Always have low Free T4 levels whether on NDT or not

[Crunchieeagle]

Unfortunately been unemployed for a while, so couldn't afford any NDT (not current Thyroid S prices anyway.

When of 2 grain NDT

CRP HS 0.96 mg/L (Range: < 5)

Iron Status

Ferritin 330 ug/L (Range: 30 - 400)

Vitamins

Folate - Serum 9.99 ug/L (Range: > 3.89)

Vitamin B12 - Active 110.000 pmol/L (Range: > 37.5)

Vitamin D 138 nmol/L

Deficient <30

Insufficient 30 - 50Consider reducing dose >175

(Range: 50 - 175)

Thyroid Hormones

TSH 0.647 mIU/L (Range: 0.27 - 4.2)

Free T3 5.22 pmol/L (Range: 3.1 - 6.8)

Free Thyroxine X 11.600 pmol/L (Range: 12 - 22)

Autoimmunity

Thyroglobulin Antibodies 16.000 kIU/L (Range: < 115)

Thyroid Peroxidase Antibodies 13.6 kIU/L (Range: < 34)

I am usually low in Folate, (usually suppliment and have a folate MTHFR mutation, but ferritin is always high.

Anyway today without thyroid supplimentation for over a year.

Vitamin D (25 OH) 85 50 - 200 nmol/L

CRP 4.42 <5.0 mg/L

Ferritin 238.00 30 - 400 μg/L

Serum Folate L 8.64 8.83 - 60.8 nmol/L

Active B12 63 37.5 - 150 pmol/L

TSH 3.89 0.27 - 4.20 mIU/L

Free T4 15.0 12.0 - 22.0 pmol/L

Free T3 5.4 3.1 - 6.8 pmol/L

T4 Total 73.7 66 - 181 nmol/L

Anti-Thyroglobulin Abs 16 <115 IU/mL

Anti-Thyroidperoxidase abs 16.8 <34 IU/mL

But with NDT my free T4 goes lower? It is worth just going T3 only as the prices seem much cheaper.

Also, due to inflammation, I have high cortisol levels in the afternoon (low CAR) and evening is fine. So i can get High reverse T3 from T4 meds anyway

I noticed there is a link between high ferritin and hypothyroidism as well (and yes i have to get the B12/folate levels back up again).

I was wondering if anyone else's Free T4 goes down on NDT.

Also, but much less important, has anyone tried Bitiron has 50 mcg of Levothyroxine (T4) and 12.5 mcg Liothyronine (T3). Now made by Abdi Ibrahim a Turkish pharmaceutical company??

Many Thanks

Russ

[SlowDragon Administrator]

Free T4 (fT4) 15 pmol/L (12 - 22) 30.0%

Free T3 (fT3) 5.4 pmol/L (3.1 - 6.8) 62.2%

why not start with just levothyroxine

Your Ft4 is low

Standard starter dose is 50mcg

Retest in 6-8 weeks

Then increase as necessary

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)

[Crunchieeagle in reply to SlowDragon]

Thank you so much for your answer Slowdragon.

I have thought about that as well .

However i also remember that when i started. I did a reverse RT£ test.

As my HPA axis is always "strained" becase of previous 7 years of akathisia from SSRI. My cortisol goes high.

I also suffer from various autoimmune disease, and do est on keto, when i am on thyroid meds.

Inflammation

CRP HS 3.53 mg/L (Range: < 5)

Iron Status

Ferritin 369 ug/L (Range: 30 - 400)

Vitamins

Folate - Serum 9.24 ug/L (Range: > 3.89)

Vitamin B12 - Active 139.000 pmol/L (Range: > 37.5)

Vitamin D 55.9 nmol/L (Range: 50 - 175)

Thyroid Hormones

TSH X 4.32 mIU/L (Range: 0.27 - 4.2)

Free T3 5.11 pmol/L (Range: 3.1 - 6.8)

Free Thyroxine 17.700 pmol/L (Range: 12 - 22)

Reverse T3 X 25 ng/dL (Range: 10 - 24)

FT3 : rT3 X 13.31 Ratio (Range: > 15)

So as my ferritin is high due to inflammation and inflammation and highest cortsiol (during the day). I had PANDAS/PANS as a kid. RA is main adult problem, usually well condrolled, i studied as a functional medicine coach.

