Advice on interpreting blood tests when on liothyronine, & getting dosage right /adjusting it as you age!!?

[MrsClanger]

Hi, I've not posted fir a long time.. Because all was going well... But keep finding bumps in the road... Need advice on how to get T3 dose correct and how to adjust.. For us older people.. I'm 55 soon..

I was self medicating with liothyronine 12.5 mg + 75 mg levothyroxine. ( levo on nhs) for about the last 2 years..

Managed to sort diet..suppliments and got my weight down to my perfect weight of 8.st 10, that was exactly a year ago.

I had some hiccups last summer where I think my meds got too hot and stopped working.. Or had a bad batch maybe. Not quite sure.. Had a bad few months, feeking v tired.

I had an appointment with the NHS endocrinology I think it was almost a year ago... and he agreed to prescribe me liothyronine on the NHS, but on the basis that I would reduce it to 10 mcg

I took the NHS liothyronine but was cutting up the rest of the T3 meds I had, Just a tiny nibble extra.. . To try keep the dose at 12.5.. For about 6 months..

I felt rather up and down..worried I could not get the dose correct...my sleeping was not good. ( skeep about midnight.. Waking at 4 am..Back asleep 7 am.. Wake at 8 am.. Take meds.. get up.. Felt like I may be slightly over medicated.. But unsure... I felt like the lack of sleep was making me tired out and I felt a bit wired. Started to gain some weight back as I kept eating sugar to give me energy.

So the whole plan and diet went out the window a bit..

Having had so many years of bad sleep, or sleeping all the time, it's very hard to know what's normal.

Blood pressure and heart rate remained normal for the first time in decades though.. .

I had been struggling with bradycardia and low blood pressure for years, so this has made a huge huge difference.

Heart rate is now around 58 bpm when I check it.. which is great, it had been as low as 42..

So I decided OK I will try what the endo said.. So i have been sticking to the prescribed dose of 10 mcg (+75 mcg levothyroxine) for about 2 and a half months.

To start with I felt OK, my sleep got better, I was getting a solid 8 hours and thought this is good...

.. but this last month everything is noticeably sluggish...

I had been having weight gain which I expected a bit.. As I had gone down to 8 stone 7.. I was expecting to settle just under 9 stone..

I am overeating because I feel exhausted all the time. Could sleep 20 hours a day if I let myself... Dragging myself ot of bed. Ive now gained back the 15 pounds I lost since starting the T3, and back up to 9 St 10..Sorry about the weight obsession but I have eating disorder and it's a struggle to not be specific and ocd about this.

Feeling depressed, often short of breath, dizzy.... headaches.. Cold feet... Constipated.. I have much less energy, and my throat hoarseness is coming back.. This is a symptom I kept getting over the years before starting the T3.

So I have a blood test booked for tomorrow.

Endocrinologist called today ( I actually got a call back within a few days.. Yay!) he is going to look at the blood tests this week.

Can someone explain, when a person is on liothyronine, are the T3 levels best in the upper third, the same as when on levothyroxine?

Or should the aim be different when on liothyronine?

Aside from menopause ( this does not apply to me as I am way post that) how does dosage differ when over 50..and why?

If I'm needing to increase my T3 back up to 12.5..( From 10 mcg..) Does 2.5 mg really make much difference?... Should I try somewhere in between...how to cut up tablets that small when dealing with such tiny amounts?!

I am hoping the endocrinighist is good, he seems to be.

But I want to know how to interpret the blood test myself also, so I can understand any suggestions from him..

I will not be taking my meds tomorrow morning before my blood test,

I normally take then at 8 am and my blood test is booked for 9.15 am ( 24 hrs clear of meds)

This is what I've always done for the blood tests.

I can't post the results yet. But will do as soon as I get them.

In regard to suppliments and diet..

I take all the recommended types of suppliments thanks to a lot of good advice from members here years ago.. to get my suppliments regime correct.

As it's a nightmare getting the gp to test everything I just continue with what should be right.

I take multi b vits ( with folate)

iron in the form of gentle iron I think it's called bisoglyconate?

Vit D

Calcium.

Zinc & magnesium.

Mk 7 or whatever it is called ( the stuff to get the calcium into the bones.... )

I am 54, and post menopause (+ 15 years / early menopause at 37)

The bone clinic prescribed calcium and vit d, so I do feel it's needed.

I'm also having another bone density scan soon. But last one saud Oestropenina but not worrying.

Diet is gluten free, as close as I can be to lectin free, ( Eg no rice grains or beans , I eat sweet potato, sometimes regular potatoes which do contain lectins but I slip.. ) I'm vegetarian, but no eggs as I'm allergic.

I eat hemp protein, avocado, and bananas, Salads veg, broccoli, sweet potatoes, nutritional yeast, tahini & lot of beetroot. Sometimes eat nuts and cheese.

As far as diet is concerned I do feel I've got that sorted and I figured a food plan that was really working for me and is really energising when I stick to it.. But being so tired the last few months I find it hard to prepare my salads and veg so it has slipped. I end up eating crisps and guacamole instead of my usual healthy fresh food..

This may have a lot to do with it, so I'm trying to get back on track.

I just need to have a clearer idea of how to get the liothyronine dose right for me..

Much appreciate this website and sending good health to all on here x

[Lalatoot]

MrsClanger interpretation depends on how you normally dose your meds. If you dose once per day and you leave a 24 hour gap between dose and test then you are measuring the lowest levels that you get.

When you get your results post them on here and we can suggest how you might alter doses.

As regards to a small change in lio dose, I found little difference to my ft3 result (0.1 numerically 5.2 and 5.1) on 10mgs and on 7.5mcg so I stuck with the lower dose.

