Is there any point me testing FT3 levels 4 hours after dosing,ie peak T3 to satisfy neg Endo that im not overdosing?

[Gillybean1]

Hi Everyone, Ie if 4 hrs in and my T3 is below 6.8 NHS range ,then I am not overmedicated am I ?

Its true I havnt found my sweet spot, and my TSH is just below NHS range. at 0.08. But my T4 is 15.3 and T3 5.8 ,both in NHS range , so how can that be overmedicated if these two are 'in the accepted range' ?

Im freezing cold, AM 35.6, - PM 36.6 on a 20 degree day, my BP is low, my pulse is 65-72 ish, my Iron/Ferritin ok, B12 v high, Cortisol slightly Am raised (pos T3 in NDT), Vit D ok.... and I know I feel better, yes 'better' not well, when my T4 is 18-20 and T3 is 6.

Im sick of being, well basically bullied for trying to get well. Rant over, my apologies. Any thoughts would be greatly appreciated please.

Every best wish G

[jimh111]

I would not play that game, it reinforces the endo's misunderstanding of thyroid hormone pharmacodynamics. Serum T3 will peak three hours after taking liothyronine giving a false impression. You can be overmedicated with both fT3 and fT4 within their reference intervals as you can be undermedicated with 'normal' fT3 and fT4. It depends on where in the intervals both hormones are.

A brief skim of your previous post suggests you are not taking high doses and have symptoms of hypothyroidism. So, going by symptoms you may be undermedicated although it is preferably to not let TSH get too low. in the final analysis it is signs, symptoms and response to thyroid hormone that define thyroid status not blood test results. Unfortunately very few endocrinologists have any concept of scientific method.

[Gillybean1 in reply to jimh111]

Hello again jimh111,

Thank you for taking the time to reply. Ok yes I see what you mean about challenging endo. I just felt so utterley boxed in when I said I was going to up my dose from 1 3/8 grain NDT to 1 1/2 grains, she let rip " I dont approve nor does the NHS of Armour, your overmedicated, your pituitary has shut down indicated by TSH at 0.08 and your problem is you insist on treating the symptoms to 'feel' how you think you should 'feel' "

It begs belief. I said "i realise low TSH is not ideal,but what do I do about these daily debilitating symptoms that prior to the last upped dose left me bed bound, and no quality of life " No response. Then she said " I have nothing further to offer you, Im wasting my NHS time with you, and you are wasting a NHS appointment , i am referring you back to your GP"

In the past I have not found any of the numerous Levo's tried that didnt cause itching, gut probs,head spin etc... but I could try again.

Jimh111 do you think its possible that if I dropped lets say perhaps a 1/4 grain of NDT and added in 12.5 or 25mcg of Levo instead to the daily dose of NDT, that it might push the recently dropping T4 (has not gone up anymore with increased NDT dose but TSH has dropped) up and put the TSH back in their range if the T3 part of my dose is reduced.

I feel quite lost and overwhelmed. Clearly I havnt got it right yet, but I have not given up.

Every best wish to you, and thank you for your kind support. G

[jimh111 in reply to Gillybean1]

You are not wasting her time, she is wasting your time. She is wasting NHS appointments not you.I would try swapping in some levothyroxine, probably won't work but it's a good idea to try

If your GP isn't supportive you might say the endo. has an attitude problem and is only interested in treating numbers with no regard for the patient. It's really difficult to deal with these people, as a fallback you need to keep your GP on side so that they prescribe levothyroxine (even if you don't take it). This keeps your hypothyroidism diagnosis active in case you find someone more helpful in the future.

[Gillybean1 in reply to jimh111]

Yes, thank you Jimh111, when I get my confidence back up, I am not letting that Endo get away with that, just in case she hurts someone elses morale. So I will word my reply to her equally scathing letter of untruths (loathe liars...my bug bear)that followed, very carefully and truthfully, just to set my medical notes straight.She certainly has set me back this last couple of weeks.

I can understand that consultants may have differing opinions, but surely there must be some respect for what has gone before with the Prof who was compliant with my regime ,supportive and encouraging by saying, keep trying, different combos, different brands, different timings etc, He prefered a detectable TSH but didnt have a meltdown if it was low.

How low is too low Jimh111 ?

To be called a time waster when like many here saved up to do blood test to cut to the chase and not waste f/u appointments with incomplete Gp tests is disheartening.

I have a knew GP on the list to try .....so fingers crossed.

Thanks for being there, Every best wish, G.

[jimh111 in reply to Gillybean1]

I don't know what TSH is too low, my gut feeling is around 0.1. There are two issues: 1. a low TSH can indicate over treatment and 2. TSH promotes T4 to T3 conversion. It's the second one that I feel is the most important. It may be that you can't get well without pushing your TSH down but it's worth trying hard to keep it non-zero if you can. Give it a try but accept that you need higher hormone doses if you have to.

[Gillybean1 in reply to jimh111]

Thank you Jimh111,

Yes, I believe thats good advice and have strived but not been able to achieve this so far without negative symptoms.......which is why I think I have a 'missing piece' to find.I will try a slightly lower NDT and a pinch of synthetic Levo to replace....eye of newt etc.