If i went thyroxine only , I may get a higher chance of RT3 . I am the type of person that can get to two grains within a month

But keto, with hypothyroidism is a big no no, so have to get my throid working "better" before i start the diet again, but it will reduce RT3 as my inflammation with be better control as 75% inflammation beins in the gut, (athors adrenal burn out, or mitochondrial dysfunction).

I do have some T3 only meds here, so could start on that (i feel better on 25 umg anyway, and add thyroxine into the mix later, reducing the T3???

Thanks for your input. I appreciate it.

[SlowDragon Administrator in reply to Crunchieeagle]

many hypothyroid patients have high cortisol and it should reduce as your thyroid levels improve

Your CRP isn’t over range

Suggest you test full iron panel

The problem with starting on T3 is your own thyroid will very quickly shut down completely as TSH very rapidly becomes suppressed

Many, many people find they need BOTH Ft4 and Ft3 at least 50-60% through range

[Crunchieeagle in reply to SlowDragon]

A full iron panel is a good idea. My ferritin does rise and fall, depending on the size of current inflammation and have been stressed and eating a poor diet last couple of months.inflammation.

If i can get my psychatrist (yes that dreaded word, as he has been studing for years of sudden onset of schizophrenia is due to the immune system. Just like my harm OCD was. Anyway I digress. It would be alot wasier for him to prescibe me Thyroxine than my GP would. If not i will but it online. Is there anywhere you recommend?

Yes the CRP is HS but even the Mayo clinic now put it at 2, as do functional medicine. It is the same there just like thyroid ranges here. UK are always last to react to anything.

I do have have high side LDL and triglycerides, to which doesn;t happen on a Keto/AIP diet, but again we know the thyroid/cholersterol correlation.

anyway LDL still has a job to do, it is the LDL-P (particle number), that is crucial.

A few interesting things we discussed last year. (you may find helpful) as you will know most of this anyway, but not so many with LDL sizes.

LDL particle number (LDL-P): Subclinical hypothyroidism has been associated with higher levels of ApoB-100, a surrogate marker for LDL particle number. T4 treatment significantly reduced ApoB-100 levels (25).

Oxidized LDL: Decreased thyroid function increases the number of LDL particles and promotes LDL “oxidizability” (26).

Thyroid health also impacts other cardiovascular risk factors:

Blood pressure: Underactive thyroid is strongly associated with hypertension. This is due to both sympathetic and adrenal activation (27). One study of 30 patients with both hypothyroidism and hypertension found that hypertension was reversed in 50 percent of patients after thyroid medication therapy (28).

C-reactive protein (CRP): CRP, a marker of inflammation, has been shown to be negatively correlated with levels of free T4 (29). Patients with subclinical hypothyroidism have also been found to have increased CRP (30).

Lipoprotein(a) (Lp(a)): Lp(a) is a measure of how many lipoprotein particles are carrying apolipoprotein A1. Apolipoprotein A1 has a high affinity for oxidized lipids and is thought to be largely based on genetics. Patients with overt hypothyroidism and subclinical hypothyroidism have increased Lp(a) (31, 32). Some studies of subclinical hypothyroidism patients suggest that thyroid medication can reduce Lp(a) (33), but others found no significant change (34).

Phospholipase A2 (Lp-PLA2): This is an enzyme that travels largely with LDL particles, is highly pro-inflammatory, and is involved in the development of atherosclerosis (35). Subclinical hypothyroidism subjects have been shown to have higher Lp-PLA2 (36).

Homocysteine: Hypothyroidism is associated with increased plasma homocysteine levels (37)

Insulin resistance and BMI: Insulin resistance and a high BMI are both positively correlated with low thyroid function (38, 39).

LDL cholesterol levels and LDL particle number are often concordant (i.e. when one is high, the other is high, and vice versa), and this is probably why there is an association between LDL cholesterol and heart disease in observational studies. The elevated LDL cholesterol was more of a proxy marker for elevated LDL particle number in these cases. But here’s the kicker: they can also be discordant. In layperson’s terms, it’s possible to have normal or even low cholesterol, but a high number of LDL particles. If this person only has their cholesterol measured, and not their particle number, they will be falsely led to believe they’re at low risk for heart disease. Even worse, the patients that are the most likely to present with this pattern are among the highest risk patients: those with metabolic syndrome or full-fledged type 2 diabetes.

