How high in range is too high for FT4

[FallingInReverse]

Been busy, haven’t been writing down all details of my titrations in one place… annoyed at myself as my notes are spread out everywhere!

So today just have a simple question about FT4 in-range target, and thoughts on my next move.

Have been feeling completely functional… at times feel pretty normal… would like to start real exercise sessions again but not ready for that yet. I’m not sure if my foundation is 100% rock solid, and still have a few moves to make, and life always throws some curve balls, but all in all feel like I’ve done it - reached a plateau where I am doing ok!

Latest bloods…. How high in range should I aim for FT4. I’d like it a little higher but know this is one of those things that is not settled. Looking for what everyone aims for, and for those who have researched the risk, to share what you know.

Also interesting my increase did very little. My life has been way busier and active, so maybe hormone needs have increased? That’s why I like this low and slow approach - it does help ferret out cause and effect.

Anyway - I’m thinking of another Levo increase - prob would go up to 125 a day.

Thoughts?

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October 2nd 2024

Was on 112 T4 for a 8-10 weeks and 10 T3 for a year + (split 5 upon waking and 5 at bedtime.)

.

FT3 - 3.9 [2.3-4.2] pg/mL 84.2%

FT4 - 1.26 [0.89-1.76] ng/đL 42.5%

TSH - 0.008 [0.5-4.7] miu/L

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July 23rd 2024 same ranges

Was on 100 T4 for 6-8 weeks-ish and unchanged 10 T3 for a year + (split 5 upon waking and 5 at bedtime.)

.

FT3 - 3.9 - 84.2%

FT4 - 1.29 - 45.9%

TSH 0.018

All bloods done under same conditions - last Levo 24 hours, last t3 18 hours (yes I know, could be a slight false low, but results are comparable over time).

Ps on vitamins

Iron optimal, D I’m up and down on iu’s as I keep bouncing under/over through the year so that’s easy enough to fix.

I’ve been waiting to decide on B supplements… last two tests:

My b12 [211-911] July-415 to Now-663

Folate [>5.4] July-13 to Now-11

My b12 has not been dire and so I prioritized Ts and iron. Not sure if now is the time to add B.

[TiggerMe Ambassador]

Yep, I'd go along with the increase to 125mcg T4, it does rather look like your last increase got taken up rather than stay in your blood doesn't it!

Personally I like my fT4 just above 50% fT3 was around 80% last time I tested correctly but as I take as a single dose which works better for me so bloods are not really much to go on 🙃

Yep, a B complex would be a good idea 🤗

[DippyDame]

but all in all feel like I’ve done it - reached a plateau where I am doing ok!

If you feel well then why increase your dose?

We are advised to take the lowest effective dose rather than the largest dose tolerated

When T3 is taken it lowers both FT4 and TSH.....addition of 12mcg levo was therefore unlikely to have much impact on FT4

last t3 18 hours (yes I know, could be a slight false low, but results are comparable over time).

It's not about comparing results, test after test, it's about the hormone level. Yes, after 18 hrs FT3 may be a false low which risks you missing a result that is actually too high and possibly causing overmedication so your logic is flawed

Testing should be 12 hrs after last T3 dose/ 24 hour gap for levo/T4

You need what you need to feel well and that will be different to most other people so, comparison with other people is not helpful.

Keep an eye on your symptoms when T3 is added they become almost as important as numbers

[TiggerMe Ambassador in reply to DippyDame]

TBH Dippy I struggle a bit with this statement...

"It's not about comparing results, test after test, it's about the hormone level. Yes, after 18 hrs FT3 may be a false low which risks you missing a result that is actually too high and possibly causing overmedication so your logic is flawed"

If FiR always tests under the same conditions then it at least gives a consistent base to compare with symptoms... personally as a single dose T3 taker my results are above range for several hours a day and have dropped back to mid range 24 hours after (perhaps next test I shall do at 12 hours post T3 dose) this gives me the best uptake results on the lowest dose, if I split dose I can take considerably more with less benefits so I think when the important thing is cell uptake/ resistance rather than blood levels as people become more experienced with treating their condition there is great scope for fine tuning and dealing with the cortisol link... blood tests have there limitations, are they of any use to you as a big T3 only user, I've often wondered?

[DippyDame in reply to TiggerMe]

Re that statement....hormone levels fluctuate throughout the day, which you have noticed. That is why we test at a time when the hormones have had the best chance to settle and therefore give an accurate picture of serum hormone....the point of testing.

That is 12 hours after the last T3 dose and 24 hours after the last levo dose.

Testing FT3 after 18 hours defeats the purpose.....after 18 hours the FT3 serum level will have dropped too far giving a false low.

