Hello there, help please! Results listed below....I have always been symptomatic with Hashimoto's, diagnosed 2019. Was on just levo for years but after DIO2 testing and conversion rate of t4 to t3 being low I was started on a trial of T3 in march 2023. I always have blood testing between 8am and 9am. I take my last dose of levo the day before bloods (24hrs) and my last t3 by lunch time (20hrs). I supplement with 210mg iron, plenty of magnesium, vitamin D and B supplements, I tend to stop these a couple days before my thyroid bloods and take them away from my meds. I take 2-3 mls of low dose naltrexone (LDN) daily, I'm gluten free for one year and working on dairy free. I constantly feel under the weather with lymphatic tissue in throat causing lumps which have been raised for a year or so. I wake up daily with a sore throat. Lately my symptoms are leading to daily tears and feeling like I have no quality of life so I'm really hoping for some support with my labs to help me figure out if I can tweak my dosing. I will post my last 4 blood results with dosage regimen. Other symptoms I have are achy neck, achy lower back, achy calves, a general unwellness where I feel I have to take paracetamol or ibuprofen. I have a query diagnosis over chronic fatigue/long covid but I suspect my symptoms are low immune system related and inadequate dosing. I am managing one very slow yoga stretch class a week but I feel very unwell dragging myself there. The only relief I get is two hours after waking , an ice cold swim in the local lake or an epsom salt bath. I cant really carry on like this as its really affecting my mood now. My weight is 66.7kg currently. Thankyou in advance...
24/03/23 Last few months before this blood test I was taking between 100-125mcg levothyroxine......
THS 3.820 (0.27-4.20 ml/UL)
FT4 17.22 (12-22 pmol/L)
FT3 3.6 (3.1-6.8 pmol/L)
TPO 286 (0-24 IU/ml)
02/05/23 Taking 75mcg levothyroxine and 2x 5mcg liothyronine led to this result....
TSH 0.874 (0.27-4.20 ml/UL)
FT4 18.71 (12-22 pmol/L)
FT3 4.1 (3.1-6.8 pmol/L)
19/09/23 Taking 50mcg levothyroxine and 3x 5mcg liothyronine
TSH 1.650 (0.27-4.20 ml/UL)
FT4 14.70 (12-22 pmol/L)
FT3 4.1 (3.1-6.8 pmol/L)
Felt horrendous at this point and figured i probably should'nt have dropped my levo to 50mcg
03/11/23: Taking 75mcg levothyroxine and 3x 5mcg liothyronine
TSH 0.704 (0.27-4.20 ml/UL)
FT4 14.10 (12-22 pmol/L)
FT3 4.7 (3.1-6.8 pmol/L)
TPO 166 (0-24 IU/ml)
So currently I'm still taking 75mcg levothyroxine and 3x 5mcg liothyronine daily. I'm not sure what the best way to take this dosage is in regards to timings. I feel like the t3 is helping but something isn't quite feeling right... Is it normal for my t4 to drop when taking t3and is this significant? At what point will I know I'm taking on board the right dose of T4/T3. Would a reverse T3 blood test show me anything? I'm a little lost in all this! Maybe I need to increase my T3? Its helped my hair grow which is a bonus
Sammy xx
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Do I take all my supplements together... no, i space them adequately away from medication.
Leave 24hrs between last dose of levo and blood draw... I do
T3 affects my sleep so I never take it 8-12hrs before a blood draw as that's not how I normally dose? Perhaps I should look at changing my routine... so maybe take cytomel 3 times daily every 8 hours?
I have the draw consistently between 8and 9am and don't eat or drink before. So the only thing off here is the time I take my last dose of T3. I was hoping these last 4 blood draws might provide a little insight at least as to how I'm feeling. Especially as I'm comparing them to when I never took any T3.
Well, it depends on your true level of FT3. If it's still low, if you're not absorbing it very well, that would account for you not feeling good. But, as I said, the results you have are false lows.
Do I take all my supplements together... no, i space them adequately away from medication.
That wasn't what I meant. I meant do you take the iron with the b vits and magnesium? Iron should be taken at least two hours away from everything except vit C. And you need to take vit C with it to help with absorption. It should be four hours away from thyroid hormones.
so maybe take cytomel 3 times daily every 8 hours?
I doubt that's necessary on a daily basis. But maybe the day before the blood test? So, if you have the blood draw at 8 am, take your last dose at 8 pm the day before.
Could even be that you need to take your T3 all in one go. Some people do.
Hi Sammy, bit too long a gap after T3 we usually work on 8 hours after last dose and 24hrs after T4.... even so here are your results as a percentage...
Free T4 (fT4) 14.1 pmol/L (12 - 22) 21.0%
Free T3 (fT3) 4.7 pmol/L (3.1 - 6.8) 43.2%
It is quite normal for fT4 to drop when adding T3, generally keeping it above 50% for combi therapy is a starting point, your fT3 is a false reading so maybe around 50%+ after 8 hours , I feel dreadful when my fT4 drops below 50% (I'm of the wonky DIO2 persuasion) even with T3 😕
I'd suggest you increase T4 to 100mcg either by adding 25mcg if you can or stepping up by 12.5mcg a day to start with... some struggle more than others when changing dose
Retest after 8 weeks and see how things are looking 🤗
Dosing T3 is trial and error, I find one morning dose works better than splitting, others leave 8 hour gaps
Have you any results for Ferritin, B12, Folate, Vit D etc?