The more components of the metabolic syndrome that are present—such as abdominal obesity, hypertension, insulin resistance, high triglycerides and low HDL—the more likely it is that LDL particle number will be elevated.

On the other hand, patients with high LDL cholesterol (LDL-C) and low LDL particle number (LDL-P) are not at high risk of heart disease.

[Crunchieeagle in reply to SlowDragon]

Thanks again, any trustworthy places to purchase Thyroxine Slow Dragon? . GP not going to entertain my old results. (T4 and synthetic perhaps T3) in case i need any.

My cortisol is high during the day (for medical reasons), normal again at night, low in the morning, so RT3 be high at lunchtime/afternoon..

I used to think high cortisol made RT3 put the breaks on, but new literature seems it doesn't make a difference? Is that the current way of thinking?

Also another question, sorry Slow Dragon, just catching up here on current thinking,

I have always assumed T4 during the day (especially on NDT or nothing) was fairly flat, and TSH and Free T3 followed a cardial rhythm 4 hours behind. is that right or does FT4 have a rhythm

If again in theory everything is working as it should T3 only or NDT (TSH, & Free T4 go down, as T3 goes up, before Free T4 goes up again ), meaning FT4/TSH doesn't matter a hoot, just how you feel, basal temps, etc

But on T4 meds only TSH will come down, if T4 goes up if conversion rate is good yes? Conversation rate is 0.27

[Crunchieeagle in reply to SlowDragon]

Thanks again, any trustworthy places to purchase Thyroxine Slow Dragon? . GP not going to entertain my old results. (T4 and synthetic perhaps T3) incase i need any .

My cortisol is high during the day (for medical reasons), normal again at night, low in the morning, so RT3 be high lunchtime/afternoon..

I used to think high cortisol made RT3 put the breaks on, but new litereature seems it doesnt make a difference? Is that the current way of thinking?

Also another question, sorry Slow Dragon, just catching up here on current thinking,

I have always assummed T4 during the day (especially on NDT or nothing) was fairly flat, and TSH and Free T3 followed a cardial rhythm 4 hours behind. is that right or does FT4 have a rhythm

If again in theory everything is working as it should T3 only or NDT (TSH, & Free T4 goes down, as T3 goes up, before Free T4 goes up again ), meaning FT4/TSH doesnt matter a hoot really, just how you feel , basal temps, etc

But on T4 meds only TSH will come down , if T4 goes up if conversion rate is good yes? Converstion rate is 0.27

[tattybogle in reply to Crunchieeagle]

"I have always assummed T4 during the day (especially on NDT or nothing) was fairly flat, and TSH and Free T3 followed a cardial rhythm 4 hours behind. is that right or does FT4 have a rhythm"

That's right in people not taking any thyroid hormone replacement , (see paper below)

academic.oup.com/jcem/artic... (Free Triiodothyronine Has a Distinct Circadian Rhythm That Is Delayed but Parallels Thyrotropin Levels )

......but taking doses of T4 / and or T3 changes things significantly .... the TSH circadian rhythm doesn't seem to change much , but when taking just levo the highest levels of fT4 will peak sharply an hour or two after dose is taken ,while the fT3 will be relatively stable,

if also taking T3, the highest levels of T3 will peak sharply an hour or two after last dose.

graphs of daily TSH / fT4 / fT3 levels in people taking Levo / Levo +T3 here : thyroidpatients.ca/2019/11/...

[SlowDragon Administrator]

the two specialists who can initially prescribe T3 are endocrinologists or psychiatrists

Low thyroid levels strong linked to depression, anxiety and insomnia

Also linked to Reversible poor kidney function, reversible high cholesterol

High homocysteine often improves once low B vitamins and low thyroid levels are corrected

[Crunchieeagle]

Yes Slow Dragon I agree. I am less worried about high cholesterol as it it is the type of LDL that is most important and we are never tested that.

