Whats going on

[susiebow]

Taking 75 mcg thyroxine and 5 mcg t3 daily.Bloods are TSH 1.75 0.4-4, t4 14.4 11.5 -27, t3 5.2 3.3 -6.1.So feeling bit better but could improve.I take 75 mcg thyroxine and 5 mcg 5 days a week and raised to 87.5 thyroxine and 5 mcg 2 days a week,for about 5 weeks.I feel really anxious and hot hands and odd,feels like overmedicated,but how can I be with above blood results which were taken about 8 weeks ago.Would increasing thyroxine increase t3 ,and can you have high t3 with tsh of 1.75.I dont know wether to persivere with this increase or not.My pulse resting pulse is 64

[Jaydee1507 Administrator]

Feeling over medicated when you're not is often due to low vitamin levels or not enough thyroid hormone or both. Are these the same results from a month ago?

I am assuming you have tried Levo only before and perhaps a poor converter?

Free T4 (fT4) 14.4 pmol/L (11.5 - 27) 18.7%

Free T3 (fT3) 5.2 pmol/L (3.3 - 6.1) 67.9%

As you're on some T3 I would expect to see your TSH suppressed which it isn't , it's not even below 1 yet so clearly you need more of something and the inbalance or fT4 to FT3 suggests more Levo is required.

I've looked through your previous post but couldn't find where you have posted your vitamin results. Perhaps ask GP to test ferritin, folate, B12 & D3 or there are options privately on this link with discount codes. thyroiduk.org/help-and-supp...

If vitamins are not OPTIMAL we caannot use our thyroid hormone properly.

[susiebow in reply to Jaydee1507]

Thanks for that info Jaydee,I have been on combo of t3 /t4 since last march.I have felt better on combo,but my t4 has always been a lot lower ,I know that happens on t3 .But I cant tolerate anymore than 10 of t3.I felt better on 62.5 thyroxine and 10 t3 but felt I needed more thyroxine.So Endo said I could raise thyroxine to 75and take 5 of t3.My vit d was 28 about year and a half ago,so on vit spray.

[Jaydee1507 Administrator in reply to susiebow]

What were your other vitamin levels then? Really need to get them all tested at least annually, twice a year for D3.

[susiebow in reply to Jaydee1507]

Gp not done my vitamin test ,only vit d.They are not keen to do them.

[susiebow in reply to Jaydee1507]

Yes this is what I have been thinking and why the increase of thyroxine for 2 days ,as I am sensitive to any change in doseage.The thing is I dont know why I have more aches and pains ,feeling hot on excertion and slight headache since increase.

[Jaydee1507 Administrator in reply to susiebow]

Low vitamin levels may well be the cause but unless you get them tested you will never know. Perhaps try a different more helpful GP at the same praactice, that often works. Failing that its down to the private tests. With your TSH above 1 on T3 they may even be hypo symptoms.

[Trina64]

Do i understand you correctly, you don't take your T3 everyday? I still have hypo brain, so may not be following your post correctly. If that is the case, no wonder you feel so awful. I take T3 and must take it consistently everyday.

[susiebow in reply to Trina64]

Hi I take My t3 every day.

[Trina64 in reply to susiebow]

Okay....I am still in the process and my brain is still fuzzy. I wish I knew the answer. Is it possible the T4 is converting well into T3 now and you need less T3? Possibly try just 1/2 the T3 now? I have been over medicated on NDT and it isn't pleasant.

Since it has now been 5 weeks, can you test again and see what is going on? I know it is better to wait until 6 weeks or more, but obviously something is going wrong.

[SlowDragon Administrator]

How much vitamin D are you taking

Essential to test vitamin D, folate, B12 and ferritin at least once a year

[tattybogle]

Hi Susie .. so these bloods are from a couple of months ago ,

(after being on on 75mcg levo/5mcg T3 from Nov 17th ~ to this test taken sometime in January ?. so you did at least 6 weeks on stable dose of 75mcg levo / 5mcg T3 )

Important to remember that the last dose of T3 was 24 hrs before this test . so the fT3 is 'really' a bit higher than what it looks here.

