Titrating Armour and FT4/FT3 has tanked

[Insomania]

I’m gutted because there had been a gradual increase in my FT3 throughout the last year titrating Armour (apart from a blip following covid at Christmas). It was at 75% in May! But now I know why I'm feeling so rough again:

24th Sept 2024

TSH 0.02 mIU/L (0.27 - 4.2) -6.4%

Free T4 (fT4) 14 pmol/L (12 - 22) 20.0%

Free T3 (fT3) 4.6 pmol/L (3.1 - 6.8) 40.5%

T4:T3 Ratio 3.043 

Thyroglobulin Antibodies (TgAb) 15.6 IU/mL (≤ 115)

Thyroid Peroxidase Antibodies (TPO) 15.1 IU/mL (≤ 34)

C-Reactive Protein (CRP) 2.1 mg/L (0 - 5) 42.0%

Vitamin B12 179.7 nmol/L (25.1 - 165) 110.5%

Vitamin D 107 nmol/L (50 - 200) 38.0%

Ferritin has been drifting downward since March 2024, now at 45. I get an nhs iron infusion at 30.

I’m taking all medications and supplements as normal and have done throughout the last year. (To add: HRT was increased in June to 75mg and added a probiotic Optibac S. Boulardii.)

I do feel like I am undermedicated (1 and a 1/4 grain per day. I’m 5’1” and weigh 55kg) and not yet optimum.

Has my FT4/FT3 dropped because I’m under medicated?

[Insomania]

To add on ferritin. I have iron deficiency anaemia. I'm under nhs haematology and I get quarterly iron panel testing and iron infusions when ferritin is at 30. My last iron infusion was Sept 2022 and I was maintaining well on treatment until March 2024. (I did have covid twice in Dec 2023 and Jan 2024.) Here’s the graph from the hospital app. The 1st high point is the infusion, 2nd high point post-Covid when CRP inflammation was 5, top of range.

Graph to show ferritin july 2022 to sept 2024

[Noelnoel in reply to Insomania]

Perhaps have a conversation about why ferritin is allowed to hit the floor before an infusion. That won’t be helping at all

[Insomania in reply to Noelnoel]

Yes, agree! Thank you, I’m going to suggest this to the haematology consultant.

[Insomania in reply to Insomania]

The haemotology Dr was helpful and agreed to book me an iron infusion now, instead of waiting. Just waiting for appt to come through.

[Insomania in reply to Insomania]

I thought I’d update that I had the iron infusion 4 days ago based on the ferritin at 46. Credit where it’s due, I’m very thankful to the NHS haematology consultant for her pragmatic approach.

[Jazzw]

Well. It could well be related to your ferritin levels. Iron is needed for the conversion of T4 to T3.

[Insomania in reply to Jazzw]

I did wonder if this was the case 😢

I’m doing all my iron treatments, supplementing, tranexamic acid.

[TiggerMe Ambassador]

I wonder if the ratio isn't quite right for you and adding some T4 would help? I know others need to do this on NDT

[Venicefan]

One and a quarter grains is a very low dose. I take two and a half grains of Thyroid S, daily, which has a similar hormone content to Armour.

My t4 is 16.4 [12.0-22.0] and t3 6.5 [3.1-6.8]. I feel really well with those levels.

You should continue to increase slowly until you feel well.

[Insomania in reply to Venicefan]

I was doing so well. Thus is where I was at the end of May:

Free T4 (fT4) 17.5 pmol/L (12 - 22) 55.0%

Free T3 (fT3) 5.9 pmol/L (3.1 - 6.8) 75.7% (best ever!)

Though my ferritin was dipping down from March 2024.

I’m so upset!