where to go from here

[samking5]

I started t3 a month ago first 2 weeks 2.5 mornings only which I definitely believe gave me more stamina and energy and then after 2 weeks added in a second afternoon 2.5, - im not sure if this made much difference, perhaps as first was going from nothing to something and this was just a small increase. However the last week especially I've actaully been struggling more with symptoms than the previous few weeks. I was having some hyper type symptoms such as palpitations along with increased aches, fatigue and some brain fog and was worried these may be overmedication so I decided to get a test.

After the last month on t3 these were:

TSH 6.19

FT4 18.4 (12-22)

FT3 5.6 (3.1-6.8)

Ferratin 41 (30-400)

Serum Iron 32.0 ( 5.8-34.5 ) umol/L

UIBC 28.4 ( 22.3-61.7 ) umol/L

Iron Binding Satn. 52.0 H ( 20-50 ) %

This was an afternoon test 6 hours after meds as I couldn't get a morning test, I know not ideal but perhaps interesting that the FT3 is not crazy high, usually, my FT3 has been around 5 but lower when my T4 was in excess. On the other hand the FT4 for an afternoon test is lower than on monotherapy. does anyone know why T3 medication suppresses FT4 levels, is this just something on the results or does it have symptomatic relevance? I am still taking the same 100mcg of t4.

These were down from in august before starting t3 on 100mcg (9am test)

TSH 10.4

FT4 18.1

FT3 5 (4-6.8)

importantly, my ferritin on this test is way lower than it normally is at around 77, I dont know why as I have actaully been eating more red meat. What could have caused this drop , t3 medication? acute illness? gluten-free diet (mostly since may)?

On the other hand my Serum Iron and iron binding saturation always run high, and my heamoglobin/HCT is always high so I didnt want to take iron supplements, but I think this now needs to be addressed, what should I do? anyway to increase ferratin without increasing the other markers?

Ive also been working very hard few last weeks (my work is physical) and have defo have some kind of viral infection/cold, so its difficult to judge how I am doing with my thyroid when other factors are changing around it. most likely without the t3 I would be doing worse now - those tremors and palpitations have passed so the cause is something else I think.

My endo wanted me to stick to current dose for 1 month at least but im not sure if I will see much further improvements now? (and there is space to increase). I think it would be sensible and lower consequence to try increasing the t3 whether now or in 2 weeks instead of fiddling with levo dose?

Any thoughts are appreciated!

[GlowCoach Administrator]

Firstly the recommended timing to allow each dose to settle and do a blood test are 6-8 weeks after being on a stable dose. If you only started a month ago adding T3 and then 2 weeks before this test added another 2.5mcgs T3 then these results are not accurate.

Suggest you retest when you have been on the same dose for 6-8 weeks.

Its really important also to stick to the same dose spacing before a blood test otherwise you cant compare one test against another.

For Levo 24 hours spacing is recommended. For T3 8-12 hours. Always use the same dose spacing at every test.

A gluten free diet will only work if it is strictly gluten free. No point otherwise.

Taking T3 can slightly lower FT4, just what it does.

You could try adding in chicken liver or pate to your diet to help ferritin.

[buddy99 in reply to GlowCoach]

Jaydee, what would be the optimal level of ferritin within the above reference interval?

[GlowCoach Administrator in reply to buddy99]

Reference ranges for ferritin differ to other vitamins as the higher end relates to males and the lower end for females.

Generally it is said that for optimal use of thyroid hormone, ferritin needs to be 90-100.

Focussing on increasing iron rich foods is the way forward for you to increase your ferritin as your serum iron is high and a supplement wouldn't be recommended. Chicken livers have the highest concentration of iron.

[samking5 in reply to GlowCoach]

so do you think a supplement might push serum iron higher without ferratin? defo want to achieve the opposite! I do eat iron rich food though, could defo try chicken liver pate. I am male, as above my levels are usually around 77 with serum iron + concentration high end, but now the ferratin has dropped and I dont know why.