Cold water swimming might feel great but its putting a huge strain on your adrenals which likely leaves you feeling pretty drained later?
What is your resting heart rate, BP and temperature looking like?
I have started to feel bad with t4 dropping so that makes sence with what you say. But if I now up my t4 to 100mcg will I not be overdosing with the additional 3 lots of 5mcg T3? I will happily try that though.
Can you explain the maths to work out the percentages you came to there?
My resting HR is 69, BP 111/68 and temp is 36.
My 25OH vitamin D is 96 nmol/L
Ferritin was 35ug/l a few weeks ago but I am now supplementing 210mg daily to get it up.
Active B12 74pmol/L
Folate 4.9ug/L
The cold water takes everything away pain wise but yes I do feel refreshed but sometimes more tired later. I was hoping it might help my immune system improve.
Unlikely that raising your fT4 is going to have much of an effect on your fT3 as you are a bad converter but even if it raises your fT3 a little you have headroom for that being that your fT3 is around 50-60%
The percentages are care of this really handy page that one of our members husbands constructed to level out the various lab ranges... thyroid.chingkerrs.online/
Vit D is good
Ferritin low, presumably GP ran a full iron panel before giving you Ferrous Fumerate? Which tends to be hard on the stomach and not well absorbed 😕but it's cheap! Many of us have used Three Arrows Simply Heme as it is well tolerated and absorbed
Active B12 could be better I think top of range is 150? So over 100 would be good
Folate very low... that'll make you feel crappy too. Which range is that on? Some top at 20 others 60 either way above mid range is the aim.
Suggest adding a good B Complex to your list, take before lunch as can be stimulating... Thorne Basic B or Igennus Super B Complex... just noticed you already take a B Complex, you'll need to add a separate methylfolate to bump it up, perhaps your complex is folic which isn't as usable?
It's good to do things you enjoy but us hypo's tend to run on the cold side like you at 36 so your body will have to work really hard during and after the cold water swimming 🥶which drains your adrenals even more
But what about my TSH if I raise my Levo by 25mcg to 100mcg and stick with 3x 5mcg T3? Would it not make me go hypo. I agree I deffo need to increase my t4… but I’m scared of dropping the t3!
My Gp hasn’t advised I start high dose iron… I just started it as I saw it was 30ish. Is it more sensible to get my full panel first?
folate range literally says above 2.5 is acceptable 🤣 Is that like the bare minimum to survive or something 🙃
That’s interesting re the dipping. I did one a day in October for charity and it was exhausting but exhilarating 😂
Thankyou for the info on b complex and active form…. Need to look into that x
Most of us have under range TSH when we start on T3 so I wouldn't worry too much about that, what is important is that your frees are in a good place for you.... you can't go hyper just over medicated and you are a way off that
I'd suggest adding the 25mcg T4 and keep T3 doses as is
You don't really want to be taking iron without the full iron panel as it is possible to be high in iron and low in ferritin 😵 and too much is as bad as too little, complicated stuff iron
Folate yeah you can survive on 2.5 but you'll feel really 💩
Was this test 6-8 weeks after being on 75mcg levothyroxine.... Yes 6 weeks
Which brand? TEVA
Day before test take last dose T3 at 8pm - 10pm OK Thankyou
Ferritin is obviously terrible. Its always been crap... between 10 and 30ish. Will try hard to get it up. What level is desirable?
Folate also far too low... I thought 4.9 was in range, what do you recommend? Gp says above 2.9 is ideal.
Gluten I am 95% free.
Dairy I am lactose free but struggle to not have cheese :/
I take LDN, IRON, MAGNESIUM, VIT D, VIT B COMPLEX, VIT C, COQ10, NAC sometimes, ginko biloba, melatonin at night. Some reiki mushroom sometimes. A probiotic.
Paracetamol/ibuprofen as needed, may move onto naproxen.
you need to click on blue reply button of other poster ….or they aren’t notified of your reply
which brand on vitamin B complex
How long before test did you stop taking it
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
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)
Post discussing how biotin can affect test results
Serum ferritin level is the biochemical test, which most reliably correlates with relative total body iron stores. In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency.
Never supplement iron without doing full iron panel test for anaemia first and retest 3-4 times a year if self supplementing. It’s possible to have low ferritin but high iron
Test early morning, only water to drink between waking and test. Avoid high iron rich dinner night before test
Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption
This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.
We have received further information the lab about ferritin reference ranges. They confirm that they are sex dependent up to the age of 60, then beyond the age of 60 the reference range is the same for both sexes:
Males 16-60: 30-400 ug/L
Female's: 16-60: 30-150
Both >60: 30-650
The lower limit of 30 ug/L is in accordance with the updated NICE guidance and the upper limits are in accordance with guidance from the Association of Clinical Biochemists. ‘
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