Hi
My GP was concerned about my blood results and the effects of my medication still don't seem to be working as I am still very tired and have not lost any of that weight I gain. I am on levo 50mcg and lio T3 30mcg. But my tsh is still really low and if I add more t4 it will drop further.
My results are below pictures.
Thanks
Your symptoms are still there as your hormone levels and therefore your doses are not right for you .When on liothyronine t3 very few folks manage to have a tsh in range. Most of us have a tsh that is barely measurable.
I would start be increasing levo as ft4 is below range.
No one can predict what doses we need. You have to find that out by trial and error.
Forget the TSH. Dosing by the TSH presumes that everyone has a perfectly working pituitary/hypothalamus. But that's just not true. If your thyroid can go wrong then so can the other glands of the endocrin system. And yours doesn't seem to be working very well because your TSH doesn't correspond to your low thyroid hormone levels - one would expect it to be much higher with those low Frees.
That said, what time of day did you have the blood draw for that test? TSH is highest before 9 am. Then it drops to its lowest point around midday, and slowly rises to its highest point around midnight. So, the time of day you have the blood draw is very important.
The most important number is the FT3, and for someone on 30 mcg T3, yours is very low, and that's why you still feel tired and can't lose weight. So, it rather looks like you are not absorbing it rather than it 'not working'.
How do you take your thyroid hormones? Do you always take it on an empty stomach and leave at least an hour before eating or drinking tea/coffee? Do you take any other medication/supplements at the same time as your thyroid hormones?
How long were the gaps between your last doses of thyroid hormones and the blood draw?
Rather than increase your levo at this point, it would be a good idea to work out why you're not absorbing it correctly. 
Hi thanks for the answer. Yes I do have issues with my pituatry gland for reproduction too (started after majorly surgery). They are all sluggish.
My bloods where taken at 8am fasted.
I thought my results looked strange but I can't understand why? Can it be stress.
Regarding the medication. T4 is taken first thing so no food / drink interaction.
The T3 I take twice daily but I do have gastroparesis so I do have a delay in digestion and digestive issues so it could be a malabsorption issue.
I do get the T3 in liquid form though so I was hoping this would help. It is just lio/olive oil/silica.
I only drink decaf so no caffeine mixture throughout the day. Food I try to take that time apart but with my digestion my stomach is never really "empty".
I feel terrible and my weight is such an issue as it's not at all that I am overweight but I am skinny but all slabby from gaining.
Maybe I should try taking t4 and T3 first thing in the morning together when my stomach is more likely to be empty.
Then I could take a second dose further away.
I do have a delay in digestion and digestive issues so it could be a malabsorption issue.
Digestion is done in the stomach, absorption in the gut. But, as you're still so hypo, you probably have low stomach acid, which will make it difficult to get the hormone out of your stomach and into the gut. I would suggest you do the bicarb test to see if your stomach acid is low, because there are things you can do about that that would help.
my.clevelandclinic.org/heal...
How are your nutrients: vit D, vit B12, folate, ferritin? Sorry, can't make out all your results above. Low B12 will also lower your stomach acid level, as will low salt intake.
But, yes, for a start, it would be a good idea to take levo and T3 together in the morning, see if that improves the FT3 a bit.
Hi
Thanks. Stomach acid is now perfect as far as I believe as I am now on the GAPS diet as it was very very low before but I did this test and it confirmed it was ok.
All my bloods where medium to high range apart from zinc which I have been supplementing for the last month along with cod liver oil , vitD/K and NAC which I take alongside LDN.
I do eat olive oil with meals as part of my diet but try not to take it near my medication.
Thanks, I will definitely try my T3 in the morning. My issue has always been sluggish T3/T4. My t4 was low but 'normal' when I started (10 in range of 9-20) and my free T3 low (0.9 in range of 1- 14 at the time) that is why I started thyroid medication.
I have definitely felt better on it but definitely not what I should be feeling and the weight is horrific when I haven't changed a thing in diet. I don't have any autoimmune thyroid issues or goitres from a scan/bloods.
I was going to start iodine but was worried but I know my diet is low in iodine due to fish / seafood /milk allergy
If you're taking vit D and K2, are you also taking magnesium? Because vit D and magnesium work together.
I do eat olive oil with meals as part of my diet but try not to take it near my medication.
Sorry? What's the problem with olive oil?
Best not to take iodine, you will be getting plenty of that from your levo and T3 - about 33 mcg from the levo and about 13 mcg from the T3. And excess iodine can cause problems.
Hi no I don't take maganese. I try not to take many supplements but I will look into this one Thanks.Olive oil can slow down digestion so I was worried it was causing a delay in my medication from the stomach to the small bowel but if hoped my diet would help absorbtion.
Thanks. Yes I am nervous of iodine and someone did tell me to take it but I took it once before In a multivitamin and it threw off my monthly cycle after that. I didn't know it was in thyroid meds, brilliant!
Thanks for your help
Magnesium, not manganese.
Well, I still think that your slow digestion is down to low stomach acid. Everything you say points to that.
Iodine is not 'in' thyroid 'meds', as in something added to it. That's what thyroid hormone is: T4 is 4 atoms of iodine to every molecule of hormone. T3 is 3 atoms. And that's what conversion is: the removal of 1 atom of iodine, which is then recycled in the body.
And, also, when you are taking thyroid hormone replacement, the body needs less iodine than before, because the thyroid is no-longer making thyroid hormone. So, it's very easy to over-dose on it.
People have some very weird ideas about iodine - even doctors! But they are never able to say what they think taking iodine is going to do for them! It is not a cure for hypothyroidism, and can make it much worse.
Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
On T3 - day before test split T3 as 2 or 3 smaller doses spread through the day with last 10mcg dose 8-12 hours before test
Is this how you did your test
what are folate and ferritin results
What vitamin supplements are you taking
Hi
Yes this is exactly how I tested above.
Folate is 16 (between 8-20).
Ferratin is 37 (between 5-200). I am taking chicken livers to improve this as it was at 5.so it is going up slowly.
I am taking vitamin D/K. Cod liver oil. Coq10 and NAC. I also take LDN.
So next step is to increase your levothyroxine by 25mcg
Retest in 6-8 weeks
Thanks
Many, many members on levothyroxine plus T3 find they need BOTH Ft4 and Ft3 at least 70% through range
I would try splitting your T3 as 3 x 10mcg
I agree with the others but wanted to flag up your high B6 is this from a B Complex?
I'd say cut it out as it isn't something you want too much of 🤗
Hi. No no supplements. I believe it's from eating chicken livers so food based. I didn't know high b levels where an issue.
Certainly supplementing too much B6 can be an issue...
Safety and side effects
Consuming vitamin B-6 through food appears to be safe, even in excessive amounts.
When used as a supplement in appropriate doses, vitamin B-6 is likely safe.
However, taking too much vitamin B-6 from supplements can cause:
A lack of muscle control or coordination of voluntary movements (ataxia)
Painful, disfiguring skin lesions
Heartburn and nausea
Sensitivity to sunlight (photosensitivity)
Numbness
Reduced ability to sense pain or extreme temperatures
Interactions
I think the other issue with liver is its high level of Vit A which is why they say 2 portions a week?
Yea this is my aim at the moment. I had some before this test so think that might be why
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