Increase needed?

[Highland49]

Hi,I've just had my thyroid monitoring results back from Medichecks and my results are lower than 18 months ago (which wasn't quite optimum then). I have hashimoto's.

Results now are -

TSH 0.24 (0.27 - 4.2)

FT3 4.5 (3.1 - 6.8)

FT4 16.6 (12 - 22).

In Nov 22, results were -

TSH 0.15

FT3 5.5

FT4 17.8

My symptoms haven't changed in years - fatigue but I work 6 days a week, so difficult to determine the cause. Muscle weakness and breathlessness on exertion persist.

I'm still on 75mcg thyroxine daily and 5mcg T3 twice a day. I take thyroxine and one 5mcg T3 an hour before breakfast and then the second 5mcg T3 mid afternoon, away from food.

Could anyone advice please whether I need to just increase thyroxine, T3 or both? I had brilliant advice when I posted here back in 2022 and did increase thyroxine slightly but was then concerned that I would run out of the extra dose if this continued long term. I didn't have a noticeable difference after increasing the thyroxine slightly once a week.

My concern is that my GP surgery no longer monitors me annually and I'm not under the care of the private endocrinologist once my dose was ok years ago. Who do patients in the UK now consult for thyroid medication and dosing?

I self inject B12, take folic acid for the B12, D3/K2/magnesium, plus the other B vitamins once a week.

The only thing that's changed in the last 15 months is going low oxalate to help treat food intolerances. Fortunately, it's gradually helping and my diet is more diverse. I have put on weight recently but I think that's from too much cheese!

Any advice, suggestions and information would be greatly appreciated. Thank you.

[Buddy195 Administrator]

Would your endo support you taking another 5mcg dose of Liothyronine to get FT3 higher in the range? Personally, I like to increase super slowly, so would start by adding an additional 2.5 mcg with your morning dose, adding an additional 2.5mcg when well tolerated. Don’t be tempted to increase both Lio and Levo at the same time….only adjust one at once.

[Highland49 in reply to Buddy195]

Thanks Buddy. As mentioned, part of the problem is I'm not seeing an endo now. I'll contact my GP surgery and see if they will approve an increase. Over the years, I've never had an increase in dose, even when I was seeing my endo for the first two years.

[GlowCoach Administrator in reply to Highland49]

Roseway pharmacy have a prescribing service thats pretty reasonably priced. You might try them.

Over time you likely need both Levo & T3 increased.

Why are you only taking a B complex once a week? Thats probably not going to cover you for folate, not to mention all the other B vits.

[Highland49 in reply to GlowCoach]

Many thanks Jaydee. I take 5mg of folic acid daily to support the b12 injections.

[DippyDame]

Dose

75mcg levo + 10mcg T3

Latest results...

FT3 4.5 (3.1 - 6.8)

FT4 16.6 (12 - 22).

75mcg levo is not a huge dose and with your FT4 sitting at only 46% through the reference range I'd be inclined to increase levo to 100mcg and hope that with T4 to T3 conversion that might raise the FT3 up from 37.84% thro' the r/range and help symptoms

We aim to have both Frees roughly 75% through the r/ranges.....yours are low and likely to be causing hypothyroid symptoms

However your T3 will be naturally lowering FT4 and TSH....so FT4 likely to be a false low reading.... and we cannot now gauge your T4 to T3 conversion status now that T3 is added

Test again 6/8 weeks after the increase and depending on those labs you may need/ be able to increase the levo by a further 25mcg to further rise FT3.

Your GP should be able to initiate the levo increase, but GPs cannot prescribe T3 unless under direction of an endo

We don't normally introduce T3 until we have first tried increasing T4 to around 125/150mcg. If that still results in low FT3 and symptoms we then consider adding T3.

What puzzles me is that your Frees 6 years ago (below), before introducing T3 did not show poor T4 to T3 conversion. Who advised you to add T3?

Free T3 5.0 [3.1-6.8]

Free T4 16.03 [12-22]

You have Hashimoto's....are you strictly gluten free?

Have you optimised vit D, vit B12, folate and ferritin.......vital to support thyroid function.

Weight increase can be due to low FT3 which in turn slows metabolism with lower calories burned.

Just a few thoughts, hope something resonates.

We're all here to help, just ask

[Highland49 in reply to DippyDame]

Many thanks DippyDame. I'm strictly gluten free and have been for many years now. I've optimised all those vitamin and mineral. I do b12 injections EOD, otherwise balance problem comes back. I take 5mg folic acid daily and 5,000 D3 twice a week. A private endocrinologist in London diagnosed me (NHS endo complete waste of time) and it was him that added T3 after he checked my reverse T3 and found I didn't convert the thyroxine well.

I did a gene test which found I have the dio2 gene defect, so at least I had an explanation plus ammunition to obtain T3 through the NHS, which was successful.

With the thyroxine dose, I've always thought it was too low based on what I've read and that 75mcg is usually a starting dose. I'll do an econsult with my surgery with my request to increase thyroxine. Thank you 😊

[DippyDame]

Is the Dio2 polymorphism inherited from one, or both parents...if only one, conversion may not be hugely impacted, if both ( like me) the effect is greater.

Interesting the endo used rT3 to test conversion....I assume your FT4 must have been over range for him to consider this because rT3 is basically excess T4.

It looks as if the endo may have been relying on old theories...

rT3 is metabolically inactive and it is old theories that suggest it blocks T3 from the T3 receptors and causes poor conversion....rT3 has it's own receptors. rT3 really isn't a problem.....but low T3 absolutely is

He would have been better testing FT4 and FT3 and comparing the results....high FT4 with low FT3 gives a more accurate indication of poor conversion status.

So, yes, all that confirms you need more levo, not more T3.

Your conversion is only slightly impaired so with the extra levo, that, and your existing T3 dose you should feel better.

I need high dose T3-only to function so I've travelled the road!!

You have all the info you need to back up your request for an increase should the GP throw his arms in the air!!!!

Good luck

[Highland49 in reply to DippyDame]

Thank you! I inherited the faulty gene from both parents too. With the addition of the T3, I had an amazing result - the feeling of suffocation I was constantly feeling which made me regularly need to take a deep breath to try and clear it disappeared with the first T3 dose. HRT that the first endo had prescribed only slowed my breathing down further. He'd refused me any thyroid medication, so I self referred again to Harley Street and was finally treated.