Am currently taking 25mg Levo & 10mg Liothyronine twice daily.
Have been feeling increasing awful for a while with previous symptoms resurfacing. Had my recent bloods come back and told to continue usual dose until a review in 3 months time but I’m really struggling. Have told the endo this and awaiting to be contacted (already been a week and not heard anything)
I don’t really understand how it all works in terms of the TSH FT3 & FT4, reading all the information and other posts I’m more and more confused. From what I gather my TSH is ‘normal’ but FT4 is very low, so is this a sign it’s not the right dose? I’ve been on the same dose for almost a year, felt really good when my TSH was significantly low at first (0.17) but now it’s creeping up.
Here are my latest results:
FT3- 6.4 (3.8-6)
FT4- 5.3 (8-17)
TSH- 1.73 (0.38-5.33)
I think I’m classed as secondary hypothyroidism as it developed after my first baby, I don’t know if that changes anything. Also since I start liothyronine last year I’ve been under 3 different endocrinologists as they keep leaving so not really felt I have had the proper upkeep in testing.
Any help would be greatly appreciated, thank you for reading
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Many, many members on levothyroxine plus small doses of T3 find they need BOTH Ft4 and Ft3 at least 70% through range
Suggest you request 25mcg dose increase in levothyroxine and retest in 6-8 weeks time
Which brand of levothyroxine are you currently taking
Which brand of T3
Absolutely ESSENTIAL to test vitamin D, folate, ferritin and B12 at least annually
What were most recent results
Exactly what vitamin supplements are you currently taking
Is your hypothyroidism autoimmune
Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease
About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high TPO and/or high TG thyroid antibodies
Autoimmune thyroid disease with goitre is Hashimoto’s
Autoimmune thyroid disease without goitre is Ord’s thyroiditis.
Both are autoimmune and generally called Hashimoto’s.
Significant minority of Hashimoto’s patients only have high TG antibodies (thyroglobulin)
20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis
In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)
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
day before test take 10mcg waking, 5mcg early afternoon and 5mcg 9pm …..test 9am following morning
Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins
T4 is the thyroid storage hormone, which doesn't do very much until it is converted into the active thyroid hormone, T3.
That said, our need for T4 is very personel: some people need it high, even when their T3 level is high, others don't need it at all. Rather sound like you're someone who needs their FT4 up higher. So, you probably do need and increase in levo.
T3 is the thyroid active hormone, needed by every single cell in your body to function correctly. Yours it quite high - possibly too high? Perhaps it would be a good idea to try a lower dose of T3 before increasing the levo. Too much thyroid hormone can be as bad as too little. We have to find the balance that is right for us.
TSH is a pituitary hormone - Thyroid Stimulating Hormone. When the pituitary senses that there's not enough thyroid hormone in the blood, it increases production of TSH to stimulate the thyroid to make more hormone. When the thyroid hormone levels rise, the TSH drops again.
A 'normal' (euthyroid) TSH is around 1, but hypos usually have it lower than that because they need their thyroid hormone levels higher. Your TSH is too high for someone on thyroid hormone replacement (levo and T3), but is probably high because your FT4 is so low.
I think I’m classed as secondary hypothyroidism as it developed after my first baby
No, I don't think so. Secondary Hypo has nothing to do with having a baby. Secondary Hypo is when there is a pituitary problem, and the pituitary is not producing enough TSH to stimulate the thyroid to make enough hormone, so TSH would be very low. Yours is not very low even though your FT3 is very high. So, very doubtful you have Secondary Hypo.
What usually happens is that women develop Autoimmune Thyroiditis - Hashi's - after having a baby. Hashi's is where your immune system slowly destroys your thyroid, making you hypo. And the test for that is antibodies: TPO antibodies and Tg antibodies. Do you know if you've had those tested?
But whatever the cause of your hypothyroidism, the treatment is the same: thyroid hormone replacement. But, the care of thyroid patients on the NHS is always very poor, so it's quite possible you aren't getting as much tested as necessary. Testing should be done 6 - 8 weeks after a change in dose. And, apart from that, the NHS will only test once a year - which is totally inadequate but the medical system has very little understand of how to treat thyroid patients. It's not just about about changing endos, it's about the whole attitude towards thyroid. So, you are not alone in that, unfortunately.
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