Socratic Lab Results – any advice?

[Koola]

… because Socrates said in many different ways “the more I go, the less I know” and when I look at my lab results over the past years they make no sense to me. However “appropriate” in theory, or not, and whatever dose(s) I take, I’m only getting worse.

I’ve been on T3/T4 combo since June 2021. I will copy last two results from Sept. and December 2023. From May to September I was on 91 T4 and 10 T3, then reduced T3 to 5 mcg.

22 Sept. 2023

TSH: 0.697 mU/l (Range 0.2 - 5) 10.35%

FT3: 3.21 pmol/l (Range 1.8 - 4.5) 52.22%

FT4: 14.1 pmol/l (Range 7 - 20) 54.62%

From 22 Sept to 18 Dec. I reduced T4 to 81 then 75 mcg, first with 10 T3 then reduced to 5 T3, because heart beating, jittery and not sleeping more than six hours. (Still the case, so when you go to bed at 10 or even 9 pm… Lucky that I’m an avid reader.)

Why reduced T4? Because for years, whenever I’ve tried 100 T4 I feel miserable. I’ve read that for some people there’s an uncomfortable dose but taking more solves the problem..? But I haven’t dared to up T4 beyond 100.

18 Dec. 2023

TSH: 0.604 mU/l (Range 0.2 - 5) 8.42%

FT3: 3.04 pmol/l (Range 1.8 - 4.5) 45.93%

FT4: 12.7 pmol/l (Range 7 - 20) 43.85%

To explain my confusion: a year ago, Sept. 2022, my labs were much better in theory but I also wasn’t well at all:

23. September 2022

TSH: 0.164 mU/l (Range 0.2 - 5) -0.75%

FT3: 3.77 pmol/l (Range 1.8 - 4.5) 72.96%

FT4: 15.8 pmol/l (Range 7 - 20) 67.69%

Looking forward to much needed advice!

PS. I regularly check vitamins etc. and supplement. I’m neither gluten- nor dairy free but get fresh eggs from a farmer and only goat or sheep yoghurt. Fruit and veggies in Greece are still quite good, though it’s changing and supermarkets are to be avoided.

[Forestgarden]

Between sept and dec 2023 results you've reduced both t3 and t4? Is that right? And in sept 2022, what t3 and t4 were you on?

I can understand your confusion because there's a lot of overlap in hyper hypo symptoms. One thing I read recently said that if you have trouble sleeping it could be due to low overnight t3. What time of day do you take your meds? Do you split doses?

[Koola in reply to Forestgarden]

Hi Forestgarden,

In Sept. 2022, I had first been on 63 T4 and 5 T3 then upped T3 to 12.50. I was definitely better. But I was better in 2021, 2020 and every year before that because, other than some tiredness since 2015, the hard symptoms started little by little at the beginning of 2018.

Maybe I should go back to summer 2022 dose?

I’ve tried to go back to T4 only, which I was on since RAI in November 2009 and till June 2021, but I couldn’t hack it. There’s a point when your whole body says no (same for NDT; later on a T3 only trial and as well when changing brands).

I split T3 when taking 10 or 12. On 5 or 6, I take it late afternoon which is more effective because I’ve always been an evening person and so it acts as a boost. Taking T3 in the middle of the night, early or late afternoon doesn’t seem to make any difference and doesn’t seem to have any immediate effect on my energy level.

After RAI in 2009, I felt really bad for the first months then slowly improved and was fine in 2010. In 2014, I unexpectedly and for no apparent reason gained about 4 kilos. Otherwise okay. How was it for you? How soon did start being hypo?

[Koola in reply to Forestgarden]

Do you have any suggestion for me?

[Forestgarden in reply to Koola]

Hi Koola, its so tricky. I agree there's a limit to how much t4 a person can tolerate, and there's no reason why this should remain constant as we get older. I also think its a fine line between hyper/hypo which can vary from one day to the next... after all, some days we use more energy than others, and with a healthy thyroid there'd be adjustments in t4/t3 output throughout the day to account for this. My feeling would be to go with a t4 that doesn't cause you problems (I get jittery, mind zipping all over, heart thumping when its too much). I've just reduced my t4 from 112.5 to 100 for this reason, even though I'm now more fatigued. I became hypo immediately after rai, and quickly bumped up to 100mcg levo, been on it since. I am hopefully going to add in some t3 in February (I'm a poor converter), but don't really know how that will work. I do know I'll be making any changes very gradually, both reducing levo and adding in t3. Good luck x

[Koola in reply to Forestgarden]

Thanks, Forestgarden.