[MrsClanger in reply to Lalatoot]

Thank you. I'll post results ASAP

[SlowDragon Administrator]

essential to test iron panel test including ferritin at least 2-3 times a year if taking iron supplement

Stop B complex 5-7 days before any blood test as contains biotin

Ideally you should test with last dose Levothyroxine 24 hours before test and day before test, split T3 as 2 x 5mcg - half dose waking and half dose (5mcg) 9-11pm - maximum 12 hours before test

[MrsClanger in reply to SlowDragon]

Ah.. OK.. So I'll have biotin in my system still :@..Abd the T3 will be 24 hrs..

I'll remember this for another time. And I can ask the endo to arrange another blood test..

Is there a way to work around the readings this time?

[SlowDragon Administrator in reply to MrsClanger]

FT3 will be falsely low if last dose 24 hours before test

Biotin may or may not falsely affect test results

[Lalatoot in reply to MrsClanger]

Yes the readings will show your lowest levels if you dose once per day.

There are different opinions on the timings of meds before a blood test. Some folks split doses the day before and others, like me, feel that if you do something so different you are not getting a measure of what is normally in your blood.

The important thing is to follow the same protocol each time, once you've decided on one. and interpret your results depending on the gap you left between dose and test.

Count the largest gap between your doses. If you leave those many hours approx between dose and blood test you are testing your lowest levels.

Half the largest gap between doses and you are testing the average levels in your blood.

Test 2 to 4 hours after a dose and you are testing the peak levels in your blood.

For example I dose levo and t3 around 6am and again around 10pm. My surgery does not do early morning thyroid tests. I am not worried about my tsh levels as they are undetectable. So I get blood tests done around 2pm. I take my t3 in the morning of the blood test but I don't take my levo dose. This means I am testing 8 hours after T3 which will give me an average level through the day. I am testing 16 hours after levo which will give me the lowest level of ft4. I just fell into this routine more or less by accident but then realised I could use it to meaningfully interpret my results.

[MrsClanger in reply to Lalatoot]

Ah OK... Well every time before I have had the blood test first thing in the morning and waited till after to take my meds. So it will be the sane this time as most other times.. So I just need to be aware the T3 is falsely low.

[Jaydee1507 Administrator]

The calculator used by many here to work out percentage though range is this one. thyroid.chingkerrs.online/

FT4 & FT3 need to be 60-70% but of course everyone varies slightly.

It sounds like your FT3 has dropped with the sleepy symptoms. It may also be that the different brand of T3 is working out to be weaker for you.

I am of a similar age to yourself and not planning dropping my dose to account for advancing years! That would be a recipe for disaster for myself anyway.

I don't think we can predict what dose you need based on symptoms. Better to wait for the blood results. Take last Levo 24hrs before test and T3 8-12hrs before test. leave off biotin containing supplements for 4-7 days.

When hypo we get low stomach acid which means we cannot absorb vitamins well from our food, regardless of a great diet. For thyroid hormone to work well we need OPTIMAL levels of vitamins. Have you recently or could you ask your GP/Endo to test levels of ferritin, folate, B12 & D3?

[MrsClanger in reply to Jaydee1507]

I think I'm going to have to ask the endocrinologist about the suppliment blood tests as my new gp is not very knowledgeable about thyroid issues.Seems I've messed up the T3 for this blood test as I took them today as usual so it will be 24 hrs past both doses.

[Jaydee1507 Administrator in reply to MrsClanger]

Your GP doesn't need to be knowledgable fr you to ask them to do vitamin tests. Find a helpful, cooperative one and ask.

`your results will show a false low T3 which isnt a bad thing for an Endo but doesnt give you much idea where you truly are at.

[MrsClanger in reply to Jaydee1507]

Yep.. I'll ask.. I see what you mean.. Maybe I should ask to be re tested again in 6 weeks and split the T3 the day before that test then?

[Meno56]

I know you said you were past menopause, but I’m wondering whether the efficacy of your thyroid meds may be affected somehow by being post menopausal. You didn’t mention taking HRT? If so, this often requires an increase in thyroid meds.

[MrsClanger in reply to Meno56]

I was not ever offered hrt at any point.None of my gps or endocrinologist has ever mentioned it!

I'll ask endos opinion though.

I don't actually know what hrt is meant to do?! I would be happy to have info. I feel like that's all pretty much ' done and dusted' though.. As I don't have any menopause symptoms any more.

[TiggerMe in reply to MrsClanger]

Having balanced hormone levels is good for your bones, heart, brain.... everything really, low levels add to the creakiness... perhaps that is another conversation needed, low levels also lead to bone lose so really relevant, oestrogen keeps our bones springy.... 55 old!! we are just getting in our stride 🤗

[MrsClanger in reply to TiggerMe]

I felt so much better after menopause.. Less neurotic.. But it coincided with being treated for thyroid so unsure what made the difference. I'm a bit reluctant to have those hormones back in my body in case it makes me neurotic again? And isn't there a cervical cancer risk?.. I had clerical cancer.. .. maybe that's why I was not offered hrt?... Yep.. Maybe another topic!!

[TiggerMe in reply to MrsClanger]

It maybe that your levels are good but you would think they would check when looking at your bone health which is a very meno issue, HRT has moved on and the body identical forms are a different kettle of fish.

I can understand your anxiety, I felt a total fruit loop as mine all kicked off at the same time, thyroid hormones helped a bit then HRT a little more and then another tweak of thyroid to get things balanced again, then the missing bit T3

It was your sleep pattern that resonated with me as mine was similar when sex hormones dropped, after a couple of years on T4 when T3 was needed

Loads of info here if you want to question them 😏

balance-menopause.com/

[MrsClanger in reply to TiggerMe]

Thank you. I'll definately look into it and read the links and talk to the endocrinologist too. Yep sleep problems are pretty persistent fir me!