I would welcome any ideas about what might be causing EXTREME fatigue , absolutely debilitating and happening day after day .

[Steni]

do any of these results suggest a cause of fatigue.

[greygoose]

Your FT3 is pretty high, and that could cause fatigue - too much is as bad as too little.

But, how long was the gap between your last dose of T3 and the blood draw?

Have you had your iron tested recently? Low iron can cause fatigue.

[Steni in reply to greygoose]

thank you - I left 24 hours between dose and testing . However I have found that when I take the meds in the morning I am slightly less fatigued during the day than if I take at night - so I has sort of deduced I was being helped by the T3 - but I could be wrong

[greygoose in reply to Steni]

So, you took your last dose of T3 24 hours before the blood draw? Is that correct? If so, that's far too long a gap, and you therefore have a false 'low' FT3 - i.e. your FT3 is actually higher than that suggesting that you need to reduce your dose. So, that could very well be the source of your fatigue.

What about the iron? Have you had ferritin tested?

[Steni in reply to greygoose]

thank you - yes that is correct about the timings I think - I take 10 mg (?) of T3 daily - would halving this be a sufficient reduction to start with ?

[greygoose in reply to Steni]

Well, that's not a huge dose, so before reducing, I would be inclined to check out any other possible causes of fatigue, such as low nutrients. Have you had any of them tested? Sub-optimal nutrients can cause terrible symptoms, not unlike low thyroid. Do you have any other symptoms, apart from the fatigue?

[Steni in reply to greygoose]

I do have extremely low Vitamin D - around 25 (?) I wonder if a vitamin D injection would help raise the levels more quickly- a previous endocrinologist used to provide these for me but that was years ago.

[greygoose in reply to Steni]

I should think it would, if you can obtain it - worth a try, anyway.

[SlowDragon Administrator in reply to Steni]

Get folate, B12 and ferritin levels tested

Meanwhile improving low vitamin D

What vitamin supplements are you currently taking

NHS Guidelines on dose vitamin D required

if vitamin D is 25nmol GP should prescribe loading dose vitamin D. That’s 300,000iu in total over 6-8 weeks

5000iu per day for 8 weeks

Or 7000iu per day for 6 weeks

ouh.nhs.uk/osteoporosis/use...

GP will often only prescribe to bring vitamin D levels to 50nmol.

Some areas will prescribe to bring levels to 75nmol or even 80nmol

leedsformulary.nhs.uk/docs/...

GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)

mm.wirral.nhs.uk/document_u...

But with Hashimoto’s, improving to around 80nmol or 100nmol by self supplementing may be better

pubmed.ncbi.nlm.nih.gov/218...

vitamindsociety.org/pdf/Vit...

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

Test twice yearly via NHS private testing service when supplementing 

vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function.

There’s a version made that also contains vitamin K2 Mk7. 

One spray = 1000iu

amazon.co.uk/BetterYou-Dlux...

Another member recommended this one recently

Vitamin D with k2

amazon.co.uk/Strength-Subli...

It’s trial and error what dose we need, with thyroid issues we frequently need higher dose than average

Vitamin D and thyroid disease 

grassrootshealth.net/blog/t...

Web links about taking important cofactors - magnesium and Vit K2-MK7

Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Interesting article by Dr Malcolm Kendrick on magnesium 

drmalcolmkendrick.org/categ...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

[seveneleven]

Have you ever tested cortisol? I get extreme fatigue, and turns out cortisol was very low. But, as yet unmedicated, so don't know if this could still cause fatigue if you're long-term on meds.

[Steni in reply to seveneleven]

thank you - does the fatigue make you feel like your body is shitting down , starting with your eyes and then your limbs

[seveneleven in reply to Steni]

Yep - I think of it as just the system powering down. Bit like body being asleep even though I'm awake. Breathing very slow. I get a 'fatigue stare' where I just glaze over and can't focus eyes, and trouble holding head up. Can feel a bit like my limbs don't belong to me, which might sound odd, but there we go!

[Steni]

thank you - good to know my symptoms are not unusual - I feel as though I have been injected with a sleeping draft too.

[SlowDragon Administrator]

How much levothyroxine are you currently taking

Was last dose levothyroxine 24 hours before test

Do you always get same brand levothyroxine at each prescription

How much T3 are you taking

Do you normally split as 2 or 3 smaller doses spread through the day

On day before test ALWAYS split T3 with last dose Approx 8-12 hours before test

List of private testing options and money off codes

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins then cheapest option for just TSH, FT4 and FT3 and includes BOTH TPO and TG antibodies -£29 

randoxhealth.com/at-home/Th...

Monitor My Health also now offer thyroid and vitamin testing, plus cholesterol and HBA1C for £65 

(Doesn’t include thyroid antibodies) 

monitormyhealth.org.uk/full...

10% off code here 

thyroiduk.org/getting-a-dia...

NHS easy postal kit vitamin D test £31 via

vitamindtest.org.uk

Only do private testing early Monday or Tuesday morning. 

Link about thyroid blood tests

thyroiduk.org/getting-a-dia...

[Steni]

thank you - I’ve read the points above many times and can say yes or no in the right places to them all .