T4 Rising

[Sat2]

Back in January I was feeling awful, worse than when I was thyrotoxic at the start of all these problems in Sept 2021. In October 2023 I suffered what appeared to be a mild bout of Covid-19 but I seemed to slowly deteriorate from then on with what appeared to be worsening hypothyroid symptoms. These symptoms seemed severe and I felt extremely unwell by January. I visited my GP three times in January but they refused to accept that it could be related to my thyroid but they had no other diagnosis to offer. On my third visit when I demanded to see my GP that very same day as I felt on deaths door (Heart rate 44 and undigested food in my poo, but also very constipated ETC) they agreed, upon pushing to increase my dose of Levothyroxine. They asked me if I wanted to start my increase from 75mcg to 87.5 or to 100mcg I opted for 87.5. I was given a prescription for 125mcg.

Results

Test providers NHS & Monitor My Health (MMH)

Dose 75mcg

10/01/2024 MMH TSH 2.98 (0.27-4.2), T3 4.4 (3.1-6.8), T4 19.2 (12.0-22.0)

23/01/24 Dose increased to 87.5mcg

22/02/2024 MMH. TSH 2.02 (0.27-4.2), T3 4.0 (3.1-6.8), T4 21.0 (12.0-22.0)

05/03/2024 NHS. TSH 2.19 (0.27-4.2), T3 not tested, T4 20.0 (12.0-22.0)

06/03/2024 Dose increased to 100mcg

03/04/2024 MMH. TSH 2.47 (0.27-4.2), T3 4.0 (3.1-6.8), T4 21.1 (12.0-22.0)

I conduct my bloods as per the advice here and I am only taking B12 & Vit D3 at present. I am feeling generally well although my stamina is not great, I feel I could still improve.

Despite an increase of T4 of 25mcg since end of January my TSH appears to be rising.

All advice welcome.

[GlowCoach Administrator]

Great profile.

So you've had a hyper phase and now into the decline of thyroid function with presumably Hashi's. Your body has had many changes to make in the past few years and it takes time for all the lack of thyroid hormone and too much to balance out.

How are you taking your Levo? Your TSH is fairly high compared to your FT4 level.

Always take Levo on an empty stomach an hour away from food or caffeine containing drinks & other meds. Many people find taking it at bedtime works well for them.

Free T4 (fT4) 21.1 pmol/L (12 - 22) 91.0%

Free T3 (fT3) 4 pmol/L (3.1 - 6.8) 24.3%

Your conversion rate isnt the best and possibly you may need to add a small amount of T3 in time.

What were your latest results for ferritin, folate, B12 & D3?

[Sat2 in reply to GlowCoach]

I was hyper back in 2021 and stable on 75mcg from nov 2021 until around October 2023 when things started going wrong. I had subacute thyroiditis not Hashi. I am very particular in taking my medication everyday at 22:30, I never forget to take it. I eat around 17:00 so as to give as many hours between then and taking my Levothyroxine as possible.

D3 was 61nmol/L , B12 was 84pmol/L, Ferritin 120mcg/L, folate 6.9mcg/L all taken 18/12/2023

How on earth do I go about getting T3, I had to scream and shout to get an increase above 75mcg of T4.

[GlowCoach Administrator in reply to Sat2]

NICE guidelines suggest a dose by weight of 1.6 x body weight in kilos = approx final dose. Its always worth mentioning that to your GP.

T3 is only prescribed initially by Endocrinologists. Its a bit of a postcode lottery as to if your area is pro T3. You can email [e-mail] for a list of T3 friendly Endo's and doctors. Pick a couple and make a new post asking for feedback on them by personal message.

Its possible to get T3 prescribed on the NHS but it is simpler and faster to go privately if that might be possible for you.

Were your vitamin tests done before or after beginning supplements?

I'd suggest a B complex as opposed to a stand alone B12 as that would also include folate and you need that too going by your latest results. Here are some suggestions:

Slightly cheaper options with inactive B6:

amazon.co.uk/Liposomal-Soft...

Contains B6 as P5P an active form:

bigvits.co.uk/thorne-resear...

healf.com/products/basic-b-...

Explanation about the different forms of B6:

helvella.blogspot.com/p/hel...

B complex comparison spreadsheet:

healthunlocked.com/thyroidu...

[SlowDragon Administrator]

I am only taking B12 & Vit D3 at present.

Ideally test vitamin D twice a year

What was last vitamin D result

How much vitamin D are you taking

B12

What was last test result

No folate result or ferritin?

As you have Hashimoto’s are you on Gluten Free or Dairy Free diet

Which brand of levothyroxine are you taking and do you always get same brand

[Sat2 in reply to SlowDragon]

I had Subacute Thyroiditis with fairly severe Hyperthyroidism with T4 of at least 69, my T4 was on the way down before this first TFT. I'm not Hashimoto’s. Although I am on what I would describe as a low gluten diet as a lot of gluten doesn't do me any favours, celiac has been ruled out. I am not diary free but diary doesn't appear to upset me at all.

D3 was 61nmol/L , B12 was 84pmol/L, Ferritin 120mcg/L, folate 6.9mcg/L all taken 18/12/2023

I generally take accord with Mercury or Wockhardt, I'm taking 1000ui of D3

[SlowDragon Administrator in reply to Sat2]

So Folate low

As our serum B12 is over 500 (or Active B12 level has reached 70), you may be able to reduce then stop the B12 and just take daily B Complex.

If Vegetarian or vegan likely to need ongoing separate B12 few times a week

Low folate

supplementing a good quality daily vitamin B complex, one with folate in (not folic acid)

This can help keep all B vitamins in balance and will help improve B12 levels too

Difference between folate and folic acid

healthline.com/nutrition/fo...

B vitamins best taken after breakfast

Igennus B complex popular option. Nice small tablets. Most people only find they need one per day. But a few people find it’s not high enough dose

Post discussing different B complex

healthunlocked.com/thyroidu...

Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule) Thorne can be difficult to find at reasonable price, should be around £20-£25. iherb.com often have in stock. Or try ebay

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

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

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) and continue separate B12

Post discussing how biotin can affect test results

healthunlocked.com/thyroidu...

helvella.blogspot.com/p/hel...

[Karlamay]

My biggest problem was extreme lethargy until I joined this group and found I wasn’t talking my Levo correctly. So now I take it first thing in morning (6.30am) and always fast till 1pm anyway so that works for me. I have much more energy and feel generally better now. Hope you can improve soon - it’s awful to feel so sick