Blood results looking like subclinical hyperthyroidism

[Sewkate]

Please can I have some advice. I was first diagnosed with Hypothyroidism 30 years ago and have spent many years trying to get the correct medication and the right dosage for myself). I have been on Armour for 16 years ( this was after my first consultation with Dr Barry Peatfield) as I don’t convert T4 to T3 (this caused a toxic build up of T4). I also suffered from Adrenal fatigue. I then added T3 which I have been doing privately for the last 8 years). I have been suffering from depression (no obvious reason and I absolutely can suffer from thyroid based depression), lack of energy and enthusiasm, sweating, weight gain and terrible brain fog. I put this down to the after effects of covid March 2022 and or peri menopause. I am 53 years old. However I have just had blood test done for my thyroid (first GP only put down TSH, so I convinced another GP to add T3 and T4). I have pulled out my thyroid books but my brain just isn’t comprehending anything!

I am on 240mg (4 grains) of Armour,

Tiromel 50mcg this I reduced to 25mcg 5 weeks ago and stopped taking it about 10 days ago.

My latest test results from 17/03/2023 are

TSH:<0.01 mIU/L (range 0.35-4.94)

Free T4 10.40 pmoI/L (range 9.01-19.05)

Free T3 5.90 pmoI/L (range 2.63-5.70)

GP has sent a message saying I need to see my endocrinologist (well I said I need a referral for that don’t I!!)

Could I have been overdosing the T3 and put myself into subclinical hyperthyroidism?

Also I have the opportunity to order blood test privately in 2 weeks time in another country, I will also be testing my hormone levels for peri menopause to see if I’m on the right medication. So I’m happy to do further thyroid and adrenal tests.

Thank you in advance for any input or replies.

[tattybogle]

Hi Sewkate

"I am on 240mg (4 grains) of Armour,

Tiromel 50mcg this I reduced to 25mcg 5 weeks ago and stopped taking it about 10 days ago.

My latest test results from 17/03/2023 "

So the first point to understand is that the condition of 'subclinical hypERthyroidism' , (and anything you read about low TSH that calls it that) is not really relevant to peoople who are already taking thyroid hormones .. that term is used to describe people who have a low TSH who are NOT taking thyroid hormone.. so you will get confused if you read stuff about subclinical hyper.

When taking thyroid hormones the level of TSH 'in relation to the T4/ T3 level' is a bit different to what it is when thyroid is producing them , so 'low TSH' doesn't mean quite the same thing in people who are taking thyroid hormone replacment .

The second point to understand is that blood tests need to be taken after being on a consistent dose for at least 6 weeks otherwise the result will be misleadsing.

It can take TSH a long while to react to different T4/T3 levels .. and altering the T4/ T3 levels also affects how fast/ efficiently the deiodinases are converting T4 to T3 ,and T4 to reverseT3, and T3 to T2 .. these effects may also take a while to stabilise after any dose change , so it is not just the TSH result that may needs 6 weeks to stabilise ,, it is also the T4 and T3 results .

What dose (s ?) were you taking for 6 week before this test ?

[Sewkate in reply to tattybogle]

Hi Tattybogle. Thanks for your reply. 6 weeks before my blood test I was on 240mg of Armour and 50mcg T3. My TSH 1 year ago was the same as my latest results. So if it isn’t subclinical hyperthyroidism could it just be a case of too much T3?

[tattybogle in reply to Sewkate]

So 6 week before that test you were taking 50 T3 , then reduced to 25 ( when ? ie how long before the blood test did you reduce to 25mcg ?)

and then stopped (after the blood test ? )

if you lowered the dose during those 6 weeks, the TSH / fT4 / fT3 results are not going to be very reliable.

also .. to properly interpret fT3 / fT4 tests we need to know the time of the last dose ... ie, how many hours before the tests did you take the last dose of T3 ..... and last dose Armour ?

[Sewkate in reply to tattybogle]

Good morning. Yes 6 weeks before the test I was taking 50 T3 and I reduced this dose 4 weeks before my test to 25 T3 and then two weeks before my test I stopped taking T3. For the Armour I take 2 grains at night and 2 grains in the morning.However I didn’t take any armour the morning of my test which was at 10am. Gosh I am feeling a bit overwhelmed. Thanks for your reply.

[tattybogle in reply to Sewkate]

Hi , yes it is all a bit much to get your head round ..

So, because of those dose changes in the 6 weeks before your test ,, you need to ignore that TSH result ,, it's not correct for the dose you are on now ( TSH is a delayed response , so it's still showing the TSH response to your T4/T3 levels over the previous few weeks.. it hasn't had chance to catch up yet)

Looking at those fT4 / fT3 results ~ if the last dose Armour was 8-12hrs before the test ( which is the right time gap for testing Armour) :

Free T4 10.40 ( 9.01-19.05)

Free T3 5.90 (2.63-5.70) ..... fT3 was over range at that point (and it will have been even higher than that in the previous few hours), that means you are getting more than enough T3 from your dose of 4 grains armour , and adding ANY T3 to to your Armour dose was not necessary .. by adding a large dose such as 50mcg T3 to this will have meant your fT3 level was way over the top of the range all day, every day.. (which is not desirable, and could well cause symptoms of overmedication)

What you need to do now is wait until you have been on just 4 grains armour for 6 weeks .. and then retest TSH / fT4 / fT3 (8 -12) hrs after last dose Armour ).and preferably at around 9 am . Then you will be able to get a true fT4/ fT3/ TSH reading , post those result here for experienced members to see and they can help you decide what to do next.

