Advice needed on two sets of test results please.

[Jackblack46]

Hi everyone

I would very much appreciate your opinion on my last two blood test results. I am on Levothyroxine. I am male and weigh approximately 95kg, I am tall, lean, athletic build. My 9am cortisol is high end of normal and all my vitamins and minerals are good.

Levothyroxine @ 150mcg per day:

Blood draw was 24hrs after last dose @ 0930hrs before taking next dose.

TSH: 2.02 REF RANGE 0.27-4.2

FT4: 17.3 REF RANGE 12-22

FT3: 4.6 REF RANGE 3.1-6.8

________________________________________

Levothyroxine @ 187.5mcg

TSH: 1.21 REF RANGE 0.27-4.2

FT4: 17.8 REF RANGE 12-22

FT3: 4.7 REF RANGE 3.1-6.8

Although I have increased the Levothyroxine dosage, my FT3 and FT4 has barely increased and presumably this is because my TSH has dropped as expected.

I read some members on this forum say most people feel their best when their TSH is closer to zero and FT4 and FT3 is 60 to 80 percent through range? What concerns me, looking at my test results, is considering my TSH still has plenty of room to lower, I would probably need 250 or maybe 300mcg of Levothyroxine to achieve the above numbers?

Thank you for reading. 😊

[greygoose]

Hi Jackblack46, welcome to the forum.

The missing information here is how long you were on these two doses before testing? Did you wait 6+ weeks? Because if not, it's possible that your dose is still settling in, and the numbers will change if you give it longer. That said, it was only a tiny increase. You had plenty of room to go up the full 25 mcg.

I read some members on this forum say most people feel their best when their TSH is closer to zero and FT4 and FT3 is 60 to 80 percent through range?

Yes, the do say that. But perhaps it would be better if they said the feel their best when their FT4/3 are closer to 75 percent through the range, and therefore their TSH is closer to zero. Because TSH doesn't make you feel anything, and should definitely not be used to dose by, nor should you aim for any particular number. TSH is a pituitary hormone, and the pituitary doesn't always work 100% correctly. Also, the pituitary gets served first, so to speak, when there is available hormone, so the pituitary can be satisfied by the rest of the body still hypo. Plus, there are so many things that can affect TSH levels, like caffeine and the time of day.

So, best to concentrate on your FT3, as that is the most important number, because T3 is the active thyroid hormone needed by every single cell in your body to function correctly. And forget all about the TSH. It doesn't signify much once it gets below 1.

[Jackblack46 in reply to greygoose]

Thank you greygooose, I really appreciate your time to come back to me.

The two blood tests were only five weeks apart. But from what I have learnt, most of the leveling out is done in the first four weeks with minor changes there after.

You mention my dosage on the second test was a tiny increase and I could have gone the full 25mcg? I had increased the dosage by 37.5mcg. I went from 150 to 187.5.

Going forward, I would really appreciate some advice on how to increase my Ft3. When I mentioned that my TSH still has plenty of room to drop, I wasn't specifically trying to lower it, but stating the fact that a increase of Levothyroxine isn't going to make much improvement to FT3 if my TSH drops further as it will be offset by the reduction my thyroid gland releases T4 output.

I am predicting to get my FT3 into the upper range of normal, I would probably need a dosage of Levothyroxine between 250 and 300mcg, or do I keep the Levothyroxine dosage at 150 and add in some Liothyronine? As I mentioned, I weigh between 95 and 100 kilos, so 300mcg of Levothyroxine would be double the recommended dose.

[radd in reply to Jackblack46]

Welcome Jackblack46

Yes, you are correct. The more Levo medicated the more likely to suppress TSH release which lowers FT4 production. TSH is also used for thyroid hormone conversion so reducing output unnecessarily risks reducing FT3 levels.

Finding your final dose is a delicate balance dependant upon many factors such as how much working thyroid gland remains and if the hormone you have is being utilised to its full potential. Things that might impair good T4-T3 conversion are inadequate iron and nutrients, elevated cortisol and chronic inflammation if you have auto immune disease.

Also these numbers are a guide and must be viewed alongside symptoms, and even if you remain symptomatic it is not necessarily because your dose is incorrect but because the reversal of a felt hypothyroid thyroid state can be long delayed behind good biochemistry as everything ‘catches-up’.

Depending on how long you were left undiagnosed will initially have some bearing on the efficacy of your thyroid meds and five weeks isn’t generally long enough for all changes to be felt. Think of recovery as a cumulative effect.

If I was you to try raising FT3 levels I would add a selenium supplement. Selenium is the base of the 5’-deiodinase enzyme so helping to make the enzymes that remove the iodine molecules from T4, making T3. It also regulates and recycles iodine stores, helps glutathione production and protects the thyroid gland against oxidative damage caused by the hydrogen peroxide required to make hormones. If you have Hashi, it also helps control thyroid auto-antibodies, so an all round winner! but also ensure other nutrients are optimised also, particularly iron.

If you post any iron/nutrient results members will comment.

[Jackblack46 in reply to radd]

Thank you for help Radd, it is much appreciated. I do take a selenium supplement 200ius and I also take Magnesium Glycinate before bed. I will look further into my iron/nutrient results.