Will reply soon. Too exhausted right now.

Wishing you a peaceful evening.

[Koola in reply to Forestgarden]

Hi Forestgarden,

I’ve been waiting to answer you because four weeks ago I decided for the 2nd time to stop T3. I was on the T4/T3 “Combo” since June 2021.

First time I tried to stop, I upped T4 to 100 mcg (I was taking 88.) I felt terrible after 10 days. I was warned on forum that it might take many months, that I’d feel terrible etc. So I went back to Combo.

Now I’ve been on T4 only for 4 weeks. It’s early days yet but I’m finally, slowly feeling better. Maybe I’ve been a good converter all along, whatever, but I will not return to T3.

I just wanted to let you know that you might give yourself a time limit to your Combo trial. For many understandable reasons, which you probably have gathered by now, many people on the forum are often very, I would add too partial to T3.

But we are all different and each of us has to find the right individual medication, no matter what doctors tell us, usually T4 only, or what info we glean on forums – very useful at the start but often too pro T3 biased.

Let me know by and bye how you’re doing.

Wish you a pleasant evening.

[Forestgarden in reply to Koola]

Good luck Koola , sounds like a good plan. Stick with the t4 only for a few months and see how you feel. Its so tricky! I am wary about adding in t3, but feel I need to give it a go. I'll make very gradual changes. In my mind I feel like 6 months is reasonable to try it and let things settle, then I'll re-evaluate. Its taken me a long time (2? 3? Years) to get to this point of trying t3. I've done everything I can in terms of diet, gut health, vitamins, minerals to try to improve my conversion, to no avail, so this is my next step. We'll see! Xx

[Koola in reply to Forestgarden]

Belated good luck wishes to you too, Forestgarden.

Have you started t3 and are you feeling any improvement? After a good start on t4 only, I’m not doing well but it’s only been 7 weeks+. Also, I’m undergoing a lot of stress and I know that this impedes the healing process.

Only thing I see is to work on not giving up hope!

Keep me posted and again, best wishes for the promptest recovery possible 🙂

[Buddy195 Administrator]

Ya Su Koola,

I just wanted to share that I get ‘hyper like’ symptoms when both under & over medicated & fully understand what it can feel like on the merry-go-round of adjusting thyroid medication. Through experience I’m now a fan of making ‘low & slow’ changes, staying 8 weeks (or more) on a dose before slightly adjusting either Levo or Lio (never both at the same time). I’ve personally found that I can tolerate FT3 higher in the range to improve symptoms but need FT4 mid range. It’s very much trial & error.

[Koola in reply to Buddy195]

Ya sou Buddy,

Thanks for nice reply and your understanding. My main question is: do you feel you’re improving steadily? I won’t ask how much you’re taking because I know now that the right dose is strictly “tailor made”. And I’m still in search of my personal Grail.

My difficulty now is that whether I add some T3 or T4, I’ll be back on a dose I’ve tried before and that’s proven ineffective.

I have been careful to augment doses slowly, though often changing both T4 & T3 at once. Some people have written that my “piddling” little doses were ineffective. I once was advised to up T4 by 25 mcg and to double T3. Six weeks later I was worse, so I was told to go back to 75 T4 and 6 T3. But nothing seems to improve.

Maybe what applies to Hashimoto doesn’t work for post RAI hypothyroidism? Unfortunately my NDT trial a while back that has helped many didn’t work for me.

One last complaint, but it might help others to know they’re not alone. Once in a while, like my 3rd day on NDT before it turned bad on me (jumping out of my skin!) I felt absolutely normal. Couldn’t believe it. All symptoms, many, gone! But the next day, right back to the inferno… This has happened a few times when changing doses or brands. But it only lasts one day. On the one hand it gives you hope but over time it drives you ba-na-nas!

Bureau of complaints now closed for the day,

Thanks again for writing, Buddy.

[Buddy195 Administrator in reply to Koola]

Yes I’ve eventually found my sweet spot… but it seemed to take ages, by adding small amounts gradually over time. I find a pill cutter extremely useful. I only ever add 12.5mcg Levo (alternate days at first) or 2.5mcg Lio. I’ve benefited from taking an afternoon dose of T3, whereas other members prefer taking it all in one go with their Levo.

[Koola in reply to Buddy195]

Yasou Buddy,

I poster the other day but only got one useful, practical reply from Slow Dragon with the word increase.

I'd like a 2nd opinion and would very much appreciate an answer from you, whenever you have time.

Hope all well with you!