Trying to understand results

[Sunsetzzs]

I posted back in May that my doctor increased Synthroid for the first time from 50 mcg to 75 mcg. I also take 5mcg of Liothyronine.

I’ve been hypo, and positive for Hashimoto’s for about 18 years.

I had my TSH, T4 and T3 checked this morning and need help understanding what these results indicate since the increase of T4.

As an aside, I’ve felt some improvement in some areas since the increase, but not in others- still not sleeping well, feeling a bit heavy-footed when I walk (not out of breath, but like it’s an effort now), and I seem to be gaining a few pounds. Pain, and afternoon fatigue are a little better, but that may also be attributed to the monthly B12 injections I’ve started in the last 2 months.

Today:

TSH result- .457 (Range .55 - 4.78)

T4 result - 1.30 (Range .89 - 1.76)

T3 result - 4.35 (Range 2.3 - 4.2)

May 31, 2024 on 50 mcg Syn & 5 mcg Lio

TSH result - 2.193 (same ranges as above)

T4 result - 1.07

T3 result - 3.98

Thanks for any advice!

[TiggerMe]

Are these result taken 24 hours after last T4 and 8-12 hours after T3?

Have you checked your iron levels?

In your last post your Vit D levels were also low have you been supplementing?

[Sunsetzzs in reply to TiggerMe]

Both T4 and T3 doses were 24 hours prior. That’s consistent with when all of my tests have been done.

I have been supplementing with extra Vit D. My doctor will not check my other blood tests- D, Iron, Ferritin, etc until it’s been 6 months since the last time, even though not everything was tested in May.

[TiggerMe in reply to Sunsetzzs]

So your fT4 has improved but you'd probably benefit from a little more aiming for 70-80% and your fT3 is surprisingly high after 24 hours?

Suggesting you probably would do better on a little more T4 and don't need the T3?

Free T4 (fT4) 1.3 pmol/L (0.89 - 1.76) 47.1%

Free T3 (fT3) 4.35 pmol/L (2.3 - 4.2) 107.9%

 High fT3 will affect your ability to sleep

Have you previously tried a higher dose of T4 as 75mcg is still quite a low dose unless you are petit?

[Sunsetzzs in reply to TiggerMe]

And yes, the ft3 was after 24 hours.

[Sunsetzzs]

I’ve only had the one increase from 50 to 75 this last May. I think my new doctor is open to raising my level as long as she doesn’t seem any concerns with my results. I am 5’4” and 133 pounds.

That’s interesting about high ft3 affecting my sleep. Thanks for replying. If I’m understanding correctly, I should see about stopping the ft3 and increasing the ft4?

[TiggerMe in reply to Sunsetzzs]

So as a general guide I'd expect you to need around 100mcg of T4 (133lbs = 60kgs x 1.6 = 96mcg) and see how well you are converting to fT3 before thinking about adding anymore...

Yes, I'd suggest dropping the T3 until you've tried a full replacement dose of T4

[Sunsetzzs in reply to TiggerMe]

Thanks for the input! I’m seeing my doctor this Wednesday, and I feel as though now I know what I should be asking for. I’m also going to request to have my other labs done too, the next time she checks my thyroid levels- probably prior to my next appt which will be in January.

[EchoWS]

Along the lines of T3 - you could cut in half and try just 2.5 in the morning. You've mentioned taking supplements. Do they contain iodine or selenium? Are you in perimenopause or menopausal?

[Sunsetzzs in reply to EchoWS]

The T3 I have are tiny and puffy (not flat). If I cut them, I’m not sure that I will be sure of the dosage being evenly split- would that matter? And is that a better way to wean off - should I not stop suddenly?

I do not take anything with iodine or selenium. Vitamin D3 w/K +K2, Vit C, Magnesium (Citrate, malate, glycinate), Salmon oil, Black seed oil, B12, and Biotin- which I stopped a week before my blood test. And I am post menopausal- hysterectomy 20 years ago due to adenomyosis.

Thank you!

[EchoWS in reply to Sunsetzzs]

Thanks - I'm just curious Free T3 is a tiny bit high. Could ask if liothyroxine available in lower dose if you are seeing Dr. TiggerMe's advice sounds good. You maybe a good converter of T4 to T3. T4 comes in 88s so also a possible amount to get but stick with same brand. You are doing all the supplements usually advised here. I asked about selenium cause it can help convert T4 to T3 (so I need as a poor converter).

When do they recheck B12 with it being a new addition? I guess in Jan with everything else. Are you taking daily supplement B12 as well as injection? I was taking a mega B12 supplement and red blood cell counts finally normal but the nutritionist was concern was that my B12 levels were too high and that supplement didn't contain folate. Could research if folate supplement a good idea?

Body is such a mystery!

[Sunsetzzs]

I’m going to ask my doctor this week, when she wants to retest my B12. I know that I will have to go off of it and skip the shot for the blood test, but I’m not sure for how long prior.

I am taking a daily B12 supplement in addition to the monthly injections. It’s only been two months of every four weeks for the shot (prior to that I only had two injections about 2 months apart). But as I’m entering 3 weeks post, I start to feel the unyielding fatigue in the afternoons. So I’ve chosen to stay on the supplement too- B12 Methyl, 5000 mcg. Though I do stop them for a week when I get the injection bc I’ve read our bodies will just eliminate any excess. My folate was within normal range this past May so I do not take that.

The body is such a mystery! And having to figure this stuff out for ourselves is not easy. I was so thankful to have stumbled upon this site. What you stated about going up to 88, may be good, instead of jumping to 100- I’ll have to see what my doctor thinks.

Do you also get B12 injections with the mega dose? How much is a mega dose 🤔

[EchoWS]

I was taking Thorne Methyl-guard. So it was a large dose but not an injection. And actually they make a Methyl-guard plus so I was really just being consistent with taking what I was everyday. I was amazed my blood work which was consistently indicating megaloblastic anemia improved. But as B12 bloodwork was high was told to cut back, a little frustrating. I think the Thorne products pretty good. The unyielding fatigue kicking in at the 3 week sounds like a sign but I've not been prescribed shots for anemia, so different needs probably. There is a Pernicious Anemia society on health unlocked maybe check with them for feedback.

[Sunsetzzs in reply to EchoWS]

That is frustrating that you had to cut back when it was clearly improving your anemia. Unless I’ve misunderstood, my learning was that one can’t overdose on B12, that the body will excrete out what it doesn’t use. Fatigue from severe anemia is so debilitating!

Thanks, I will check out the PA group too.