please can I have some advice on my latest results?

[Knackeredandcross]

Please could I have some advice? These are my results today. I’m on 125mg Levo and 12.5mg t3. I’m still absolutely exhausted, gaining weight and hair falling out, etc. I’ve optimised my b12, ferritin, vit d and folate and am maintaining them at least 75% through range so not sure what to tweak next?

Im a poor converter which is why I added the t3 as I was struggling to get it over 25% through range. This is the highest it’s been so far and I thought it would make a big difference but I don’t feel any better. I know some people need it near the top of range so should I increase my t3 by another quarter of a tablet do you think? And does my t4 matter so much if my t3 is then ok or does that need a small increase too? According to my weight I should be on 137.5mg of t4 but not sure if that relates only to t4 mono therapy.

test was taken at 9am after fasting and splitting the previous days dose as advised.

thank you in advance 🙏🏽

[Jaydee1507 Administrator]

Free T4 (fT4) 18.6 pmol/L (12 - 22) 66.0%

Free T3 (fT3) 5.1 pmol/L (3.1 - 6.8) 54.1%

The weight calculation only relates to levo monotherapy.

T4 does matter on combo therapy. It should be around 70% of range and yours is not far off.

You're really not far off and it might take some months before you feel much benefit depending on how long you've been hypo. Perhaps add another quarter tablet of T3?

I see you've tried gluten & lactose free, did you try dairy free?

What other things have you done with diet?

[Knackeredandcross in reply to Jaydee1507]

thanks for replying 🙏🏽 I’m dairy, soy and gluten free and have a pretty good diet. Im trying to increase my activity levels but I don’t seem to ‘come round’ until late afternoon. In a test last year my morning cortisol was very high so I’ve also been taking an adrenal support supplement alongside my vitamins. Im not sure what else I can do. I have booked to see an endo in May in the hope he will let me try ndt as I’ve heard lots of people with Hashimoto’s do better on that. Do you think my low tsh will be a problem?

I will try the extra quarter of t3 in the meantime. Thank you for your advice 🙏🏽

[Jaydee1507 Administrator in reply to Knackeredandcross]

Some people never will be morning people. I am one too!

You could try some kefir to help your gut. Sluggish gut caused by being hypo can mimic hypo itself even. There's commercial coconut kefir or you can make water kefir at home cheaply.

Not sure how you are splitting your dose but a bed time dose of T3 might help. Would recommend splitting your T3 to 3 doses, so morning, late afternoon, bed time.

Do you know that this Endo prescribes NDT? I can't speak for them regarding TSH levels. Some are sticklers and others not but in a way best to find out before you see them, you can always ask his/her secretary.

[Knackeredandcross in reply to Jaydee1507]

thank you, yes he definitely prescribes ndt. I double checked before I booked 👌🏽 I did try splitting my dose at the start but it was a nightmare juggling it with my vitamins, hrt and trying to leave long enough after eating. I kept missing doses or meals so in the end I just took it with my t4 in the morning. I noticed when I split it the day before my blood test I was falling asleep at 7pm when I normally get through the day without napping now. And I know what you mean, mornings have never, ever been my strong suit!

[Jaydee1507 Administrator in reply to Knackeredandcross]

You don't need to worry quite so much about when you take T3, it's Levo thats really fussy. A bed time dose might just help you.

[Knackeredandcross in reply to Jaydee1507]

so it’s not the same 3 hours after eating and 4 hours away from supplements?

[FancyPants54 in reply to Knackeredandcross]

You don't need to worry about food and drink around T3. I'd still keep my supplements apart though. And I think you mentioned HRT. If it's transdermal it won't matter either.

[Knackeredandcross in reply to FancyPants54]

thank you, it’s oral progesterone and magnesium i take at night. I just assumed t3 would be the same basis as t4. Never even thought to question it 🤷🏼‍♀️

[Jaydee1507 Administrator in reply to Knackeredandcross]

No not at all. An hour is plenty, in fact if people were struggling to take it they used to recommend taking it with a meal.

[Knackeredandcross in reply to Jaydee1507]

well that could change everything! Thank you so much. I’ll try taking the night time one when I have my progesterone before bed. Do you think it will be ok with progesterone and magnesium or should I leave the hour between?

[Jaydee1507 Administrator in reply to Knackeredandcross]

Magnesium is another one like iron that does need a good space between it and other things due to it causing absorption issues. Recommended space is 4 hours for magnesium. I'm assuming you take that at bed time to help sleep but T3 can also do that so maybe move the magnesium to early evening?

[Knackeredandcross in reply to Jaydee1507]

thank you, I will try that 👍🏽

[FancyPants54 in reply to Knackeredandcross]

It's oestrogen by mouth that can cause issues as it's metabolised through the liver. I'd not bother about progesterone.

[Knackeredandcross in reply to FancyPants54]

thank you 🙏🏽

[greygoose]

How much T4 anyone needs is a very personal thing. And no-one can tell you how much you need, you have to find out by trial and error. Some people on combo therapy need it a bit higher than yours (but not by much, I think) and some are just fine with it a lot lower. Myself, I need zero T4, I'm best on T3 only.

But, first try increasing your T3 because that is the active hormone - T4 is basically a storage hormone that doesn't do much until it is converted into T3. It could be that all you need to do to feel well is tweak your T3 a bit - or maybe a lot. Only time will tell.

Oh, and there's such thing as 'should' when treating hypo.

[Knackeredandcross in reply to greygoose]

thank you kindly 🙏🏽 I will up my t3 by a quarter and see how I fare.

[greygoose in reply to Knackeredandcross]

Sounds like a good idea!