Advice needed. Is it time to increase T4?

[Kriticat]

I've been on 75mcg T4 (tirosint) for about 6 months now, and my latest results are:

Free T4 (fT4) 1.3 pmol/L (0.8 - 1.8) 50.0%

Free T3 (fT3) 4.94 pmol/L (3 - 6.5) 55.4%

4 months ago they were:

FT4: 1.6 Ng/dl (Range 0.8 - 1.8) 80.00%

FT3: 6.06 pmol/l (Range 3 - 6.5) 87.43%

My vitamin and mineral levels all seem OK, B12 still just mid range (677 nmol/L (200 - 1050) despite taking both b12 and b complex, Vit D up from 41 to 66, (30-100) so still a way to go for optimal, zinc finally increased slightly, (once I started taking it away from my oats!) but still only 29% through range. So definitely room for improvement there (other vit/min levels were all good at the end of last year so haven't retested recently)

Overall I still feel much better than I have for years, but I've noticed a few symptoms creeping back, mainly insomnia and feeling like a zombie in the morning, constipation and frequent urination. It's not every day, it comes and goes, and my waking body temperature is still around 36c (it was 34.9) and I haven't put any weight back on, but I am also getting more joint pain again.

So I am unsure if I should increase to 88mcg, or sjould I stick to 75mcg for stability, try to improve my vit/min levels and accept that as I have Graves antibodies as well as Hashimoto's, I will always fluctuate and just enjoy the good days.

Any advice, thoughts, suggestions, gratefully received

Thanks in advance

,

[radd]

Kriticat,

It’s tricky. First reaction would be to increase as when building to establish our sweet spot, a reoccurrence of symptoms and a drop in labs generally indicates it’s time to raise the dose and 75mcg Levo isn’t very much.

However, you have a way to go with your deficiencies and especially the zinc that is huge in not only the making of thyroid hormone but converting it. And I would be factoring in how much working thyroid gland you have left as your previous labs are good, but also consider stimulating antibodies that might have given that raised thyroid hormone reading. You haven’t included TSH. Was it raising?

I think it this were me I would hold off a Levo dose raise for a few more weeks to get another set of labs to confirm those lower levels are true, and meanwhile keep trying to raise the nutrients and iron.

‘accept that as I have Graves antibodies as well as Hashimoto's, I will always fluctuate’

No, the goal is to manage the (auto)immune response through various methods to reduce high antibody levels and prevent high fluctuations which can make you feel very unwell. Even when Hashi & Graves antibodies offset each other, you still risk a huge internal war that produces further damaging inflammatory cytokines that fuel other autoimmune conditions and can impair our thyroid meds from working well.

Replacing missing thyroid hormones with Levo will help calm the immune response as reduces thyroid gland activity but it’s a balance over how much shutting down is necessary. Are you supplementing selenium? This is also big in thyroid hormone function and known to reduce TPOAb’s. Zinc and Vit D are also immune modulators.

Are you gluten-free? Isabella Wentz’ book The Root Cause offers great info regarding the damaging effects of autoimmunity and how to control it. I found fish oils and curcumin helpful in controlling the chronic inflammation (aches & pains) that thyroid autoimmunity induces.

[Kriticat in reply to radd]

Thanks radd , I actually took an 88 this morning as I was awake all night and feeling desperate! But I will take your advice and go back to 75 for now. ...although this is the 2nd lot of tests that show thyroid hormone dropping. My TSH is stationary at 0.01, and only increased when I was severely under medicated, and felt awful, so I'm just ignoring it now and focusing on FT3 and FT4... The interim results, when I still felt OK, were Free T4 (fT4) 1.6 ng/dL (0.8 - 1.8) 80.0%

Free T3 (fT3) 5.62 pmol/L (3 - 6.5) 74.9%

So T4 the same but T3 dropping... but I'm due the next tests in 2 weeks, so I guess I can hang on a bit longer!

I realise how important it is to have optimal vit/min levels, and am doing my best to increase them... I've been supplementing with zinc for almost 2 years now and it has barely shifted! In fact it kept dropping until I heard that wholegrain interferes with absorption. I now take it with my evening meal. I've also started to occasionally eat red meat in order to up my intake, I'm not actually vegetarian but used only to eat a bit of fish or chicken... I'm wondering if I should also take Vit A or C to help absorption, but I eat a lot of carrots and huge quantities of fruit!

I don't supplement with selenium as my levels are top of range with just a couple of Brazil nuts a day. I am gluten-free and also take fish oils, turmeric, glucosamine and collagen to try to control the inflammation ... if they're helping I dread to think how I'd feel without them! All the supplements I take are top quality, mostly as recommended on this forum. Not sure what else I can do! I'll keep trying.... don't know where I'd be without the help and support of the people on this amazing forum