new results. Dose increase not reflected

[Mag999]

I’m on 75 mcg levothyroxine and 20 mcg liothyronine, was feeling a bit better and t3 and 4 were increasing but latest results show decrease in both pretty much where I was when not on any medication at all except tsh below detection.

I don’t feel great still a lot of fatigue and exercise intolerance

I don’t really understand what’s going on

The private gp wants me to do reverse t3 as she thinks I should just take t3 at higher dose.

I now have the nhs endo to deal with too who won’t agree with the gp. Yet to have follow up with her after she agreed to prescribe t3 so I’m still free to make choices.

I’ve had a lot of advice from this forum so I know I took the test properly and I’ve been on all the vitamins although I struggle to raise my ferritin.

options are

1. Trial t3 alone

2. Raise one or other of levo or lio

3. Raise both

4. Come off all of it and see how I feel and start again.

I am waiting for latest vits results I have pernicious anaemia so I know I don’t absorb very well wondering if I don’t absorb thyroid meds?

Anyone else have problems like this I’m getting to end of my tether now

[Jaydee1507 Administrator]

When did you take your last doses of Levo & T3 before this test and how much T3?

T3 has a short half life and day before test need to delay a portion of dose until 8-12hrs before test.

[Mag999 in reply to Jaydee1507]

Yes followed instructions for dosing before testing

[SlowDragon Administrator]

Assuming last dose Levo was 24 hours before test

Ft4 is very low

How much levothyroxine were you taking BEFORE adding T3

T3 ….day before test split T3 as 2 or 3 smaller doses spread through the day, with last dose approximately 8-12 hours before test

is this how you did this testc

What vitamin supplements are you taking

What are most recent vitamin results

[Mag999 in reply to SlowDragon]

Yes that’s how I do the test every time, I’m on b12 injections methylated b vitamins vitamin d and k, folate, magnesium plus a variety of specialist supplements from functional nutritionist

I don’t know what else I can do.

I have been on 100mcg levo alone but that made t4 top of range and didn’t shift t3

I’ve tried various combinations of 50 and 75 mcg levothyroxine plus increasing dose of liothyronine e and did get a slight improvement in t3 but it hasn’t been sustained

[SlowDragon Administrator in reply to Mag999]

So try increasing levothyroxine to 87.5mcg daily

Retest in 6-8 weeks

I have been on 100mcg levo alone but that made t4 top of range and didn’t shift t3

Adding T3 often improves how we use Ft4 and Ft4 frequently reduces after adding T3.

Many of us find we then need to increase Levo back up.

Fine tuning dose

Increasing levothyroxine should improve Ft4 and Ft3

You may need further increase after next test

You need to test vitamin levels including ferritin

[Insomania]

I had a similar negative step change to FT4 and FT3 recently and it seemed to be due to low iron. I’ve just had an iron infusion (I have iron deficiency anaemia) and a NDT increase so hoping that helps.

[Mag999 in reply to Insomania]

Thanks that is helpful, I will look again at my iron as it often declines

[Blue_Lagoon]

Hi Mag999

It sounds to me as though by getting your fT4 and fT3 to where they were before you were medicated and with a supressed TSH you have effectively ended up in exactly the same place but you are just replacing exactly the same amount your own thyroid was making with synthetic versions and you had hypo symptoms in the beginning so it’s unsurprising you still feel under medicated.

It could be that your pituitary is suffering the effects of hypothyroidism and not producing enough TSH or perhaps you have an actual pituitary problem. I would request pituitary testing from your private GP. Sounds like they are rather clued up if they are talking about rT3. In my opinion it sounds like you need an increase in either T4 or T3. I wouldn’t jump ship just yet and go T3 only. Keep that up your sleeve for later! Plus there is always NDT to consider as another half way house. And after all your hard work on suppressing your own thyroid hormone production and raising your doses I wouldn’t stop taking it all either.

Additionally you may have cellular resistance but that is resolved by T3 only (perhaps a future step to look at but not yet) or perhaps your vits are not up to scratch and you are not using your T3 effectively in your cells.

Hope this helps.x

[Mag999 in reply to Blue_Lagoon]

Thank you, this has been going on for 2 years now and at no point have I felt I’ve got it right

At 100mcg levothyroxine I had high t4 and no symptom improvement hence the addition of t3. I feel maybe increasing t3 is my first step

How do I find out if I have cellular resistance?

I will increase iron intake too I suspect it’s a bit low, all other vitamins are ok.

[Blue_Lagoon in reply to Mag999]

Oh I’m sorry. The frustrating thing is it just takes so long to fix a thyroid problem.

Maybe you’re just not converting enough and your T3 isn’t high enough, which is why you added the T3 and your GP is talking about testing your rT3 which is produced from T4 instead of active T3. I would get your pituitary tested before you add any extra T3 as you are now where you started T4 and T3 wise so might be a good baseline. I imagine your GP will say you have to reduce your T4 if you add any T3 but if you’re not converting anyway then it won’t matter.

I think you find out if you have cellular resistance by taking T3 only and seeing if it alleviates your symptoms. If it doesn’t then you may need to try higher doses of T3 to bombard your cells. It’s a bit more involved than that but I think that’s it in short. I would recommend reading Paul Robinson’s book Recovering With T3 as he sets out the correct order to do everything in when starting T3 only.