[samking5 in reply to GlowCoach]

also wondering if gluten free food is low in iron compared to gluten - could be a culprit?

[GlowCoach Administrator in reply to samking5]

You're dropping ferritin as your TSH is too high. As you get better medicated your levels should stabilise more. In the mean time chicken livers a few times a week will help.

[samking5 in reply to GlowCoach]

My ferratin was higher when my tsh was 20+ though, every test it has been 77 apart from this one, so I think there is something beyond the tsh only. I was wondering if the t3 made it happen but when I searched online it said the opposite - low t3 causes low ferratin.

[GlowCoach Administrator in reply to samking5]

Things will fall into place better once you are more optimally replaced.

[samking5 in reply to GlowCoach]

yes hopefully!

[SlowDragon Administrator]

This was an afternoon test 6 hours after meds as I couldn't get a morning test,

So this was only 6 hours after taking levothyroxine?

That’s false high result then

Always last dose levothyroxine 24 hours before test

Extremely common for Ft4 to drop when T3 added

You may end up needing dose increase in levothyroxine as well as T3

Retest correctly 6-8 weeks after starting on T3

At next test get vitamin D, folate and B12 levels tested

What vitamin supplements are you taking

[samking5 in reply to SlowDragon]

hiya thanks for your reply. So yes I agree it is higher but I found that I could be overmedicated and feel quite hyper even when my FT4 levels were not over the range in the morning but were over the range post dose. im really very sensitive to excess levo. (meanwhile t3 never changed or went down hence why my dr and me wanted to try a combination to see if we could get more balance between the two hormone levels)

do you know why ft4 drops? does it have any symptomatic relevance? I am still taking the same amount of levo.

you may be right on the levo, Does the introduction of t3 create more demand for t4 too? seems strange. My dr wanted me to try to get up to 10mcg lio, going off the current test that may well get me to tsh 1 and then there may not be space more levo then.

vit d was 122 n mol (48 ng ml) but I only increased just over a week ago to 4000iu so it may be registering on results before I am feeling effects of it. was aiming for 50-60 ng ml based on guidance this would give best benifit.

I am taking b12 but not folate, active b12 pre supplementation was a bit low, folate mid range.

[SlowDragon Administrator in reply to samking5]

What was last folate result

Rather just adding folate we always recommend a daily vitamin B complex

Low B12 symptoms

b12deficiency.info/signs-an...

methyl-life.com/blogs/defic...

With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a separate B12 supplement and a week later add a separate vitamin B Complex 

Then once your serum B12 is over 500 (or Active B12 level has reached 70), you may be able to reduce then stop the B12 and just carry on with the B Complex.

If Vegetarian or vegan likely to need ongoing separate B12 few times a week

B12 drops

natureprovides.com/products...

Or

B12 sublingual lozenges

uk.iherb.com/pr/jarrow-form...

cytoplan.co.uk/shop-by-prod...

B12 range in U.K. is too wide

Interesting that in this research B12 below 400 is considered inadequate

healthunlocked.com/thyroidu...

Low folate

supplementing a good quality daily vitamin B complex, one with folate in (not folic acid)

This can help keep all B vitamins in balance and will help improve B12 levels too

Difference between folate and folic acid

healthline.com/nutrition/fo...

Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid.

thyroidpharmacist.com/artic...

B vitamins best taken after breakfast

Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule)

Thorne currently difficult to find at reasonable price, should be around £20-£25. iherb.com often have in stock. Or try ebay

Other options

healthunlocked.com/thyroidu....

Igennus B complex popular option too. Nice small tablets. Most people only find they need one per day. But a few people find it’s not high enough dose

IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate folate supplement (eg Jarrow methyl folate 400mcg) and continue separate B12

Post discussing how biotin can affect test results

healthunlocked.com/thyroidu...

[samking5 in reply to SlowDragon]

hi sorry for delay last folate was 7.7ug/l (4-25) and active b12 64 (40-210) total b12 was around 400.

[SlowDragon Administrator in reply to samking5]

So both on low side and need improving