Hypothyroid - help please with blood test results

[1965Katy]

Hi brilliant group,

I would be very grateful for your help regarding my recent blood test results. My GP is not very good on thyroid matters. I did post 8 months ago and I apologise for not replying to SlowDragon. I have had a lot of health stuff going on but now am thinking some of the symptoms are thyroid related.

I weigh 51 kg and height is 163.5 cm. I have osteoporosis and have annual Zolendronic Acid infusions so do not want to overmedicate. Also have low WBC and macrocytosis.

Sept 2023

Iron Binding Studies (I take ferrous sulphate 200mg daily)

Serum iron level 17 umol/L (14.00 - 30.00umol/L)

Serum transferrin 2.09 g/L (2.00 - 3.60g/L)

Transferrin Saturation 33 % (15.00 - 50.00%)

Serum ferritin 124 ug/L (13.00 - 150.00ug/L)

Total iron binding capacity 52 umol/L (50.00 - 85.00umol/L)

Serum B12 486 ng/L (180.00 999.00ng/L)

Serum folate 14.2 ug/L (3.89 - 26.80ug/L)

Vitamin D 110

I increased my Levothyroxine last August to 100mg a day but had only been taking it for 6 weeks

Serum TSH 0.1 (0.27 - 4.2) (taking 100mg of Levothryoxine)

Free T4 22 (10.80 - 25.50)

I increased my Levothyroxine last year to 100mg a day as suggested but felt overmedicated (palpitations and chest pains) and was tested in October 2023

Blood results October 2023 on 100mg Levothyroxine

TSH 0.07 (0.27 - 4.2) -5.1%

T4 19.1 (10.8 - 25.5) 56.5%

T3 4.1 (3.1 - 6.8) 27%

Reduced Levo to 100mg 5 days and 75mg 2 days a week

I am currently taking 100mg five days a week and 75 for two days. Symptoms feel rubbish - tired, no energy, brain fog, constipated, heat sensitive - can suddenly overheat and get sweats when everyone else isn't hot.

Most recent blood tests

Blood test result 12th March 2024

(I took Levothyroxine 2 hours before as did not know it would be tested but only water no food and also biotin the day before)

T3 2.9 (3.1 - 6.8) -5.4%

Blood test results 3rd April 2024

(blood taken at 8am only water before and last Levothyroxine 24 hours before and stopped B Vits week before).

Serum TSH 1.24 (0.27 - 4.20) 24.7%

Free T4 17.3 (10.80 - 25.50) 44.2%

(Lab wouldn't retest my vitamin levels)

Since results in Sept 2023 I have been supplementing with B complex and B12. I have been taking Vit D 20000iu and ferrous sulphate daily for years.

My question is: do I need T3 added to my Levothyroxine? If so how much? Do I need to increase my Levothyroxine?

I currently take 100mg Levothyroxine 5 days and 75mg for two days. I feel totally wiped out but do not want palpitations again. I want my life back!

Any help would be really appreciated. Thank you.

[Buddy195 Administrator]

I had palpitations/ tremor (and ended up in A and E) when I raised thyroid medication too quickly. Since then I now increase only super slowly 12.5mcg Levo alternate days at first and find a pill cutter useful for this.

As a first step, I would increase Levothyroxine slowly upwards (eg changing the 75mcg to 87.5mcg) and retest after 6-8 weeks on a consistent dose. I prefer to wait 8 weeks to retest as it takes me longer to ‘feel the benefit’.

You first need to try & optimise your Levo dose, getting FT4 to around 60%, then you can look at FT3 levels and determine if your conversion is poor / if a combination treatment trial is worth pursuing.

[1965Katy in reply to Buddy195]

Thank you Buddy195 for your helpful reply.

When I was taking 100mcg every day my TSH was suppressed - TSH 0.07 (0.27 - 4.2) -5.1%

T4 19.1 (10.8 - 25.5) 56.5%

T3 4.1 (3.1 - 6.8) 27%

My FT3 has always been low and most recently in April was below range - T3 2.9 (3.1 - 6.8) -5.4%

This has made me wonder if I need a small dose of T3 as well.

I will do as you recommend and increase levothyroxine very gradually to 100mcg daily and then retest. I agree with waiting a good 8 weeks, before that I don't really feel the changes.

[SlowDragon Administrator]

I am currently taking 100mg five days a week and 75 for two days.

Which brands are your levothyroxine tablets

I would agree with Buddy195

First increase levothyroxine a little

Try 100mcg daily

Retest in 6-8 weeks

[1965Katy in reply to SlowDragon]

Thank you SlowDragon for your reply.

I am taking Accord for the 50mcg and 100 mcg tablets, and Wockhardt 25mcg tablets.

I have replied to Buddy195 saying

Last October on 100mcg every day my TSH was suppressed - TSH 0.07 (0.27 - 4.2) -5.1

T4 19.1 (10.8 - 25.5) 56.5%

T3 4.1 (3.1 - 6.8) 27%

My FT3 has always been low and in April 2024 was below range - T3 2.9 (3.1 - 6.8) -5.4%

Hence wondering if I need a small dose of T3 as well.

I will do as you both recommend and increase levothyroxine very gradually to 100mcg daily and then retest. It's interesting that the results are so different on such a small difference in Levothyroxine dosage.

Thanks again

[SlowDragon Administrator in reply to 1965Katy]

Is your hypothyroidism autoimmune?

Ever had thyroid antibodies tested

If autoimmune have you tried gluten free/dairy free diet

Last October on 100mcg every day

TSH 0.07 (0.27 - 4.2) -5.1

T4 19.1 (10.8 - 25.5) 56.5%

T3 4.1 (3.1 - 6.8) 27%

TSH was low …..not quite suppressed

Yes if Ft3 remains low you are going to need T3 prescribed alongside levothyroxine

Roughly where in U.K. are you

Here’s link for how to request Thyroid U.K.list of private Doctors emailed to you, but within the email a link to download list of recommended thyroid specialist endocrinologists who will prescribe T3

Ideally choose an endocrinologist to see privately initially and who also does NHS consultations

thyroiduk.org/contact-us/ge...

[SlowDragon Administrator]

High cortisol typical with low Ft3