T3 only is a real faff to get right so I would see it as a last resort really. Depending on the results of pituitary tests and how you feel about taking NDT I would investigate that first as it could be that you’re missing calcitonin which is also made in the thyroid which because your thyroid is now not working it won’t be producing any (or very little). There’s also the other thyroid hormones to think about - T1, T2 etc which your thyroid wont be making either. All these are present in Armour so if it was me I would investigate that first before trying T3 only. Depending of course on how you feel taking animal products!

Increasing your iron sounds like a good plan ☺️ you say you struggle to raise it - have you tried taking it with Vit C? A glass of orange juice or a supplement perhaps? This helps absorption as it helps the iron transporters in the gut work better.

[Mag999 in reply to Blue_Lagoon]

O dear, a lot to think about! Animal products are a real problem for me, I stopped the creon (pancreatic insufficiency) as the production is unclear, I’d need to be at last resort to contemplate it

I have Paul Robinson’s books so will go back to them

I’ll ask about pituitary testing as had not thought about that

Thanks so much for your help

[Blue_Lagoon in reply to Mag999]

Sorry I didn’t mean to overwhelm you with info! Don’t panic. Everyone on this forum is here for you ☺️

Maybe skip trying NDT then if you’re not happy taking animal products and go for T3 only. Paul Robinson’s books are great. I’ve just ordered the yellow one so can’t wait for that to arrive! 😀

[Mag999 in reply to Blue_Lagoon]

Don’t worry! All info welcome, and without this forum I’d be utterly lost!

Really grateful for you taking the time to reply.

[Blue_Lagoon in reply to Mag999]

Me too!

No problem at all ☺️

[Blue_Lagoon]

On the other hand, your GP is suggesting more T3 so perhaps you should bite her hand off! I don’t know. Something to think about.x

[SlowDragon Administrator]

Never supplement iron without doing full iron panel test for anaemia first and retest 3-4 times a year if self supplementing.

It’s possible to have low ferritin but high iron

Test early morning, only water to drink between waking and test. Avoid high iron rich dinner night before test

If taking any iron supplements stop 5-7 days before testing

Medichecks iron panel test

medichecks.com/products/iro...

Look at increasing iron rich foods in diet

Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption

List of iron rich foods

dailyiron.net

Links about iron and ferritin

irondisorders.org/too-littl...

davidg170.sg-host.com/wp-co...

Great in-depth article on low ferritin

oatext.com/iron-deficiency-...

drhedberg.com/ferritin-hypo...

This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.

[Mag999 in reply to SlowDragon]

This is something I don’t understand, low ferritin normal haemoglobin, is it just I don’t get enough to store? I am vegetarian so I know my diet is low in iron and I have frequently been anaemic so will get iron panel done

[SlowDragon Administrator in reply to Mag999]

Virtually impossible to maintain good iron/ferritin on vegetarian diet

Posts discussing Three Arrows as very effective supplement - but is derived from meat

Great replies from @FallingInReverse

re ferritin and Three arrows

healthunlocked.com/thyroidu......

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Great reply by @fallinginreverse

healthunlocked.com/thyroidu...

Ferrodyn supplement

healthunlocked.com/thyroidu...

Iron patches

healthunlocked.com/thyroidu...

Thyroid disease is as much about optimising vitamins as thyroid hormones

healthunlocked.com/thyroidu...

restartmed.com/hypothyroidi...

Post discussing just how long it can take to raise low ferritin

healthunlocked.com/thyroidu...

Iron and thyroid link

healthunlocked.com/thyroidu...

Posts discussing why important to do full iron panel test

healthunlocked.com/thyroidu...

Good iron but low ferritin

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Chicken livers if iron is good, but ferritin low

healthunlocked.com/thyroidu...

Shellfish and Mussels are excellent source of iron

healthline.com/nutrition/he...

Iron deficiency without anaemia

healthunlocked.com/thyroidu...

Ferritin over 100 to alleviate symptoms

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Great research article discussing similar…..ferritin over 100 often necessary

ncbi.nlm.nih.gov/pmc/articl...

Low Iron implicated in hypothyroidism

healthunlocked.com/thyroidu...

Really interesting talk on YouTube, link in reply by Humanbean discussing both iron deficiency and towards end how inflammation can also be an issue

healthunlocked.com/thyroidu...

Inflammation affecting ferritin

healthunlocked.com/thyroidu...

Updated reference ranges for top of ferritin range depending upon age

healthunlocked.com/thyroidu...

Thank you for your incredible patience while you have been awaiting the outcome of our ferritin reference range review. We conducted this with Inuvi lab, which has now changed the reference ranges to the following:

Females 18 ≤ age < 40. 30 to 180

Females 40 ≤ age < 50. 30 to 207

Females 50 ≤ age < 60. 30 to 264l

Females Age ≥ 60. 30 to 332

Males 18 ≤ age < 40 30 to 442

Males Age ≥ 40 30 to 518

The lower limits of 30 are by the NICE threshold of <30 for iron deficiency. Our review of Medichecks data has determined the upper limits. This retrospective study used a large dataset of blood test results from 25,425 healthy participants aged 18 to 97 over seven years. This is the most extensive study on ferritin reference ranges, and we hope to achieve journal publication so that these ranges can be applied more widely.

[Mag999 in reply to SlowDragon]

Wow! I really need to look at this plenty of weekend reading! Thanks very much, I think I’ve neglected the iron side of things for other vitamins as I was so depleted In b12 and d and kind of accepted I’d always struggle with iron but will revisit