"when I got bloods done at gp surgery, for endo, they said they need thyroid bloods for gp. I said can't you just take the results of the endo bloods ?. They said no. Got endo results TSH 1.75 and gp TSH 1.69 !! From same blood taken"

TSH 1.75 (0.4-4), t4 14.4 (11.5 -27), t3 5.2 (3.3 -6.1)

TSH 1.69 t4 is 14.4 t3 is 5.1 "Bloods taken 08.30 am ,no thyroxine or t3 for 24 hrs, no ranges yet "

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

Then on Feb 17th (just after your bereavement) you wrote:

"I have increased thyroxine to 87.5 2 days a week for past 3 weeks and feel terrible , would that small dose increase have had such an effect on me. ...... I feel like I did 2 years ago when was over replaced, but can't be with above bloods"

So you went back down to 75 to allow things to settle.

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

On March 2nd (3 weeks ago) you wrote : "So feeling bit better but could improve. I am keen to raise thyroxine to 87.5 two days a week, to try improve t4 levels".

~ So by my reckoning you have now been back on 75/ day + 5mcg T3 for 5 weeks ( since about 17th Feb) .

Given that a lot has happened to you since these results were done , and that they were not done correctly to see the fT3 level..... and that you reacted quite badly to your 3 week trial of a tiny levo increase ... then in an ideal world you would wait another week (so it's 6 weeks on stable dose) and then get another blood test done correctly (12 hrs from last dose T3 , 24 hrs from last dose T4),.. so you knew where you really are with your T3 levels before considering if you should try more Levo again .

Your fT3 was definitely higher than 5.2 in Jan ... because you left 24hrs ..

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

If you can hang on and test TSH / fT4 / fT3 correctly in a weeks time , then i think you should .... so you have a clear picture of where you are NOW ,before you change anything again.

[susiebow in reply to tattybogle]

Hi tattybogle,I had been on 75 thyroxine and 5 t3 for 12 weeks when i last had bloods above,was feeling a lot better ,but room for improvement,and taking 75 thyroxine and 5 t3 5 days and 87.5 thyroxine and 5 t3 2 days a week for past 8 weeks.I do feel my t3 may be higher than stated,because I take my t3 and thyroxine in morning ,if I got bloods done I would have to take thyroxine in morning 24 hours before bloods and t3 in the evening before bloods.If my t3 is high how could I reduce it as I feel I need my t4 a bit higher than 14.4,it would have to mean I need to reduce t3 to 2.5 whuch is a very tiny amount.Does this make sense ? I really do not understand why my t3 is so high .

[tattybogle in reply to susiebow]

oh , i see, i thought you'd gone back down to 75/ day ,, sorry for the misunderstanding

So ...even more reason to test correctly before you change anything.. to find out where your fT4 is now you 've had 8 weeks on 75x5 /87.5 x2 (+ 5mcg T3) .

"because I take my t3 and thyroxine in morning ,if I got bloods done I would have to take thyroxine in morning 24 hours before bloods and t3 in the evening before bloods".

I'm not sure how people who just take a small dose of T3 once a day in the morning usually test to get 12 hrs for fT3 .... ask SlowDragon / SeasideSusie how they recommend you do it ~ (Last bloods were on 75mcg Levo / day + 5mcg T3 TSH 1.75 (0.4-4), t4 14.4 (11.5 -27), t3 5.2 (3.3 -6.1) Bloods taken 08.30 am ,no thyroxine or t3 for 24 hrs )

"If my t3 is high how could I reduce it as I feel I need my t4 a bit higher than 14.4,it would have to mean I need to reduce t3 to 2.5 which is a very tiny amount.Does this make sense ? I really do not understand why my t3 is so high "

~ We don't know T3 is too high , might be fine.

~ Your fT4 is probably a bit higher than 14.4 now because that test was done on 75mcg / day .

~ If you do decide to increase Levo more , it doesn't necessarily mean you would have to reduce T3 ~it depends where fT3 is and how you feel .

.

Do you feel better on 75 x 5 / 87.5 x2 than you did on 75/day .. or is it difficult to be sure , given everything else you've been dealing with ?

[Lalatoot in reply to tattybogle]

Some folks who dose once a day choose to test 24 hours after t4 and t3 dose because this is in reality a true measure of the lowest their levels get. This is fine as long as they interpret their results as such

If I want an 8 to 12 hour gap after a dose to get average results, which I do for t3, I do that by getting afternoon bloods done accepting the impact that a later test has on TSH. I found this suited me better as my body didn't like me altering my t3 dosing regime.

