Got my strange results back after 6 weeks of being on T3.

[Katherine123]

My results are looking a little strange to me. Can anyone give me a hand here on the interpretation.

Back story - Endo cut my 100mcg of T4 down to 50 and gave me 10mcg of T3 once a day dose. Endo has now given me another 3 month prescription for the same 10mcg T3. I was expecting a T3 dose increase as I did really well on the T3 for 3 weeks, and have now crashed and feel more hypothyroid. On advise from here I have upped my T4 this week to 75mcg (brain fog has lifted). Fatigue still bad. I was unable to split T3 as it is a capsule. I am going to ask pharmacist for tablets this time. I do not see him face to face until May 2024. The endo nurses gave me a print out of my blood tests with lab ranges this time.

My previous results (no lab ranges):

May 2023 - TSH 3.2 - FT4 22 - FT3 3.5 (T4 medication only 100mcg)

September - TSH 0.45 - FT4 27 - FT3 4.4 (T4 medication only 100mcg)

New results (6 weeks on 50mcg T4 and 10mcg of T3)

TSH 2.01 - (lab ranges - 0.27 - 4.2)

FT4 12.30 - (lab ranges 11.9 - 21.6)

FT3 4.0 - (lab ranges 3.1 - 6.8)

[GlowCoach Administrator]

It does look like your Endo has been heavy handed with the reduction of 50mcg of levo.

What was the dose timing of Levo & T3 prior to the blood test?

If you have a capsule then it can be tricky to split the dose & aim for 8-12hrs T3 dose before test.

Levo - should allow 24hrs before the blood test.

Free T4 (fT4) 12.3 pmol/L (11.9 - 21.6) 4.1%

Free T3 (fT3) 4 pmol/L (3.1 - 6.8) 24.3%

A 25mcg Levo dose increase will help.

Can you contact his secretary prior to your appointment to discuss a dose increase? You may need to get the Levo dose authorised to ensure you have enough tablets each month.

How are your vitamin levels looking?

What supplements are you taking?

[Katherine123 in reply to GlowCoach]

Jaydee I take my T4 before bed and T3 in the morning. I had early morning blood tests because they keep checking my low cortisol too. So all tests 9am. I did not take T4 the night before and did not take T3 that morning until I got back home at 10.30 am.

It is just weird that all my hypothyroid symptoms have come back worse now and my TSH has gone up from last time. My T4 is coming down as it was way over range on T4 only and T3 low. I have upped my T4 another 25mcg on advice from here. I am on day 6 off doing this and my brain fog has disappeared. Fatigue still very back and hair has gone like straw and breaking off when I brush it.

[GlowCoach Administrator in reply to Katherine123]

So the T3 result is what would be called a 'false low' and would have been higher had 8-12hrs been allowed before the test.

How are your vitamin levels looking?

What supplements are you taking?

[Katherine123 in reply to GlowCoach]

Jaydee I rattle. I take b complex, thiamine B1, extra B2 and B5, high dose folate (I am on B12 injections), selenium, amino acids, extra L Tyrosine, natural vitamin E capsules, cod liver oil, vit C, zinc copper, magnesium, boron, taurine.

[greygoose]

Why do you think they're strange?

Your endo reduced your levo by too much and you are now under-medicated. Difficult to say anything for sure without the ranges but it looks to me as if it only needed reducing by 25 mcg, not 50. The level would have reduced anyway when taking T3.

But, you're not even taking enough T3 because your FT3 result is under mid-range, not much better than it was without T3. You're right in that you need an increase in dose. But, maybe get an increase in levo, first, see if that helps.

[Katherine123]

Strange to my untrained eye greygoose I have lab ranges new results (6 weeks on 50mcg T4 and 10mcg of T3)

TSH 2.01 - (lab ranges - 0.27 - 4.2) FT4 12.30 - (lab ranges 11.9 - 21.6) FT3 4.0 - (lab ranges 3.1 - 6.8)

I have upped my T4 to 75mcg the last 6 days and brain fog has lifted, although fatigue is still really bad. I will up it again back to 100mcg after 6 weeks. I am asking the pharmacist to give me T3 tablets this time to allow me some wriggle room to increase if I need to. I was given capsules last time.

How long would you suggest after the T4 increase should I increase T3 greygoose?

[Lalatoot in reply to Katherine123]

You wait 6 to 8 weeks. Then get bloods done. Then you decide what the next step is. You only change 1 thing at a time so you can tell what effect that change is having. This may seem slow and frustrating but it removes guesswork and gives the body time to adjust and adapt.

[Katherine123 in reply to Lalatoot]

I hear you Lalatoo, I am been so sick for such a long time. I just want to be well, life is just passing me by Endo will not check my bloods again until 3 months time.

[SlowDragon Administrator in reply to Katherine123]

Endo will not check my bloods again until 3 months time.

Endo clueless then

I’m have upped my T4 to 75mcg the last 6 days and brain fog has lifted, although fatigue is still really bad.

Retest 6-8 weeks time

as you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test

If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal

Day before test split T3 …..taking half capsule early morning and half capsule 8pm

At next consultation request change to 20mcg tablets (MUCH cheaper) and cut into 1/4’s ……quite likely to need 5mcg increase in T3 after next test

[Katherine123 in reply to SlowDragon]

I only changed T4 to before bed SlowDragon as taking it in the mornings left me with no energy and feeling so ill. My blood pressure would bottom out heart race and even times I was fainting. I did not start to get a bit of energy until 4pm. 10 years ago I change to night time dose and did not wake-up so ill in the mornings.

I shall follow your regeim for my next blood test. Thank you dearest.

[SlowDragon Administrator in reply to Katherine123]

I much prefer taking levothyroxine at bedtime (11pm)

I split my 20mcg tablet T3 as 4 x 5mcg

Timing - 6.20am, 11.30am, 5.30pm and 11pm

[Katherine123 in reply to SlowDragon]

I am going to split my T3 dose SlowDragon. I have a new 3 month prescription and I am going to ask the pharmacist to give me tablets not capsules. It will be better for me. I had to change my working hours to 2 to 9pm, 20 years ago. As mornings I was so ill and a no go. Being on T3 10mcg once a day at 10am leaves me so tired and fatigued from 5pm onwards, that I am just scraping by with my evening zoom clients