T4 & T3 dose change advice for persistent brain fog, please.

[kevultralight]

Hello, I have hypothyroidism and have been trying to find the right T4 and T3 dosage.

-I still experience brain fog, mental fatigue, and leg fatigue.

-Additionally, I’m dealing with LPR (globus), low testosterone, and elevated liver enzymes (which have improved significantly since earlier this year).

I would greatly appreciate any recommendations for adjusting my T3 and T4 doses.

-Currently, I take 125 mcg of T4 (Tirosint) and 5 mcg of T3 (Cytomel) each morning... but still experience persistent brain fog.

-My endocrinologist has suggested increasing the T3 by 2.5 mcg every 7-10 days if the fog continues... So I will likely increase to 125 mcg of T4 (Tirosint) and 7.5 mcg of T3 (Cytomel) each morning and hope for the best

Note:

-Male: 6ft, 155-160 lbs

-My vitamin levels are all looking pretty good right now. (Taking supplements for b12 and vitamin D)

Please see labs and thyroid medication history below for context. (Note around 7/24/24 I was starting to feel super good, but then brain fog came raging back around 8/1/24).

——LABS (before starting thyroid)——

1/18/24:

TSH: 1.89 (.4-4.5)

T4, Free: 0.99 (2.3-4.2)

2/18/24:

TSH: 1.550 (.4-4.5)

T4,Free: 0.88 (.8-1.8)

T3, FREE: 1.6 (2.3-4.2)

Reverse T3, Serum: 31.7 ng/dL

Triiodothyronine (T3): 47 ng/dL (71-180)

05/04/24:

Testosterone, total: 116.0 ng/dL (264-916 ng/dL)

Testosterone, free: 2.8 ng/dL (5.00-21.00 )

Testosterone, percentage free: 2.41% (1.50-4.20 %)

Prolactin: 3.5 (3.9-27)

Cortisol - AM: 21.7 (6.2-19.4)

——MEDICATION——

5/31/24: 138 t4

——MEDICATION——

6/25/24: 138 t4 & 5mcg t3 in the morning

——LABS——

06/20/2024:

TSH: 0.088

T4 FREE: 1.45 (.8-1.8)

T3 FREE: 1.7 (2.3-4.2)

Reverse T3, Serum: 17.2

Triiodothyronine (T3): 40

Testosterone, total: 124.0 ng/dL (264-916 ng/dL)

Testosterone, free: 2.3 ng/dL (5.00-21.00 )

Testosterone, percentage free: 1.9% (1.50-4.20 %)

Ferritin: 177 ng/mL

——MEDICATION——

7/19/24: 138 t4 & 5mcg t3 in the morning + 5mcg t3 in the afternoon

——LABS——

7/24/24:

TSH: 0.01

T4 FREE: 1.3 (.8-1.8)

T3 FREE: 2.8 (2.3-4.2)

——MEDICATION——

8/12/24: 125 t4 & 5mcg t3 in the morning + 2.5 mcg t3 in the afternoon

——LABS——

8/20/24:

TSH: .02 (.4-4.5)

T4 FREE: 1.5 (.8-1.8)

T3 FREE: 3.0 (2.3-4.2)

SHBG: 60 nmol/L

Cortisol - AM: 20.6 (6.2-19.4)

Ferritin: 154 ng/mL

DHEA-Sulfate: 294

Testosterone: 258 (188-263 ng/dL)

Testosterone,Free: 5.91 (5-21 ng/dL)

% Free Testosterone: 2.29% (1.50-4.20 %)

——MEDICATION——

9/14/24: 125 t4 & 2.5mcg t3 in the morning

——LABS——

9/21/24:

TSH: .02 (.4-4.5)

T4 FREE: 1.4 (.8-1.8)

T3 FREE: 2.6 (2.3-4.2)

——MEDICATION——

10/1/24: 125 t4 & 5mcg t3 in the morning

THANK YOU ANYONE FOR THE HELP!

[TiggerMe Ambassador]

So you were starting to feel good at the end of July...

7/19/24: 138 t4 & 5mcg t3 in the morning + 5mcg t3 in the afternoon

——LABS——

7/24/24:

TSH: 0.01

T4 FREE: 1.3 (.8-1.8)

T3 FREE: 2.8 (2.3-4.2)

But then reduced your dose and went down hill again... why the reduction just as your levels and symptoms were starting to improve??

Can you not get some testosterone gel to deal with your low levels?

[kevultralight in reply to TiggerMe]

Around 8/1, I suddenly developed brain fog, felt wired, and had trouble sleeping, possibly indicating a hyper state, so we lowered the dose. Since then, the brain fog persists, but my sleep has improved.

My endocrinologist recommends waiting on testosterone replacement, hoping my levels will rise as my thyroid function improves. They want to avoid lifelong therapy. My testosterone has increased from 124 ng/dL to 228 ng/dL in 1.5-2 months after my T3 and T4 levels stabilized... Have you used TRT temporarily?

[TiggerMe Ambassador in reply to kevultralight]

Chances are they were just reacting to your low TSH (you can't become Hyper just over-replaced) as your free's were still really low so nowhere near over-replaced.

Free T4 (fT4) 1.3 pmol/L (0.8 - 1.8) 50.0%

Free T3 (fT3) 2.8 pmol/L (2.3 - 4.2) 26.3% 

You'd only been on this dose for 4 weeks so chances are things were still settling in and too soon to retest, it could be that taking T3 as one dose first thing in the morning would suit you better or some find a small dose at bedtime actually aids sleep so worth experimenting with timings before altering dose