Who would think that getting blood taken could be so difficult and have so many different ways of being done? It can get quite confusing for folks, I'm sure!

[susiebow in reply to tattybogle]

Hi tattybogle,I feel worse with the added 87.5 2 days a week with 5 of t3,but I do want my t4 higher than 14.4,but it seems my t3 is too high and I feel that .Yes ,that is a good idea about bloods ,as I too do not like altering my dose timming.Thanks for that.

[tattybogle in reply to susiebow]

I'm curious why you want fT4 higher than 14.4 ?

that level would be fine for some people and so it's perfectly possible that 14.4 is fine for you ....... and if increasing to 87.5 for 2 days feels worse than 75 x 5 did , i think that is a big clue that perhaps YOU don't need a higher T4 than 14 .4

Some people feel best with a highish T3 and a lowish T4 . Individulity is the thing , just because higher fT4, or balanced T4/T3 , might work for 'most' people, it doesn't mean you need it any higher than 14.4

it is quite common for 'healthy' (unmedicated) people to have their T3 a little bit higher than their T4.

See graph below ~ 6 out of those 10 healthy unmedicated people , have their T3 a little bit higher than their T4 .

Also note how common it is to have pretty low T4 levels (some lower than 25% through range)... granted we can't directly compare hypo people on medication to healthy people who aren't , but it's just to give you an idea of how individual everyone is ,and show there in no reason to assume you need to have a higher fT4 than 14.4

I understand lalatoots reasoning to do an afternoon test get a 8-12 hr fT3 without the need for meddling with dose times, BUT if you are also interested in accurately comparing your fT4 level to your previous fT4 level, then i think i'd go with slowdragons idea (9 am test , just split the T3 the day before and take half at 9pm) , because that way you still keep a 24 hr gap for Levo and then you can compare your fT4 level now to your last test.

(if you did do an afternoon test , then your last dose levo would have to be moved to get 24hrs .. or else it wouldn't be a proper comparison to your last 14.4 result )

,

[susiebow in reply to tattybogle]

That is really interesting,thankyou for that.I think I am caught up the bloods have to be optimal school of thinking.

[tattybogle in reply to susiebow]

yes .. i wondered if you might be ..

i think you'd do better to stick to the " do i feel better ? , if so , carry on doing what i'm doing and don't fiddle with it just yet " school of thinking ...lol

[susiebow in reply to tattybogle]

Hi tattybogle,yesterday I only took 2.5 mcg of t3 with my thyroxine and felt better not so hot and anxious,it may be that i can only tolerate a small amount,I do not know.My t3 levels before I started t3 were 5.5 and have always been quite good.The Endocrinologist said I had been over medicated for years,I must say since reducing thyroxine dose I have felt a lot better,but not right.Thats why we went for adding t3.I still want to persevere with t3, but is 2.5 dose ok.

[tattybogle in reply to susiebow]

no reason why it wouldn't be.. if it's ok for some people to need more than expected , then it's ok for some people to need less than expected.

i do think though, that while you have been on 5 T3 +(75x5 / 87.5 x 2days) Levo for 8 weeks now would be the perfect time to test and see what your T4/T3 levels are ,, then you can have that for reference, might come in handy later next time you get lost .

Then after that , if you want to try (75x5/ 87.5x 2) + 2.5mcg T3 ,, give that a go for a few weeks and see how that feels ?

Tiny adjustments of one thing at a time , long enough to allow it to settle in , then test..... seems to be the best way to go .

[susiebow in reply to tattybogle]

Thanks again tattybogle ,as usual, a great help.

[SlowDragon Administrator in reply to susiebow]

I would cut 5mcg T3 in half day before test

2.5mcg waking and 2.5mcg at 9pm before test

[SeasideSusie Remembering in reply to SlowDragon]

This is what I do. I normally take T3 all in one dose with my Levo in the early hours of the morning. When testing I split my dose into two the day before, move the Levo + 1/2 my T3 dose to 9am instead of around 4am and the second half I take betwee 9pm and whenever I go to bed, the second dose tends to usually be about 10-11 hours before test. I don't get an immediate "hit" from taking T3 so changing the time doesn't make any difference to me.