I was sent for an mri for consistent blood results suggestive of pituitary issues. It revealed an empty sella. I was referred to endo/neurology. They did tests - no problem with my pituitary. I had consistent blood results showing very low TSH with low/mid level t4 and t3 while on t4 and t3 meds. I was unwell with palpitations, pulsatile tinnitus fatigue and brainfog which got worse when I tried to increase t3 even slightly. Following investigations endo suggested I was on too much replacement t3 hormone and to try a t4 only trial. I slowly reduced t3 and noticed brain fog improved. I do think I was sensitive to t3. I felt well on 100t4 and 5 Thybon but agreed to try t4 only. Latest blood tests
July (100 eltroxin) Sept (125 eltroxin)
tsh0.2 TSH 0.21 (0.27-4.2)
Ft4 15.3 Ft4 19.5 (12-22)
Ft3 2.7 Ft3 3.3 (3.1 - 6.8)
In Sept I couldn’t sleep and heart was racing so reduction to 112 eltroxin, yet to be retested. Endo has handed over to the GP.
I still cannot sleep. Cannot relax and brain and body are so fatigued. Heart beat is pounding and ears pulsing. Totally confused at this stage. Now the Doc insists I don’t need t3. Is he right? Going round and round with this for years. T4 only, then t4 & Thybon, ndts, then eltroxin and Thybon again, now eltroxin only again. I find a balance for a while then it goes. Vitamins are okay B12 595 (197-771) folate 7.2 (3-26.9) ferritin 81 (13-200) with transferrin saturation high at 47. No iron supplements. But taking methylfolate and methylb12 plus methyl b complex.
And the question is - do these bloods suggest a need for t3. Or do I persevere with t4 only and try to increase again to 125? A bit of a round- a -bout text but I’d really appreciate any feedback.
THANKYOU for reading!
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Chumchum
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I'm wondering if you have an Endo that doesn't believe in T3. My knowledge of empty sella is very limited but I understand that it can possibly affect TSH so I am wondering why you are still being treated by TSH and not free thyroid hormone numbers.
Many Endo's and about all GP's rely on and believe that TSH is the only indicator of treatment levels when this simply isn't the case.
Too lower level of FT3 can cause all the symptoms you describe originally. You may have needed to tweak your dose at that point but not drop T3.
Free T4 (fT4) 19.5 pmol/L (12 - 22) 75.0%
Free T3 (fT3) 3.3 pmol/L (3.1 - 6.8) 5.4%
To me this indicates that you need T3. Your FT3 is far too low and should be at least 50% of range if not higher.
What were your results when you felt well on 100 Levo + 5 T3?
Did you remember to stop the B complex 3-5 days before this test? It can interfere with thyroid blood results.
Your folate is still on the low side. It would be better in that range at around 20.
I would find yourself a different Endo. You can email info@thyroiduk.org for a list of T3 friendly Endo's. Make a new post here asking for feedback by PM only on one or two you have chosen.
THANKYOU Jaydee for the % breakdown - that makes it really clear. I got all muddled by both the Doctor’s convictions and the Endo’s suggestions. I’ll go back to the doc and show him this. It was an experiment initially I think and now we have the proof that t3 is in fact needed🙏
Not that it would affect your TSH anyway but how did you take the test?
What time of day?
When did you last take Levo prior to the test? We recommend a time gap of 24hrs between last Levo dose & blood draw then take Levo for that day AFTER the blood test.
If this Endo still doesn't see the need for you taking T3 then move on and find a different one.
Always follow the advice on here re blood tests. All were 9am with the space recommended between t4 and t3 doses. Also B multi stopped for 7 days prior. In Ireland but will check the list to see if there’s somebody there. Thanks Jaydee
THANKYOU Slowdragon. Added clarity for the addition of t3 again. I was both gluten and dairy free for over 12 months with no real difference. And no I never had the thyroid ultrasound . Might ask about that. I don’t have the autoimmune version as both antibodies tests showed results less that 13.
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Blood test results in (finally)
Hypothyroid blood results advice.
Blood results? Under or over 
