New Year New Bloods! It's time to titrate! Please help!

[FallingInReverse]

I made it to 8 weeks. This feels like a long post - I have both Thyroid and Iron issues to work out... I tried to make it shorter, but did not succeed, so here is a 5 bullet summary first.

TL;DR: Got results I didn't quite expect:

- I only changed a wee bit... + 12.5 on the levo Changed from 50 Levo, 10 Lio TO the last 8 weeks on Levo 62.5 and 10 Lio. I was going to increase a full 25 but chickened out.

- Got Thyroid panel - do I change Levo or T3?, I'm not sure what to do. FT4 flat, FT3 up now close to "optimal"????

- Got Iron panel - Ferritin is my TOP PRIORITY, it's TERRIBLE. I will be eating a very iron rich diet. My iron is up and down so am afraid of/avoiding supplements. Can I do anything else?

- Vitties - Will be upping D supplement... Vit D way low. What about the others?

- Symptom summary at the bottom - but it's been a horrible 8 weeks! A real struggle.

THANKS TO EVERYONE FOR ANY TIME & ADVICE YOU CAN OFFER ME.

BLOODS

All tests consistent last Levo 24 hours before, Last Lio 2.5 mcg 16-19 hours before, test at 8 am, fasting. D supplement no pause, not taking any others. Below compares January 12th vs 8 weeks prior with only the +12.5 levo.

TSH - Nice and low; got lower!!!

* Jan12: 0.079 ( 0.55 - 4.78)

* dropped from 0.553

FT4 - Added Levo and this DROPPED 2 percentage points! Still super low only 7% in range. Do I need T4 up if T3 is OK?

* Jan12: 0.95 (0.89 - 1.76)

* dropped from 0.97 (9.2% in range) to 6.9% in range.

FT3 - On surface looks like "no change" but actually the 0.3 increase = + 15 percentage points to 68% in range! Leads me to think this is not the culprit this time around??? Should I let this be since it's 68%?

* Jan12: 3.6 (2.3 - 4.2)

* increase from 3.3 (52.63% in range) to 68.42% in range

Vit D - Dropping LOTS since I stopped drinking milk in the fall. Currently on supplement 2500 a day, will double to 5000, or can I go to 7500 a day for a bit?? 200 mcg K2 MK-7 also.

* Jan12: 47 ng/ml (31-100) 23% through range, target 80 ngs...

* Another decrease from 84 to 56 now to a low of 47

B12 - Dropped from 84% to 51% in range, no idea why, or how I might prioritize this.

* Jan12: 568 pg/mL (211-911)

* decrease from 800 (84.14% in range) to 51% in range

Folate - This is OK? I have no idea.

* Jan12: 13.3 ng/mL (>5.4)

* decrease from 21.1

IRON PANEL

Ferritin - Single digits for past 3 months THIS IS MY PRIORITY... Am doing iron-enriched diet because of iron levels.

* Jan12: 9 ng/mL (7-271)

* Was 7-13 in 2 diff tests 8-10 weeks ago.

Iron - 8 weeks ago was 90% through, now 17%. Anyone know if there is correlation between how quickly it drops to how quickly it rises? Unless I know, I'm staying away from iron supplements.

* Aim for 55% to 70%

* Jan12: 71 (50-170) WAS 158 (this is now 17% FROM 90% through range)

% Saturation - I NEED TO UNDERSTAND THIS... Re the relationship to T3... with this low % is my T3 inefficient/ineffective? Or do I have it backward? Does it matter?

* Jan12: 21% (24% in range of 12-50) WAS 43 which was 81% in range

* Notes: Optimal is 35 to 45% to calculate divide serum iron by TIBC• minimum saturation of 30% required to successfully treat with T3• Low, beginning doses of T3 can be started with saturation at 25%

I think it's clear I need more iron, these seem to support that; and also don't seem too important: * TIBC (high in range - indicates need more iron) Jan12: 339 (250-425) WAS 369 - about 55% through range, which is a good place to be. * Transferrin (low means a lack of capacity for more iron, high meaning need supplemental iron) Jan12: 279 (200-360 mg/dL) * CRP Sensitive - lower is good. Jan12: 0.4 (0 - 2.9) WAS 0.7 - inflammation marker, low is good * UIBC- what does this mean? Jan12: 268 (130 - 375) WAS 211

CORTISOL IF IT MATTERS

I get this tested I think it will be useful one day, but I don't know why... On Jan12, test was 26.5 ug/dL (7-9 am 5.3 - 22.5 mcg/dL), which was slightly higher than the 22.9 is was 8 weeks ago (which was drawn 30 minutes later.)