Every best wish to you, G.

[Lalatoot]

I have never test 4 hours after dosing as the endo wants. We do not run on peak levels for most of the day and levels can fall steeply from the peak.If asked I say that I always follow the same protocol for blood tests so I can compare like for like. If asked 'Was this done 4 hours after a dose?', I would reply, 'thats what I have been told to do'.

[Gillybean1 in reply to Lalatoot]

Hello again Lalatoot,

Thank you for taking the time to reply. True, I liked your answer. Maybe the Dr's ,usually private that ask for this method are covering themselves from critisism.

I remember a few years back having had chest pains for a couple of weeks my GP sent me straight to A&E. The young Dr there did a heap of blood tests, and I remember saying to him "oh no ,I took my NDT 3 hours ago, its going to peak now, probably out of range and your going to say that why I have chest pains "

To my astonishment he said " No im not bothered in the slightest by that, but thanks for telling me, I will make a note to reassure others your medication peaked at the time of these blood tests".

So some are savvy and that gave me a little hope for others like us........sadly not the case with my latest Endo. Im exhausted with her.

Every best wish to you, G.

[Lalatoot in reply to Gillybean1]

All the best to you too, Gilly. My endos were from an NHS team from NHS Grampian so I presume it is written in their protocol.Certainly my thyroid journey has made me question all doctors. Glad there are some good 'uns out there.

[Gillybean1 in reply to Lalatoot]

well that was a young Houseman on A&E and one just knew he was going places and without tunnel vision. Take care too , G

[radd]

Gillybean1,

This isn’t about your endo, although I have had labs at 2 hours after T3 meds taken by a knowledgeable endo just to see how high T3 peaked.

But I feel for you. You’ve tried every med in every dose it seems like forever 😔, and your numbers at present are good! I would stick where you are and look at WHY your meds aren’t working.

Last post indicated ‘My pulse is 65-70 my BP very low at typically 90/58 or 100/ 62, Ferritin low side in range. Vit D, !2, Folic , FBC all good. Chloride low ,now taking electrolytes’. I'm glad you are taking electrolytes as adrenals love them and we fall short when they aren’t working well. Maybe even add some extra salt and Vit C too.

I assume you are conscientiously supplementing to address all deficiencies and eating well. Until deficiencies aren’t deficient, meds might not work effectively and this is when we continually miss our sweet spot.

It is a chicken and egg game because low thyroid hormone causes deficiencies in the very nutrients it requires to work effectively. If you think you have ‘functional B12 deficiency’, why don’t you inject? As you say it may be the missing piece 😊.

[Gillybean1 in reply to radd]

Hi Radd,

Lovely to here from you again. I think I am too afraid to inject myself....just in case I get a bad reaction. I react to so many things some with consistancy and some without ,and yes it is chicken and egg very much, because if I was optimally medicated and able to absorb optimally I am sure I would not have so many reactions

Funnily enough in 2014 out of nowhere came a reaction to chicken, i tried to eat it 2 more times and boom the same reaction, totally undigested. Lab analysis to confer, GP said advice was to leave it out. From that day on till this year I continued with eating eggs daily in some form or another, as I thought with no problem, until I fully documented gut flares by the hour in February, gut flares since 2012. I stopped all eggs completely in April, 3 days in no gut flare inflammation at all, so I have stayed off the.,But it has allowed me to reintroduce more missing foods that I couldnt eat because of chronic inflammation.I still have a problem with the gallbladder and fat digestion though.

I often wonder whether there was ever a weakness from 12 weeks of Salmonella poisoning from chicken back in the 90's............or whether eggs which are rich in B12, and if B12 is a possible gene fault in myliver as I have the DIO2+ fault. I have PA on my Mothers side of family ,which I dont appear to have,.

I do supplement well, but yes its clear despite addressing the borderline achlorhydria with betaine and digestive enzymes when I can tolerate I still have chronic malabsorbtion problems judging by my ridged nails and crepey skin now.

One massive improvement has beeen shifting the first dose of meds to 5am or 6 am, so I will keep going, and seeking. And thank you for being there.

Every best wish to you , G

[radd in reply to Gillybean1]

Oh, awful having foods so restricted.

'I still have a problem with the gallbladder and fat digestion though'.

I'm using this although for different reasons to you .... nutriadvanced.co.uk/gall-pl...

It thins the bile, encourages improved detox/recycling, better function all round. You need good bile to emulsify fats and excrete unwanted.

[Gillybean1 in reply to radd]

Thank you Radd,

Yes I know it from nearly 18 years ago, long before I was diagnosed with Hashi;s and Dio2+ it came up on a Kinesiology treatment. I didnt get on with it so well then, but that may have been that I was doing 2 jobs + carer and found the reaction too much to cope with then, as it is a process to assist the gallbladder function ,and couldnt take time out for me at all back then. I think I will give it another try.Plenty of time now I cant move!!

Thank you for the nudge. Every best wish, G.