Test results following change of dose

[Smorzando]

Hello all, I’ve just updated my profile to hopefully provide some background on all this.

Following on from my recent post with test results from 28th February (TSH 0.08, FT4 21 (12-22, 90% of range) and FT3 4.6 (3.1-6.8, 40% of range), I decreased my Levo dose slightly and have recently had a new test done after 8 weeks on changed dose.

Previously I was on 100mcg T4 and 10 T3; reduced this to 82mcg T4 (75/5 days and 100/2 days) and 10mcg T3.

New results, April 24th:

TSH 0.36 (0.27-4.2)

FT4 16.7 (12-22) 47% range

FT3 4.6 (3.1-6.8) 40% range

No change in FT3, and really, no change discernible in symptoms - still horribly tired, exercise intolerant, stiff, achy, low mood. I have added another 5mcg of T3 so am now on 82/15 - that’s been about a month now, and I am much the same, except that initially I had a very noticeably increased heart rate, although I tend to get that before my period each month. I have also, in the last week, become extremely (and I mean debilitatingly) anxious to the point where I have made a GP appointment to discuss increasing my antidepressant medication.

I have struggled for over 3 years now to find a dose that will make me feel well and am feeling very lost. I have been reading a lot of Tania Smith’s blogs (thanks to  radd for pointing me in that direction) and am trying to understand how raising my T4 levels seems to decrease my T3 levels, and sometimes vice versa it seems.

If anyone has any thoughts I would be very grateful.

[SlowDragon Administrator]

How do you take your T3

As 2 x 5mcg doses roughly 10-12 hours apart

Now on 3 x 5mcg - roughly equal 8 hour intervals

Day before test always take last 5mcg dose approximately 8-12 hours before test

Last dose levothyroxine 24 hours before test

Do you always get same brand levothyroxine at each prescription

What are your most recent Vitamin D, folate, ferritin and B12 results

What vitamin supplements are you taking

[Smorzando in reply to SlowDragon]

Thanks SlowDragon

Yes, all test done as you describe and I have been on Teva for both T4 and T3 all this time as am lactose intolerant.

I currently split my T3 into two doses so I take 5mcg at bedtime and 10mcg with my Levo around 5-6am. I am on ferrous sulphate 2x a day to try and raise ferritin and since advice is to take all thyroid hormones four hours away from iron, I wouldn’t be able to split my dose further.

Recent test results from February:

Vit D 98 nmol/L

Folate 6.7 ug/L

Active B12 104 pmol/L

Ferritin 33 ug/L

I take ferrous sulphate 2x day, a B complex daily & additional methyl folate every other day; 3000 IU Vit D, Magnesium citrate when I remember.

Iron panel done last week:

Ferritin 48.9 (13-150)

Transferrin saturation 23.7 (20-50)

TIBC 53 (45-81)

UIBC 40.4 (24.2-70.1)

Iron 12.6 (5.8-34.5)

[SlowDragon Administrator]

Very helpful profile 👏👏

Improving ferritin important

Have you tried dairy free

Worth retrying gluten free

[Smorzando in reply to SlowDragon]

I have tried gluten free about three times now; always very strictly, always for 2-3 months. No changes/improvements whatsoever. Also have tried dairy and even sugar free - again, for three months, no benefit!

[radd]

Smorzando,

It’s so tricky finding our exact sweet spot because of all the influencing variables.

You’ve decreased weekly total of Levo amount by 125mcg. FT4 levels are variable in themselves, and I don’t think that small decrease of Levo alone has reduced labs that much (90% through range to 47%!), but other factors and it is most likely those that need to be paid attention to. 

Were tests like for like? Was test taken the same time on your menstrual cycle? (oestrogen is known to raise TBG).   Did you change anything else around the time of testing, eg sups, other meds, etc ? 

Once we regain wellbeing and everything works better, we gain a better window of tolerance for these natural variations in thyroid hormone levels but when we are ill we are more susceptible to feel the changes and also more focussed on the levels which sometimes isn’t a good thing. 

If this were me, because either the first or the second test intimated dubious results, I would have remained on that dose and retested after another six weeks. Now adding an extra 5mcg T3 you still don’t know your true Levo requirement, and appear to have increased your hypo symptoms ☹️.

Another area to work on might be your gut as low iron is indicating absorption issues which would directly and indirectly be effecting thyroid hormone. You have considered gluten but what about other inflammatory foods? Is gastrointestinal motility good? What about gut infections? Do you have enough gastric acid and bile?

Just thinking of other reasons why thyroid hormones aren’t working effectively for you.

[Smorzando in reply to radd]

Radd,

Thank you for your helpful and considered reply.

I make a conscious effort to keep as many variables the same when I test; so, roughly the same time in my cycle, always follow timings as recommended on the forum. So I don’t think that explains the discrepancy. Supplement wise, I had only increased my ferrous sulphate dose between the two tests.

Since being diagnosed in Jan 2020 I have pretty much always had inconsistent test results in regards to T4 (and presumably T3 levels). In fact if I recall correctly, there was a very large difference in T4 levels when on exactly the same dose and tests about a week apart. This is no doubt a large part of why I am finding it so hard to discover my ‘sweet spot’ when it comes to dosing, especially as I am on combination treatment.

I don’t actually have much in the way of ‘gut symptoms’, and generally feel like that’s one part of me that works reasonably well I have noticed that my bowels are very overactive when overmedicated, that’s about it. I also tolerate the iron tablets extremely well. Regards the low iron, I suspect that it is my horrendously heavy periods that are to blame, although it is true that I eat very little meat.

I am due to see the GP in about ten days- and I am dreading it. I have no idea if they will blame this on mental health, perimenopause, or ‘over treatment’ with thyroid hormones (due to low TSH). I have been very fortunate, I guess, that they prescribe 100mcg levo and 15mcg Lio and basically leave me to my own devices (or have done so far), so I have been able to make these small adjustments myself - it’s just that I am totally lost as to why I don’t seem to be getting better.