Results help please

[ThyroidFrazzled]

Hello All,

Apologies for the long post

I have found such helpful advice on this forum - eternal gratitude to the admins. I have not posted much but have certainly learned a lot.

I'm writing today for advice on T3 and for any thoughts on the interaction between my HRT and my levothyroxine

I have autoimmune thyroiditis (Ord's I suppose or more commonly called Hashi's)

My thyroid was removed in 1994 and I've been on Levothyroxine 100 mcg ever since. I function but don't have much stamina and have lots of hypo symptoms (dry skin, brain fog, dry eyes, fatigue, etc)

I was told many years ago that I am a poor converter from T4 to T3 and that I should ideally be on Armour. But I was living abroad where it wasn't available and so sadly that wasn't an option. I moved to the UK three months ago and am keen to find a way to feel better.

I am also on bioidentical HRT (Estradot patches, 100 increased to 137 twice weekly and 200mg progesterone daily).

My gynecologist increased my estrogen patch dose to from 100 to 137 two months ago. My levothyroxine dose stayed the same. I began to have MASSIVE hair loss. Hair loss is always a key hypo symptom for me. I suspected I needed to increase the levothyroxine due to the increased estrogen dose. I understand that estrogen can block thyroid hormone uptake.

I increased my Levothryoxine dose to 112

My GP practise ran routine blood tests two weeks ago - I didn't realise they would run a routine TSH so I wasn't fasting. It was noon.

That TSH result was : TSH = 2.06 mU/L (0.3-4.2)

Of course the GP did not run tests for T3 or T4

When I saw that TSH result, I thought this was the reason for the hair loss and increased my Levothyroxine to 150 mcg every other day, alternating with 112 mcg. (I have supplies at home that I bought abroad)

The same week as the GP blood draw, I also booked a Medichecks test, results below (done at 9:00 am on an empty stomach, as I have learned thanks to this site !)

TSH 1.41 mIU/L (Range: 0.27 - 4.2) (

Free T3 4.1 pmol/L (Range: 3.1 - 6.8)

Free Thyroxine 18.7 pmol/l (Range: 12 - 22)

Thyroglobulin Antibodies 61.1 IU/mL (Range: 0 - 115)

Thyroid Peroxidase Antibodies X 45.2 IU/mL (Range: 0 – 3)

(I see that the T4 to T3 conversion is really low)

CRP HS = 2.1 mg/l (Range: 0 - 5)

Ferritin = 108 ug/L (Range: 13 - 150)

Folate - Serum = 8.1 ug/L (Range: > 2.9)

Vitamin B12 - Active X = 181 pmol/L (Range: 25.1 - 165) (I was supplementing, will stop)

Vitamin D 83 = nmol/L (Range: 50 - 200 nmol/ ( I guess this can be higher)

Looking over these results, I see that

1) I am poor converter from T4 to T3

2) My vitamin D could be a bit higher

3) B12 is a bit high so I will stop supplementing

4) My HRT and levo dosing is not optimal (as in my HRT is affecting my levo uptake)

My problem is I have such brain fog I am struggling to figure out what direction to go in. Reduce HRT patch? Stay on 150 mcg levo every other day?

Ideally I would like to trial T3.

Your thoughts welcome!

Many thanks

[greygoose]

Your B12 was probably high for two reasons:

- you were supplementing it

- your folate was low

Rather than stopping it, I would start taking a B complex containing methylcobalamin (B12) and methylfolate (about 100 mcg) plus all the other Bs. All the Bs work together so need to be kept balanced. Just taking one isolated B may improve blood levels but won't do much for your health. Your B12 will probably drop once you start taking folate.

If you take vit D you also need to take vit K2-MK7 and magnesium, it's cofactors.

Do you take your levo and HRT at the same time? If you leave a gap of about 4 hours it should be ok. But in any case, it doesn't look like your absorption of T4 is being affected, it's quite high in range. It's 67% through the range, which is about one would expect on your dose.

Your FT3, on the other hand, is only 27% through the range, which is much too low. Increasing your dose won't help your conversion - which is poor - and might make it worse. So, yes, what you need is some T3 to add to your levo.

[ThyroidFrazzled in reply to greygoose]

Thank you so much Grey Goose, much appreciated.

Can you recommend a vitamin B complex brand?

I am taking the Better You vitamin D +K2 spray that was recommended here.

Re taking the Levo and the HRT at the same time - the estradiol patch is on continuously, I change it twice a week. I take my Levo on waking and I wait an hour before having tea. If I wake in the night to go to the loo I take it then.

