I'm sorry I still havn't completed my profile so a brief history. Undermedicated for years by GP but eventually seen by Endocrinology last year & started T3 in December 2023. I have slowly been increasing my T3 dose & reduced my Thyroxine T4 to 75mcg. My current dose of T3 is 10mcg am & pm.
Results on 4th Jan 24 - TSH 0.44 (0.27-4.2) T4 19 (11-22) & T3 3.8 (3.1-6.8)
Results on 24th Jan 24 - TSH 0.13 T4 16 & T3 4.2
Today's results 1st March 24 - TSH 0.03 T4 14 & T3 4.5
On the whole I have been feeling brighter with a bit more energy which is great but then 4 days ago I have been feeling awful & its virtually impossible to keep my eyes open just needing to sleep most of the day for no obvious reason. Also have a bad headache & pounding heart beat (both bearable).. I have a follow up phone appointment with my Endocrine Nurse next Wednesday but have a really busy weekend ahead so i'm just wondering if my low TSH could be responsible for the sleepiness. It may be unrelated as I'm still learning so any help greatly appreciated.
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Otto11
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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)
T3 ….day before test split T3 as 2 or 3 smaller doses spread through the day, with last dose approximately 8-12 hours before test
is this how you do your tests
Do you always get same brand levothyroxine and T3 at each prescription
Your Ft4 has dropped at each test and now very low …..probably too low
19…….17….14
How much levothyroxine were you taking BEFORE reducing to 75mcg
You need to increase levothyroxine back up at least 12.5mcg per day
Retest in 6-8 weeks
You may then need to increase T3 by 5mcg after next test
Many on levothyroxine plus small doses of T3 find they need BOTH Ft4 and Ft3 at least 60-70% through range
currently only
Free T4 (fT4) 14 pmol/L (11 - 22) 27.3%
Free T3 (fT3) 4.5 pmol/L (3.1 - 6.8) 37.8%
Very common on T3 for TSH to be very low or suppressed
What vitamin supplements are you taking
When were vitamin D, folate, B12 and ferritin last tested
Hi thank you for your quick reply. I always do blood tests as per protocol & took my last dose of T4 24hours prior to test & followed protocol for T3 too. Today however although I was at the hospital before 9 it took till 11am to get my bloods taken. Only 1 phlebotomist for the whole hospital! I was taking 100/125mcg prior to starting T3 in December. This reduced to 100mcg /75mcg at the beginning of January then to 75mcg at the end of January. I was initially taking Mercury 25mcg tablets x3 daily but 2 weeks ago I was prescribed 50mcg tablets which are Accord. (I did take 100mcg Accord tablets previously so I have had those in the past quite recently until December) My Vitamins were last tested in November 23 prior to starting T3 they were B12 755 ( I had a B12 injection just prior to blood test), Folate 8.8 Ferritin 77 & Vit D 89. I'm currently taking Methyl folate drops but not every day as also taking B Complex but with Folic Acid not Folinic Acid as bought them before I knew the difference. I could do another private test as I doubt GP would do them again. Or I can ask my endocrine Nurse on Wednesday although they have never mentioned vitamins to me at all! I have learn't that from you. Thank you very much for your help I hope this all makes sense.
The TSH itself doesn't cause any sort of symptoms, whether it's high or low. It's T3, the active hormone, that does that. And yours is a little on the low-side. You need and increase in dose.
Well, your FT4 is also low, but you can't increase both at the same time. Personally, I'd increase the T3 first and then see how you feel. You can increase the levo at a later date.
Yes, increasing levo would increase your FT3 slightly but would it be enough? I imagine that the reason you started T3 in the first place is because you are a poor converter. So, that might work and it might not. No guarantees.
Thanks. This is all a learning curve. Yes I am a poor converter having been undermedicated by my GP for years. I initially increased Thyroxine from 75mcg to 125mcg as advised by Endo but T3 was still low. It is slowly improving but suddenly last week I'm white washed. It came on suddenly just out of nowhere late afternoon & cant keep my eyes open for long.I'm going away next week & don't even have the energy to pack. Oh well I will see what my Nurse says on Wednesday. Thanks again.
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