I'm sorry if my explanation confused you.

You asked...As someone who relies on a supraphysiological dose of T3 I no longer have blood tests.....they show TSH and FT4 on the floor and FT3 in orbit. No help really.

In that situation, symptoms alone are the guide....and were how hypothyroidism was monitored before lab testing!

We have to learn to listen to our body, it will soon tell us if something is wrong. I actually think that monitoring the T3-only dose is made to sound more complex than it needs to be causing a lot of angst.

Unfortunately there are no tests to measure cellular T3, except post mortem ....so back to symptoms.

It takes time, a lot of it, and patience, lots of it, to reach one's therapeutic dose....there are no quick fixes.

Like all of us here I cannot claim to be an expert....out of necessity we learn as we travel a long bumpy road.

Take care.

[TiggerMe Ambassador in reply to DippyDame]

I'm thinking testing for many is generally done for the purpose of placating medics and can be misleading/unhelpful as like you say testing 12hours after splitting your T3 when on a 'normal' day you dose once every 24 hours is going to give a skewed result, but it's the hoop jumping often needed to obtain a prescription as the medics generally request it to be 3 hours after which catches the peak and often leaves people under-replaced and struggling. If I told my Endo I take my dose once a day rather than the prescribed 3 x she'd probably implode such is the lack of understanding 🤣 a far from perfect system we have to navigate

I agree with you when dealing with T3 the old ways are considerably more useful and user friendly

We have to learn to listen to our body, it will soon tell us if something is wrong. I actually think that monitoring the T3-only dose is made to sound more complex than it needs to be causing a lot of angst.

Seems like the final insult that they bother to test cellular levels when we turn our toe up 😲

[DippyDame in reply to TiggerMe]

Your endo needs to read about the late Dr John Lowe's work. He was a T3 expert and for most of his adult life took about 150mcg T3 daily, in a single dose. He died as the result of an accident....not from the T3!!

His theory was that the T3 stays in the cells for roughly 2/3 days and it is gradually released in waves throughout the day...so avoiding peaks and troughs. Treatment is smoother.

Makes complete sense to me....and why I followed his protocols.

[TiggerMe Ambassador in reply to DippyDame]

I absolutely agree, I have tried in the past to educate her but she is rather resistant and we have agreed to differ... she has also put me onto an annual telephone review so no more face to face 😂 I shall keep working on her though 😁

[DippyDame in reply to TiggerMe]

Good luck with that....I decided to self medicate rather than listen to "advice" that I knew would make me ill. Not an option for everyone though.

Madness!

[TiggerMe Ambassador in reply to DippyDame]

I have a vested interest, if my daughter follows in my footsteps it will likely be this Endo she has to deal with 🫤 so I'll put in the effort to train her up for everyone's benefit

[tattybogle]

if only 8-10 wks on 112 and feeling basically ok i'd be tempted to stick to that for another few months .... sometimes improvements continue to accrue over several months

[FallingInReverse]

TiggerMe DippyDame tattybogle

Thank you wise friends! I am so grateful for everyone here.

I think… this is what I will do.

1) stay put…. tatty, you’ve pointed out what I was deep-thinking - the two result sets are so similar… and yet I would have said “ I felt better” in the last couple months. Things do indeed settle don’t they. I am the biggest proponent of low-and-slow and somehow still need reminding to do so for myself. I am one of those who say you can’t go low enough nor slow enough : )

2) Dippy - whereas I feel ok (brain fog gone!!!!), I do think I can do better… I don’t need to run another marathon but I sure would like to be able to do some weight training. And I just can’t get it together enough to do so. Plus although I’m grateful to be able to live what looks like a normal life again… Ive still had one or two crash days in the past few months. Maybe I always will but I not sure 40% through range is my ft4 sweet spot.

HOWEVER, you’ve also reminded me of my goal to get on the recommended blood test dose timing. And sticking with this for a little while longer would make me feel better about making that change. I think I’m going to make the break to do that next time. Tx for emphasizing that.

Also fyi - my t3 story is upside-down. I went from 50 mcg Levo for my first year (summer ‘22 to summer ‘23), right to 25 mcg Levo + adding 10 T3 daily. Would never do that again, I just did what my doctor said. Took me 9 months for the horrible palpitations to subside and a year to get my Levo back up from what I think was like 10% through range. But I have not changed my t3 dose since day 1. So I have watched/felt my symptoms dissipate because the T4 was raised and the t4 m/t3 combo raised my t3 OR my iron situation improved OR the confluence of it all settling in. Who knows right!