I will start a separate thread re T3 so this one doesn't get locked.

[greygoose in reply to ThyroidFrazzled]

Oh, ok! I didn't realise it was a patch. That should be ok then.

The B complex brands I take are Thorne Basic B or Igennus. There are other good ones but I don't know their names.

Do you take magnesium with your vit D?

[ThyroidFrazzled in reply to greygoose]

Thank you again Grey Goose,

I was taking Magnesium (not very regularly). If you can recommend a brand that is not too large to swallow or capsules that I can tip into water, that would be really helpful

[greygoose in reply to ThyroidFrazzled]

Well, the ones I take are large but easily snapped in two. I think that's the case with most magnesium tablets. I don't know anything about capsules.

[Tina_Maria in reply to ThyroidFrazzled]

Are you tolerating magnesium citrate? In some people it can be laxative (in some this is a nice side-effect when a bit slow in that department! 😅).

Amazon have a magnesium citrate powder (Peak supps) which is easy to stir into fruit juice (I use orange juice). It does not dissolve completely so can be a bit gritty, but it is easy to swallow and good for dosing as well. You can start with a lowish dose and see how you get on?

Other good forms of magnesium are glycinate, maleate, taurate or threonate. I think Amazon may have capsules of some of these, in case you are not getting on with the citrate.

[ThyroidFrazzled in reply to Tina_Maria]

Thank you

[pennyannie]

Hello ThyroidFrazzled :

You may wish to discuss the above results with your doctor, and depending on where you are in the country, you might be referred to an endo to be considered for T3 on the NHS.

I very much doubt you will get NDT as it is still blacklisted for new patients but there has been some easing of prescribing of T3 - Liothyronine - on the NHS and become something of a post code lottery.

Obviously if you can afford to go Privately there is a very different landscape.

Thyroid Uk - the charity who supports this patient to patient forum hold a list of patient recommended endos/thyroid specialists - NHS / Private - so this might be of some use also - just email admin @ thyroiduk.org asking for a copy of the Patient Recommended List of thyroid specialists :

[SlowDragon Administrator]

I increased my Levothryoxine dose to 112

increased my Levothyroxine to 150 mcg every other day, alternating with 112 mcg.

Retest after 8 weeks

That might be too big an increase

125mcg daily might have been more appropriate

Roughly where in U.K. are you

Would strongly recommend you pursue getting T3 prescribed as first option

Here’s link for how to request Thyroid U.K.list of private Doctors emailed to you, but within the email a link to download list of recommended thyroid specialist endocrinologists who will prescribe T3

Ideally choose an endocrinologist to see privately initially and who also does NHS consultations so that might eventually transfer to getting T3 on NHS

thyroiduk.org/contact-us/ge...

Folate level low

Are you currently taking a daily vitamin B complex?

IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 5-7 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate folate supplement (eg Jarrow methyl folate 400mcg) and continue separate B12

Post discussing how biotin can affect test results

healthunlocked.com/thyroidu...

helvella.blogspot.com/p/hel...

[ThyroidFrazzled in reply to SlowDragon]

Thank you so much Slow Dragon. I will go to 125 as you suggest.

I am in London.

I’ve made an appointment with a private Endo now from the list, but it’s not until the very end of January unfortunately.

I will start taking a B complex

[Alternatively]

Hi ThyroidFrazzled

So sorry to hear that you have to wait until the end of January before getting to see the private endo 😔 That’s a long time to wait while you’re feeling ill isn’t it. Maybe you could send an email to the secretary to ask if you could e contacted in the event of a cancellation? How did you choose who to see?

I too am a poor converter and have seen two different private endos, and neither were amenable to prescribing me T3. I hope you are more fortunate with yours. I managed to be prescribed via a phone consultation with a pharmacist.

It’s tricky though to find your particular sweet spot. I started off at 5mcg per day, then 7.5, now trying 10mcg. Testing bloods 6/8 weeks after each increase or decrease.

This is an amazing forum, I’ve learnt everything from reading posts and reaching out for help. Would love to know how you get on.

[ThyroidFrazzled in reply to Alternatively]

Thank you so much, that is a good idea and I will write to the secretary as you suggest.

I identified the consultant by looking on the list of specialists posted here and looked up reviews. I chose a female physician who was rated very highly and who has Hashimoto herself.

This forum is amazing, incredibly helpful and like you, I have learned so much.

[Alternatively]

Well it’s certainly worth a try … it’s my motto!

Your Endo sounds very promising as she has personal experience of your condition!!

Would love to know how it goes for you!

[ThyroidFrazzled]

Thank you, I’ll share how it goes