Which dose? Please help

[lisan1]

I have other diseases so it is difficult to know which dose is best. If you look at my test results which one would you recommend when I don't feel any difference 1, 2 or 3?

1. Ft3 5.2 (3.5-6.5)

Ft4 17 (12-23)

2. Ft3 5.8

Ft4 17

3. Ft3 5.8

Ft4 19

[radd]

lisan1

 On any of these results if I was still symptomatic, I would be raising Levo by 25mcg and retesting after six weeks. 

However, remember whichever result you choose will always be variable, eg retesting later in the day or if you developed a cold, etc will bring a different set of results. 

The numbers are only a guide and never static. Dose tweaking is essential but once symptoms aren’t improving no matter what dose you take, then it may be you are hitting your sweet spot and meds are not working for other reasons. 

Common reasons on this forum are low iron,  or imbalanced cortisol or sex hormones. Also (other) heath conditions involving chronic inflammation being a great negative influential on all aspects of thyroid physiology. Then we look at ways of improving the effectiveness of thyroid hormone meds as opposed to constantly adjusting the dose. 

[SlowDragon Administrator]

What are most recent vitamin D, folate, ferritin and B12 results

[lisan1 in reply to SlowDragon]

They are all optimal except ferritin. But my iron levels are good so unsure if it's wise to supplement iron?

[Lalatoot]

I had a choice of 2 doses both with very similar results. I had been altering doses for 2 years and reckoned that my body now just needed to be on a stable dose no changes so I picked one of the doses. I stayed on that dose for 2 years and improvements in symptoms have been happening all those 2 years on the fixed dose. I have just changed to the other choice of dose and will stick with it for a long period to see if there are any benefits to be had.

Pick a dose and then see how the body settles longer term.

[lisan1 in reply to Lalatoot]

Yes, will do that. But I was kind of wondering as I can't seem to notice any difference of it would be best to be on lowest dose or the higher one?

[SlowDragon Administrator]

Post discussing Ferritin and iron

healthunlocked.com/thyroidu...

[jimh111]

All these results are very similar and I wouldn't expect any noticable change in symptoms. Our hormone levels fluctuate from day to day so it's best to avoid too much testing.

I notice from your other posts that initially you had a slightly elevated TSH with low normal fT3 and fT4 (both). This suggests your pituitary isn't producing enough TSH, not really a damaged pituitary just underperformance. This can happen when there is a long period of excess hormone or when concurrent illness causes reduced TSH secretion with TSH that has reduced bioactivity.

You mention you have other diseases, what are they? (I'm thinking of disorders that have been around since your first post).

[lisan1 in reply to jimh111]

I didn't have any diseases until hypothyroidsm 7 years ago. Caught covid 3 years ago and been very ill since then.

Would it make sense to try lowest dose possible where I don't feel any difference?

Where in range would be good to opt for if I feel the same on the doses I'm taking? Like 50% for ft3 and 30% for ft4?

[jimh111 in reply to lisan1]

I wouldn't target particular levels other than to keep them above the lower limits of the reference intervals. I suspect you will need more T3 as there is evidence a subnormal TSH reduces T4 to T3 conversion. What symptoms do you have?

[lisan1 in reply to jimh111]

I can't say what symtoms I have as I have so many from long covid and some of them are (almost) the same as hypothyroidism.