So the plan is try an get some Levothyroxine from my psychiatrist (see him on July 5th, incidently), due to always having low Free t4 historically, full iron test, rather than sourcing NDT . No T3 at this stage? He trust me complicantly, . The reason for my impatience is that i always lose weight on Keto asnd Intermittant fasting,

We all know Keto reducees T4 to T3 conversion (as does IF), and a very small study, actually also states that a Keto diet raised T4 levels (it is a small study), as an admin, you may find it interesting.

ncbi.nlm.nih.gov/pmc/articl...

I showed him my RT3, Free T3, Free T4 levels with a low TSH, and he couldnt believe it. He is very open-minded. Which is unusual. He diagnosed me with akathisia in 2008

Again i am never worried about TSH, but it is playing the system (was lucky enough to see both Dr Skinner and talk to Dr Peatfield), and Dr Skinner was much more pro thyroxine , both NDT (both more so), and Dr Peatfield was T3 only.

My morning basal temps are low, and I am a high BP, cant stand the heat (lack of sweat), kind of person rather than a cold to touch when hypo.

Many Thanks again

[pennyannie]

Hello Crunchieeagle :

On NDT we track on the T3 and the T4 can be low in range - and I take this to mean that I am converting it to T3 as now I have some T3 in the NDT to kick start my metabolism.

If it helps when on T4 monotherapy my T3 was 25% through the range with my T4 at around 110/110 % through the range -

Now on NDT these readings seem to have totally reversed as now my T3 is 90/110% with my T4 at around 25/30% through the range -

I feel well - my brain fog gone, and my fear of dementia is gone - as now I know the kettle does not live in the fridge !!

As for Bitiron - the T3/T4 ratio is pretty much that of NDT -

but it's synthetic and while I can afford NDT - I think I'm staying put and not sure I want to be another guinea pig -

I'm with Graves Disease post RAI thyroid ablation 2005 and dealing with the longer term consequences of drinking this toxic substance, for which the NHS are in total denial.

[Crunchieeagle]

Thanks for your reply. Pennyanne

I am so sorry to hear about your graves disease, yet another poorly understood autoimmune disease.

Did you ever have your TSI measured?

I see a lot of people become functional medicine doctors because they beat it naturally.

chriskresser.com/hyperthyro...

I got severe akathisia for 7 years from an SSRI (and tardive dystonia) which the later resolved with a deep brain stimulation operation. Anyway i could not sit down for 2-3 years for the first year for no more than 5 seconds.

youtube.com/shorts/vICrGk96...

Anyway, I had Harm OCD or PANDAS/PANS an autoimmune disease and whilst thyroid meds helped with the mood a little, it would not stop the harmful thoughts.

I was (rarely diagnosed), in 2008, as i found a blog on it, but 3 years passed , and the NHS and work n pensions were blaming each other, and after 3 years, that was it. No disability, nothing.

It is really horrible what can happen.

Anyway, thanks for your input, I have always done well on NDT 3 grains winter, 2 grains summer, but as Slow Dragon has kindly answered, i wondered why my Free T3 is OK, my Free T4 is always low, on NDT or not (even though RT3 hasn't, but it has never pooled in the blood either, as cortisol have never been low).

So will i just do better on thyroxine better than most, as i seem to convert what i have very well, or how Dr. Skinner put it, "your heart is pumping it around as fast as it can converting it as best as it can lol - he was a character). and your TSH" doesn't matter a hoot! "

Yeah Bitiron used to be made from Aspen i think but OTC in Turkey?? Seem odd lol

[pennyannie in reply to Crunchieeagle]

If you want to speak directly to a forum member you need to make sure you reply in their reply box as then their name comes up as you type and they get notified they have a message -

otherwise you need to type eg   Crunchieeagle and the they get notified - otherwise it' pot luck if they see anything you have ever written to them -

I was undiagnosed hypo from a child - attacked in my mid 50's by a work colleague and 4 months later diagnosed Graves / hypo and I ended up going to the doctor for help with insomnia as I hadn't slept more than an hour a night for 3 months.

[Crunchieeagle in reply to pennyannie]

Thanks i thought id hit reply, thanks for letting me know

Must get over to the ADHD topic (i have it after akathisia, so I can joke about it - i hope)