved vitamins could contribute. But do you have autoimmune thyroiditis aka hashimotos? Is this a hashis flare where you experience a temporary surge in levels due to the autoimmune system damaging the thyroid?

Decreases in lio are usually in 5mcg increments. Wait 6 weeks and do bloods. I found that it took 4 days to a week for the effects of too high a dose to wear off after the reduction but then we have to wait for the knock on effects to settle.

It might be that when you reduce your lio that your ft4 will rise slightly as taking lio suppresses ft4 . I found that when I lowered my lio by 5mcg my ft4 tended to rise by 0.5 numerically so say from 14.5 to 15 for example.

I spent 2 years working my way up and down (and roundabout!) doses of levo and lio - anywhere from a levo daily total of 50mcg - 112.5mcg along with lio daily total from 5mcg -20mcg. In the end I felt that 100mcg levo and 7.5mcg daily totals split into 2 doses suited me best. I have been on that dose for nearly 2 years now and things are still improving symptomise.

[hippy66 in reply to Lalatoot]

Hi Lalatoot and thanks for your reply. I usually do my bloods in the morning before I take thyroid meds. Historically my T3 has been really low and T4 below average so it's. big difference in my results since starting liothyrine. I do have hashimotos so it could be a flare up. I don't feel over medicated apart from being heat sensitive but I am a female of a certain age so that is not uncommon. I'd like to get my levels right before I next see the endo which was supposed be in February but hey ho, it gives me more time to get my T3 levels under control before I see him next.