SYMPTOM SUMMARY

It's been a crap 8 weeks. Fatigue has settled in, no relief from it. Naps only once a week or so, but a handful of other days zoning out and stuck. Brain fog/memory trending worse. Making it hard to be productive at work, which just adds to the stress of course. This whole thing is getting to me, seeing no light at the end of the tunnel other than intellectually knowing I still have a couple rounds of action to take towards optimizing. Annoying palpitations that got less intense in recent weeks but are still present, although heart rate itself stays steady ~68 bpm. New insomnia trend about 50% of my nights. I am either tired by midnight (my target) or wide awake until 2-3 am. Would LOVE to feel wide awake during the day!! I was always a night owl, and my brain has always worked best between 10 pm - 3 am. So I do wonder if this is an emergence of my pre-Hashi's body clock. I did stop my daily walk in the past 2 months, fell off the wagon. And maybe most notable for new things - my period lasted a few days longer and my cycle changed for the first time in years from the 25 days to 31 days this month. Oh dear!

[TiggerMe]

So 😵... with a more than 12 hours after your last T3 your bloods are showing a slightly false low... how often do you dose?

The small increase in T4 does seem to have been converted into fT3 hence the rise (optimal fT3 is what works for you rather than a specific number)

Low vit D this should help work out dosing... grassrootshealth.net/projec...

Iron... fickle, if you want to raise it through diet then remember to include Vit C and don't over do the liver due to high Vit A content.... it could take years and your ferritin is borderline deficient

Blood cortisol isn't a great help as it is total rather than free, would recommend a 4 point saliva test with DHEA to see where your free levels are... waking in the early hours is often a sign of an adrenalin rush due to low cortisol... might be worth taking your T3 early hours of the morning with the aim to boost cortisol when it should peak around 9am...

paulrobinsonthyroid.com/the...

Add in a good B Complex like Thorne Basic B to support B12 and folate

Do you take magnesium?

fT4 is still extremely low so I would think another increase with the aim to get to 50%?

Probably more to be said but I'd need to go back and re-read and check your previous posts 🤗 I'm sure others will chip in

Edit... Great Bio!... but more than my brain can cope with in one go.... from what I can see you have never taken more than 50mcg T4 so never a full replacement dose unless you are extremely petite <70lbs?

[FallingInReverse in reply to TiggerMe]

TiggerMe I never said thanks for the above, I’m 2 weeks into actioning your advice. I’m also sharing your amazing D calculator a lot with friends, family, and on this forum : )

Changes: 2 weeks ago I’ve upped my Levo to 75. Eating as much iron as I can. Doing tons of iron research. Upped my D to 7500 and added 400 K daily.

And waiting in the wings on: cortisol test, and learned about LDN in another post to consider later with likely fibromyalgia/nerve issues identified. Menopause is a new idea this month so will be on the lookout for that.

Long list of action items also contains: magnesium, B complex, and maybe way later gluten free. Newer idea - test copper and zinc. Longer term would like to get off the T3 but won’t deal with that until who knows when.

It’s been 8 weeks of really bad brain fog and fatigue. Worst it’s ever been. I’m drowning really so just keeping my eye on the ball and praying for the progress I know will come from the above actions.

Thanks. I’ll be back in 6-8 weeks or sooner : )

[TiggerMe in reply to FallingInReverse]

Your welcome🤗

Sounds like you have a plan!

I didn't mention Three Arrows Simply Heme works really well at raising ferritin without stomach ache, I think the 10% discount code is FRANKLIN

[FallingInReverse in reply to TiggerMe]

Thanks - that’s part of my plan. Got them for my daughter… but the recommended dose put her iron above range in a short 4-5 weeks.

So for her, and concurrently for me now, I am studying and putting a test plan in place to have just the right mix of iron rich foods, iron fortified foods, and heme supplements to strike just the right balance !