[Jackblack46 in reply to Jackblack46]

I also supplement with zinc

[Jackblack46 in reply to Jackblack46]

And a B complex

[radd in reply to Jackblack46]

Jackblack46

Regarding your elevated cortisol, sometimes just replacing deficient thyroid hormones is enough to encourage a better circadian pattern. However, if cortisol was to remain imbalanced you could try supplementing an adaptogen. Holy Basil & Rhodiola Rosea are popular, I like Ashwagandha and there are some great combos available.

However, use with caution as these can be powerful modulators of the HPA axis and sometimes we have to try several to see which suits best.

[greygoose in reply to Jackblack46]

Yes, sorry, maths isn't my strong point, and it was late at night. So, in that case, it was rather a large increase, so 5 weeks wouldn't be long enough to see the final results.

FT4: 17.8 pmol/l (Range 12 - 22) 58.00%

FT3: 4.7 pmol/l (Range 3.1 - 6.8) 43.24%

So, your conversion isn't too bad, and could improve with a further increase in levo, as long as the FT4 doesn't get too near the top of the range. The whole idea of thyroid hormone replacement is that it replaces the hormone your thyroid can no-longer make enough of on its own. It doesn't just top up what your thyroid makes. So, yes, you TSH is going to drop, but some people seem to convert quite well without it. There are so many things that can affect conversion that it isn't always about the TSH.

I would suggest you stop predicting because there's nothing linear about reactions to hormone, and you cannot guess your future dose by judging your present rate of conversion. Get you FT4 up to about 75% and then see how your FT3 is doing before deciding that you need to add in T3. One step at a time is my advice.

[Jackblack46 in reply to greygoose]

Thank you Greygoose.

I will increase my Levothyroxine and retest in 6 weeks.

[greygoose in reply to Jackblack46]

Frankly, if it were me, I wouldn't increase just yet. I'd wait another six weeks and retest first.

[Jackblack46 in reply to greygoose]

OK

So are you saying that it is possible my FT3 may greatly increase after another six weeks on the same dosage?

[greygoose in reply to Jackblack46]

No, I don't think I said that. What I'm saying is you can't know what may happen, It could all change - TSH, FT4 and FT3. Lot's of people prefer to wait 8 weeks after a dose change because they know how things can change in that time. And yours was a large increase so will take longer to settle. 5 weeks was too soon to retest. You don't gain anything by going to quickly, patience is the key.

[Jackblack46]

greygoose radd

VITAMINE D 150 NMOL/L

REFERENCE RANGE 50-200

SERUM FOLATE 31.8 NMOL/L

REFERENCE RANGE 8.83-60.8

FERRITIN 192 UG/L

REFERENCE RANGE 30-400

ACTIVE B12 116 PMOL/L

REFERENCE RANGE 33.7-150

I supplement with a B complex and Vitamine D. I stopped the B complex one week before blood draw.

[radd in reply to Jackblack46]

Jackblack46,

Nutrients all look good 👍.

Reading your replies above, I would discourage any further med raises atm. You increased by 37.5mcg Levo and are now on a very good dose.

The trouble with just increasing and increasing thyroid meds is everyone has a T4 glass ceiling which if exceeded by a little, the bodies window of tolerance will deal with it effectively. However, if this excess is continued long term or jumps to a larger amount more than your body can deal with, it becomes difficult to just disable and excrete and might start causing negative changes to FT3 levels as a sort of safety mechanism. The longer this state is allowed to continue, the harder to reverse.

This is when people become very confused about their correct dose as any further adjustments both up and down may appear to have little/no effect. The way forward is slow mindful med adjustments as there is often a lot of damage created by the untreated hypothyroidism that has to undo.

[Jackblack46 in reply to radd]

Thank you Radd

Your advice is much appreciated

[Jackblack46]

radd greygoose

Latest blood results 8 weeks Levothyroxine @ 150mcg daily

Hi

Firstly, I should apologise for not following the recommended advice. The main reason for dropping my dosage back to 150 was because when I increased the dosage to 187.5 I felt worse and also because I was told that 6 weeks on a dose may have been too soon to do bloods. Below are my latest results by Medichecks. The previous two tests were done by Lola, however, all three samples were sent to a science Park in Guildford, so it could in fact be the same lab. Also, for the past five weeks, I have added 400ug supplement of Folic acid.

TSH 1.85 (0.27-4.2)

FT3 4 (3.1-6.8) 24.32%

FT4 16.7 (12-22) 47%

FOLATE 45.4 NMOL/L

VIT B12 119 PMOL/L

VIT D 138 NMOL/L (50-200)

FERRITIN 171 UG/L (30-518)

THYROGLOBULIN 17.9 (0-115)

THYROID PEROXIDASE 12.9 KIU/L (0-34)

In terms of how I feel, I am still a million miles away from firing on all cylinders. I definitely see a slight improvement on 150mcg of Levothyroxine than I do 187.5mcg. Personally, I believe I need to add in T3 but would prefer to hear opinion from the experts 🙂 And going forward, I will follow instructions.