3) Tigger I’m feeling impatient again lol - I want to do all the things! But maybe this is a good time to add my Bs. I’ve wanted to for a while. And also maintain on a D homeostasis. And Keep on increasing ferritin (have gone from 5 to 30 in a year, progress but with a ways to go. Very happy with that though.) With the nil response to the extra 12 mcg Levo, and DD’s comment about t3 suppressing t4 and DD saying to take the least we need… and also what people (like Jimh111?) talk about on here about the risks of high ft4 (whatever “high” means) …. Hmmm, I’ll put that aside and just do another couple months of vitamin optimization. It’s a good time for it while my brain fog has finally gone 99% of the time.

I think that’s a plan! And I will (or won’t) worry about increasing Levo later.

((For my own reference, I’m also in the middle of active perimenopause but haven’t prioritized tackling HRT (yet) as this Ts optimization is yielding fruit, have cortisol on the back burner to monitor as I do sometimes get that wires/tired thing, watching zinc/copper, and one day in the distant future may consider gluten free (even though I have no physical reaction to eating it, I know it’s worth trying), or general upskilling on gut health and/or silent reflex, and maybe histamines.))

[TiggerMe Ambassador in reply to FallingInReverse]

Sounds like a plan! Just to put your mind at rest high fT4 would mean above range so you're fine there 🤗 Just letting everything settle is a great idea and just keep tabs without over stressing is lovely place to be

We all know it's a personal thing but I needed a little increase in T4 once I added T3 as it knocked it down by 40% but then I'm on HRT so there's another twist 😬

[FallingInReverse in reply to TiggerMe]

That’s the twist isn’t it! It’s all on my long list, and one step at a time. I am so tempted to increase to 125. I even bought the stock to do it… haha! Practicing all patience and self control right now. I do love how time changes and settles things all on its own.

Also - I have indeed reached a plateau. And I am having a moment today… looking down the mountain I have climbed and all the fighting I’ve had to do my body and the healthcare system to get here.

And I am feeling so grateful for you and everyone else. And for my health now peaking back through. Feeling a little melancholy for what was. And still hopeful it can be better.

Here’s to another set-it-and-forget it 6-8 weeks! Cheers 🥂

[TiggerMe Ambassador in reply to FallingInReverse]

There is always a halfway house if needed, you can always split the difference 😅

Such a great image of you climbing your mountain, I hope you gave a whoop or a song and little dance, we need to celebrate these moments so when we have a set back we know we can turn it around 🤗

You are an asset to this forum so no taking up paragliding from that mountain!

You might well find when you tackle your sex hormones your strength will improve

[DippyDame in reply to FallingInReverse]

about the risks of high ft4 (whatever “high” means) …

It basically means over range for a prolonged period

Amongst other issues, research shows that high FT4 can raise the risk of cancer...so best avoided....but your FT4 is safely low!

So, give this dose time, monitor symptoms and don't be tempted to push yourself too hard...probably too soon to hit the weights.

Patience was never my strong point but experience taught me it's value.

You're doing well....don't knock yourself backwards

We are all works in progress....only yesterday after much thought I decided I really needed to increase my T3-only to 125mcg....after increasing/ returning symptoms. I have a form of Thyroid Hormone Resistance... Now it's wait and see time.

Take care and relax!

[Tina_Maria in reply to FallingInReverse]

With regards to exercise, I know it is tempting to set yourself high goals - but steady and slow is the ticket. Be kind to yourself and don't demand too much too soon, as this can be counterproductive.

I was not very fit about 3 years ago (out of breath easily). I decided to go it slowly, so I started with just trying to increase my walking to around 3000 steps a day (and sometimes not every day). After a while, I noticed that I could do more, so increased steadily and now do around 7000 steps a day (the 10.000 steps a day is not easily achievable, and studies have shown that beneficial effects can even be seen when you walk around 3000 or more steps!). I do quite a bit of yoga, which is great for flexibility, strength and balance and there are plenty of free videos on you tube, which have short sessions (15-20min) for all levels - or even longer ones if you like it. As it works with your own bodyweight, it is great for building up strength and really works out your muscles too. But there are other exercises like Pilates, if that's more your thing. Or start very slowly with some lighter weights - a few reps at a time - very small sessions. Just find something you really like!

It all sounds very time consuming and daunting at first, but if you start slowly and don't set yourself too high goals, it can be done. Don't be harsh with yourself, if you cannot exercise on a day and don't think you have to exercise every single day; just go at your own pace and do things at a speed that is comfortable for you, on your own terms, and in a way that feels true to yourself. Be patient! As they say here - every little helps!👍😉

[Ashupan]

re T4

My endo would tell you it depends if you had cancer, a total thyroidectomy and other things.

I also had above and take 125 Eltroxin daily.

Endo wants keep my T4 a little low