Latest results after starting combination meds

[Kayakingkim]

Hi all just thought I would post my latest results as they are a bit unexpected!

I was diagnosed with central hypo 18 months ago by a private consultant as GP and nhs endo refused to acknowledge an issue with my thyroid

I was taking 75 Levo 5 days a week and 50 levo 2 days a week but recently added liothyronine as still symptomatic

Prior to combo treatment my results were

TSH 0.04 (0.27-4.2)

Free T4 20.9 (12-22)

Free T3 4.2 (3.1-6.8)

After 6 weeks on Liothyronine prescribed 5mcg but had to drop to 2.5 due to side effects once daily in the morning

TSH 0.05 (0.27-4.2)

Free T4 16 (12-22)

Free T3 5 (3.1-6.8)

My consultant advised me to stay on same dose of levo and not reduce it prior to starting lio which I did- I know the general practice is to reduce levo so was a bit anxious but followed his advice

He also instructed me to take the lio 4hrs before being tested which I also did. I took levo 24hrs before being tested and followed all recommendations prior to being tested

I didn’t test vitamins etc as they were ok on the previous test

Does any one know why my TSH has gone up a bit and free t4 down? Is this because I have central hypothyroidism. I still have some hypo symptoms and I am seeing my consultant in a few days time

A big thanks in anticipation of your always helpful responses

[greygoose]

Your FT4 has gone down because you are taking T3. That's the way it works. And the TSH is irrelevant once you are taking T3. It's going to be low/suppressed because that's the way it works. And a different of 0.01 is negligable because TSH does vary - especially if you have the blood draw at different times.

What is more concerning is your FT3. Taking your lio four hours before the blood draw will give you a false high - and I can never work out if endos do this deliverately or if they just don't know. It is always recommended to leave a gap of 8 to 12 hours between your last dose of lio and the blood draw to give your your normal circulating level. And if you had done that you would have a lower result. Were these tests done on 2.5 mcg or 5 mcg? In any case, you more than likely need a higher dose.

Don't worry about the endo not reducing your levo. I know they usually do but they would be hard put to explain why they do it. It isn't logical because taking T3 is going to reduce your FT4 anyway, as you have seen. Doubtful your FT4 level is too high now.

[Kayakingkim in reply to greygoose]

Thanks Greygoose appreciate your support 👍 will ask for an increase in t3

[greygoose in reply to Kayakingkim]

You're welcome.

[SeasideSusie Remembering]

Kayakingkim

My consultant advised me to stay on same dose of levo and not reduce it prior to starting lio which I did- I know the general practice is to reduce levo so was a bit anxious but followed his advice

It's sometimes the right thing to do to reduce Levo, especially when FT4 is over or at the very top of the range. Your FT4 result before adding T3 was a bit sort of borderline where that's concerned and it looks like your endo was right not to reduce your Levo.

He also instructed me to take the lio 4hrs before being tested which I also did. I took levo 24hrs before being tested and followed all recommendations prior to being tested

We here would disagree with that. By taking your Lio 4 hours before the test you are testing FT3 when it's at it's peak - T3 peaks 2-4 hours after ingestion and that risks a false high FT3 and the possibility of having Lio dose reduced.. That's not the measure you want, you want a measure of your normal circulating hormone and the best way to measure that is to take your last dose of Lio 8-12 hours before the test.

Does any one know why my TSH has gone up a bit and free t4 down? Is this because I have central hypothyroidism. I still have some hypo symptoms and I am seeing my consultant in a few days time

TSH 0.04 (0.27-4.2)

TSH 0.05 (0.27-4.2)

You can disgregard the "increase". The difference is so minimal - only 0.01 - that you can ignore it. No hormone level is static, they fluctuate throughout the day, so your level is effectively the same. If you'd gone from 0.04 to 2.00 for example then yes that would be considered an increase in your TSH, but definitely not a difference of 0.01.

However, with central hypothyroidism the feedback between pituitary and thyroid doesn't work so we only look at FT4 and FT3.

Your FT4 has reduced because you are taking T3, that's just what it does and is to be expected.

I still have some hypo symptoms and I am seeing my consultant in a few days time

This is likely to be because your FT3 is effectively still low. Because you took your Lio 4 hours before the test you have a measure of the peak (as explained above) so giving a false high result. If you'd left the time we suggest your FT3 would be lower and because you're only taking a very small amount - 2.5mcg - it may well be that your FT3 is no higher than before you started taking Lio.

You really should do a thyroid panel following the timing of last dose of meds as we advise to give an accurate picture. I expect it will show that you need an increase in your dose of Lio.

[Kayakingkim in reply to SeasideSusie]

Hi seaside susie

I will ask about an increase in T3 , do you think I need to take it twice a day or more ?

Do you think I should also increase T4 or is that not so important when taking T3?

Many thanks

[SeasideSusie Remembering in reply to Kayakingkim]

I will ask about an increase in T3 , do you think I need to take it twice a day or more ?

Experiment, see what suits you best. I was taking mine once a day, tried twice a day but it made no difference so I went back to once a day. However, as you had side effects on 5mcg and dropped down to 2.5mcg, it might be worth taking twice a day to start with and see how it goes.

Do you think I should also increase T4 or is that not so important when taking T3?

That's something we have to find out for ourselves - what's the best balance of Levo and T3. Some people are fine with a low FT4 as long as FT3 is in the upper part of it's reference range. Others need them fairly well balanced over half way through range. Again, see how it goes. Getting the right balance can take a long time but remember to only change one thing at a time, never change dose of Levo and T3 at the same time, if you do you wont know which you have benefitted from. So change one, wait 6-8 weeks to retest and see how you feel, then if necessary make the next change.

[Kayakingkim in reply to SeasideSusie]

Thanks for the great advice I will focus on T3 increase and like you say see how it goes