Advice please on blood results please - confused - too much levo?

[florasmate]

Hi everyone. It's taken me a while to get it together to write this post and I apologise in advance for its length.

I was diagnosed with Hashimoto's in May 2023 and since then had regular blood tests and given very small increases in Levothyroxine from 25 up to 100 ug in April 2024.

My June 2024 blood results were as follows

TSH 0.81 (0.27 – 4.2)

T3 2.96 (2 – 4.4) 40%

T4 1.36 (0.93 – 1.7) 55.8%

At that point my doc refused to increase my levothyroxine even though I was still feeling tired, anxious, brain-foggy, and not at all as I should. I argued that T3 at 40% through the range was too low. But I have a (first) endocrinologist meeting planned for mid-September and the doc insisted that I stay on 100 ug until then, to see what the endo says.

She reluctantly gave me a prescription for a full thyroid blood test (ie including T4, T3), to be done just before the endo meeting, which I'll have in a few week's time.

[I have had persistant problems persuading my doctors to not rely on TSH results, and especially to include T4 and T3 in blood tests – I've sometimes hand-written them on the prescription paper until I got a warning (of law breaking so prison, fines!) from another doctor at the medical centre, and accused of relying on 'doctor google' urgh!. That's another story but it indicates that relations between me and docs is less than great.]

I still have a stash of old Levo pills so after very much procrastination, and based on my symptoms, I unilaterally increased my dose to 112.5 at the end of June. Then I paid for a private blood test 7 weeks later with the following results :

TSH 0.19 (0.27 – 4.2)

T3 3.2 (2 – 4.4) 55%

T4 1.63 (0.93 – 1.7) 90.9%

That seems a really big change in just a few weeks ... do these results suggesting hyperthyroidism?? Though I am feeling better at the moment, my mood is much better, I'm more able to concentrate (I can finally write this for example!) and I've a bit more energy.

So – my main question – have I gone too far? If I took those results to the doctor she would almost certainly want me to go back to 100ug - at some point I will have to admit to increasing my dose.

I've read about low TSH being ok in younger people, but I'm 61. Is it risky to be this low?

And is it ok to have such a high T4? Yet T3 is still only at 55% through the range …

I'm still taking the 112.5 levo daily, and will have another blood test the second week of september before seeing the endo (a meeting I am not truly optimistic about, they are very few and far where I live in France, and I have no idea if this one has much knowledge of thyroid problems). I have wondered whether I need to ask for T3, as suggested previously by Greygoose.

A bit more information, with latest results on vitamins etc :

Ferritine: 90 (15 – 150)

Serum folate: >45 (10 – 70.2)

B12: 528 (145-569)

Vit D: 64 (30 – 60)

Magnesium: 22 (16 - 24)

Selenium: 233.4 (70 – 130)

I have stopped taking daily selenium (it was very low a year ago) and reduced vitamin d3+K2 to one spray a day (perhaps I should stop it altogether?) I take vitamin B complex daily, and magnesium every few days.

Perhaps I should just wait until the next blood test and see if they are similar ... 🤔

Thanks to anyone who has read this far! Any thoughts or advice gratefully received.

[pennyannie]

Hello Florasmate :

No - these results do not suggest hyperthyroidism - as once on any form of thyroid hormone replacement we should be dosed and monitored on our Free T3 and Free T4 readings and not a TSH.

The TSH was originally introduced to be used as a diagnostic tool to help identify a person suffering with hypothyroidism and was never intended to be used once the person was a patient as then you measured T3 and T4.

I don't think you have gone too far - the idea is to dose to the relief of symptoms - which you have experienced by increasing your dose - and your T3 has improved a little but not enough to restore thyroidal T3/T4 balance.

We generally feel best when on T4 only medication once the T4 is up in the top quadrant of its range at around 75/80% with the T3 tracking just behind at around 60/70% through its range.

So the next logical step is to add in a little T3 - Liothyronine - which I read is easier to obtain in France than here in the UK - and possibly reduce your T4 just a little to around 70/80% :

The brain and heart take the lions share of your T3 in order to function every day and even with this small improvement you have noticed a clearer head and less of brain fog -

so you have seen the benefit of an increased T3 and you just need a more sustained slighter higher level of T3 to continue to feel well and have your health and well being restored.

I now aim for a ferritin at around 100 - folate 20 - active B12 125 ( serum B12 500++ ) and vitamin D up at around 125.

[florasmate in reply to pennyannie]

That's so clear and helpful Pennieannie. Thanks a million x

[pennyannie in reply to florasmate]

From 1 previously very brain fogged - to one less foggy than before - I 'll take that as a compliment !!

[florasmate in reply to pennyannie]

😄

[pennyannie in reply to florasmate]

Ditto - as I don't know where these live on my laptop !!