Up and down…: I’m on 87.5mcg levo. My last blood... - Thyroid UK

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Up and down…

JoJoloveschocolate profile image

I’m on 87.5mcg levo. My last blood tests showed low ferritin (32), t4 19.1 (12-22) t3 3.9 (3.1-6.8), slightly over range testosterone (on hrt but not on any testosterone). I’m seeing a thyroid specialist for the first time at the end of the month and will ask about iron testing and low ferritin, and supplements, as well as thyroid history, treatment and doses etc.

The thing is…recently I seem to have a run of really good days where I feel briiliant (a couple of weeks ago I felt that well, I even thought about cancelling my upcoming appt) then I have a total crash and end up in pain and shattered for a few days, feeling cold in the afternoons and having to go to bed with the electric blanket on…after a few days like this, I then pick up again. I’ve been on the same dose since April and the levels seem fairly stable.

Why does this happen, please?

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JoJoloveschocolate
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greygoose profile image
greygoose

The levels may be stable, but your FT3 is too low.

FT3: 3.9 pmol/l (Range 3.1 - 6.8) 21.62%

I'm surprised you can get out of bed at all.

You are a poor converter and need T3.

JoJoloveschocolate profile image
JoJoloveschocolate in reply to greygoose

Thank you, greygoose . I will ask about T3 at my appointment. I do wonder if I’ve just got so used to feeling really ill that my idea of a “good day” is a bit screwed up. I was also wondering if the t3 builds up a bit and then drops again…then that would account for feeling a bit better…or maybe it’s other things at play…like just getting a good night’s sleep every now and again that refills the empty battery! Thanks for your reply. I will definitely ask about t3.

greygoose profile image
greygoose in reply to JoJoloveschocolate

It could very well be that you've forgotten what 'normal' feels like - I know I have. Sometimes my good days other people would call terrible. But, no, T3 doesn't build up and drop again, but your absorption and conversion could vary a lot. Do you have gut/stomach problems?

JoJoloveschocolate profile image
JoJoloveschocolate in reply to greygoose

Ahhh, absorption… yes, of course…I take omeprazole for acid reflux. I’ve been on it for years and every time I try to stop it I end up with acid so bad at the end of the day that I have to take it as nothing else works. Also, may/may not be relevant but I had my gallbladder removed years ago too.

greygoose profile image
greygoose in reply to JoJoloveschocolate

Do you get your FT4 tested from time to time? Because that will show you how well you absorb in general. But it could fluctuate from day to day. But it's true, the omeprazole won't help - especially as hypos usually have low stomach acid, anyway, but the symptoms are the same as high acid. I think PPIs are habit-forming, so not surprised you have trouble coming off it after such a long time.

Agitator23 profile image
Agitator23 in reply to JoJoloveschocolate

I was on anti-reflux medication (not Omeprazole, though I'd been on that for a good while, too) and I stopped it when I started taking Levothyroxine to help absorption. I was nervous about doing this and had some reflux to begin with but at 100mcg Levothyroxine I have no reflux at all. I'd had reflux since my 20s. I believe the reflux was definitely associated with hypothyroidism and slow digestion.

JoJoloveschocolate profile image
JoJoloveschocolate in reply to Agitator23

Aww, thank you so much for you reply! You have given me hope that once I get my levels sorted the reflux might settle and I can come off meds. That would be amazing. I don’t know why but I seem to have had all the symptoms and issues of hypo at ridiculously extreme levels and I was only classed as sub clinical when diagnosed. It’s nuts x

Agitator23 profile image
Agitator23 in reply to JoJoloveschocolate

Yes, shame they don't take into account the patients symptoms and their severity anymore! I had quite severe symptoms but was always at the lowest end of the FT4 range with 'normal' TSH levels.

SlowDragon profile image
SlowDragonAdministrator

Have you tried a higher dose of levothyroxine

Free T4 (fT4) 19.1 pmol/L (12 - 22) 71.0%

Free T3 (fT3) 3.9 pmol/L (3.1 - 6.8) 21.6%

ESSENTIAL to test vitamin D, folate, B12 and ferritin

What vitamin supplements are you taking

Any PPI like omeprazole will significantly lower vitamin levels

gov.uk/drug-safety-update/p...

webmd.com/heartburn-gerd/ne...

pharmacytimes.com/publicati...

PPI and increased risk T2 diabetes

gut.bmj.com/content/early/2...

Iron Deficiency and PPI

medpagetoday.com/resource-c...

futurity.org/anemia-proton-...

onlinelibrary.wiley.com/doi...

sciencedirect.com/science/a...

Thousands of posts on here that discuss low stomach acid

healthunlocked.com/search/p...

Web links re low stomach acid and reflux and hypothyroidism

nutritionjersey.com/high-or...

stopthethyroidmadness.com/s...

thyroidpharmacist.com/artic...

How to test your stomach acid levels

healthygut.com/articles/3-t...

meraki-nutrition.co.uk/indi...

huffingtonpost.co.uk/laura-...

lispine.com/blog/10-telling...

Useful post and recipe book

healthunlocked.com/thyroidu...

Getting ferritin level up at least over 70 minimum

JoJoloveschocolate profile image
JoJoloveschocolate in reply to SlowDragon

Than you SD. I haven’t tried higher Levo from GP because my tsh is too low for them to increase Levo,but I’ll see what the private doctor says about it at my appt. I’ll ask about iron testing and ferritin levels too. They also have my sex hormone and cortisol results to look at. My vit d b12 and folate are all ok. I’m stuck with the ppi as nothing else works. I’m taking supplements for vit c,d,zinc and selenium for now

My t3 did go up a bit but then dropped again

SlowDragon profile image
SlowDragonAdministrator in reply to JoJoloveschocolate

Are you taking a daily magnesium in afternoon or evening

Ppi strips out magnesium

Have you tried reducing PPI extremely slowly and/or adding slippery elm

Are you gluten free and/or dairy free

JoJoloveschocolate profile image
JoJoloveschocolate in reply to SlowDragon

I’m continuing with gluten free which is good for my stomach cramps and have tried df but didn’t feel any different. I’ve ordered some new magnesium to try. The ppi issue is a dead loss - nothing else works. I had the same issue with hrt- tried all the herbal supplements, creams, etc nothing worked apart from hrt patches and pessaries.

SlowDragon profile image
SlowDragonAdministrator in reply to JoJoloveschocolate

Until your vitamins are all optimal and on increased dose Levo and/or T3 added I guess you won’t be able to ween off PPI

Ft3 needs to be at least over 5-5.5 minimum

Unless you are very petite, you’re on very low dose Levo

JoJoloveschocolate profile image
JoJoloveschocolate in reply to SlowDragon

thanks SD. I’m going to ask about t3 as I think I’ll just have to keep upping the Levo to get to that kind of decent level of t3 and I don’t want to run my t4 at the top of the range, Lots to think about/consider. I’ll see what the specialist suggests while bearing in mind all the advice on here at the same time. Thanks for your advice and thoughts on it,

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