Also try to get Ferritin / Folate/ Vit B12/ Vit D tested .. good levels of these are necessary for thyroid hormones to work best.

( bear in mind that the fT4 and fT3 levels above may be a bit different once you have been on a stable dose of 4 grains armour for 6 weeks)

Note** .. have just noticed that you have given different times for reducing / stopping T3 in your reply to pennyannie . to me you wrote:

4 weeks before test you lowered to 25mcg ,

and 2 weeks before test you stopped .

.... but in reply to pennyannie it says :

you reduced to 25mcg 8 weeks before test ,

and stopped 4 weeks before test.

, so there's a bit of confususion , but whatever... you always need to be on a stable dose for at least 6 weeks before blood tests , otherwise the results won't be a true representation of your hormone levels on that dose .

[pennyannie]

Hello Sewkate and welcome to the forum :

Once on any form of thyroid hormone replacement the TSH reading is not a valid reading of anything and you must be dosed and monitored on your Free T3 and Free T4 results :

You are not sub clinical anything - you are hypothyroid and taking Armour - a Natural Desiccated Thyroid medication and your blood tests look normal for someone on NDT - they may not be optimal but that is a very different issue to your doctors knee jerk assumption.

The blood tests, ranges and guidelines were all introduced alongside Big Pharma's launch in the middle of the last century, with their own treatment options for hypothyroidism - T3 - Liothyronine and T4 -Levothyroxine.

Armour - the most well known brand of Natural Desiccated Thyroid had successfully been used for around 50 odd years to treat hypothyroidism and Big Pharma launch their products in around the 1950/60 on the back of NDT - and then went about gaining market share.

There were and are no blood tests for NDT - you simply dose to the relief of symptoms and successfully used long before we even knew of the science of a blood test or analyse bloods to find levels of T3 and T4 and suggest these need to fit ' in a range ' that wasn't even designed to be used for NDT.

Having said all that I presume your doctor knows nothing about Armour/NDT nor thyroid.

Do you split your 4 grains of Armour and how long from your last dose was this blood test drawn.

Why did you start adding in T3 and then stopping it - presumably you didn't get any benefit ?

Was that 50 mcg T3 a day and then you dropped to 25mcg and then nil just before these blood tests ?

No thyroid hormone replacement works well until your core strength vitamins and minerals are up and maintained at optimal, do you have any recent readings and ranges for ferritin, folate, B12 and vitamin D ?

I read that when people start HRT some find they need to increase their dose of thyroid hormone replacement ?

[Sewkate in reply to pennyannie]

Hi Pennyannie. Thank you for your reply and welcome. I had completely forgotten about the benefits of Armour and how you can’t rely in “thyroxine results”from blood tests. I added the T3 as I don’t convert T4 to T3 and suffered a toxic build up of T4 when on Thyroxine. I added T3 about 8 years ago but think sometimes other medication/operations affects its efficacy for me. When I have too much T3 in me my Mum says I start to talk too fast and my resting heart rate increases, this has has now decreased since stopping T3. Yes 50mcg T3 a day and then I dropped to 25mcg about 8 weeks before my test and had completely stopped T3 for 4 weeks before my test.

However I am suffering Thyroid depression and brain fog - when I have no reason to be depressed but I am. I’m not sure if this is because my Armour is too low or my eastrogen levels are too low, I have also wondered about my testosterone levels. I am having a complete battery of blood tests on the 10th of April, whilst they will be done in Belgrade it’s only costing £200 for about 40 different tests. This should give me a much clearly understanding of any deficiencies I may have.

When I am in a brain fog I don’t think to remember it may be because my Armour dose is too low but rather more of an after affect of Covid (1 year ago) or my peri menopause as I don’t know my hormone levels for that.

I really do appreciate all the replies I get

[pennyannie in reply to Sewkate]

So - what were you originally diagnosed with ?

I presume prescribed T4 monotherapy which didn't work well for you and switched to Armour which contains T3 and T4 thyroid hormones.

I presume you worked your way up to 4 grains split evenly twice a day and this alleviated your symptoms completely or to up to a point - and then to help relieve symptoms you added into the mix the T3 - Liothyronine.

So in the month prior to this blood test you were taking 4 grains Armour daily + the T3.

What happened - do you feel you may have overdosed yourself ?

So anyway - of course your ability to utilise the Armour well will need you to maintain optimal vitamins and minerals as already mentioned and yes, of course - life is not static - and any other health issues may down regulate the T4 into T3 conversion.

Are you self medicating and have the option of adjusting your dose of Armour.

Is your doctor aware that you take Armour ?

[tattybogle in reply to pennyannie]

pennyannie ~ see Note** about time of stopping T3 at end of my reply above ..