TSH, FT3 and FT4 result

[Kramyy]

Hyperthyroidism underwent RAI now Hypothyrodism Last July 2024 . I am currently on Synthroid (75cmg Mon- Sat ) (100mcg Sun) . Thats my GP advise me to take. My ferritin and B12 are normal. And my Folate is 45.4 which is slightly high normal is (5.0 -45).My previous levothyroxine dose was 75 mcg daily . Im still feeling bouts of tinnitus and feeling tired on the morning. Would this suggest will increase my FT3 will normalize then tinnitus will go ? Any advise please see result

[Pandora777]

hi. I am afraid some of us never get rid of tinnitus. I have it and I have learnt to live with it. You might be one of the lucky ones and yours becomes quieter as your levels improve. Hopefully  pennyannie will give you some more advice when she wakes up she also has had RAI. It is the middle of the night here in the UK so it will be in a few hours before you get anymore replies

[pennyannie]

Hey there again ;

Your T4 is just under 40% ( 35.90 % ) through the range with your T3 tracking below the reference range :

We generally feel best when the T4 is up in the top quadrant of its range at around 80% through with the T3 tracking just behind at around 70% through its range:

Can you please share your actual ferritin, B12 and vitamin D results and ranges - as normal doesn't tell us anything - and are you supplementing folate and why it is over the range ?

Did you stop all supplements around a week before the blood test and leave around a 24 hour window from your last dose of T4 and have an early morning fasting blood test ?

I would think you need your dose of T4 - Synthroid - increased until your T4 is heading up into the top quadrant of its range as this should then see your T3 moving into and up its range and start to alleviate your symptoms of hypothyroidism -

as it is low T3 that causes all the symptoms of hypothyroidism.

You may well need the addition of a small dose of T3 - Liothyronine to rebalance your thyroid hormones to around a 1/4 ratio T3/T4 -

but we can't know that until you have maximised your dose of T4 and your reading around 20 - with your T3 reading coming hopefully in at around mid ' 5s ' in the range.

Have you been checked out for stomach absorption issues ?

Having 1 Auto Immune disease means you are ' prone ' to others - have you been checked out for pernicious anemia and celiac disease - as these are common ' bed fellows ' -

I know it's a lot to take in and understand especially when being so tired, foggy brained and unwell.

[Kramyy in reply to pennyannie]

Sorry for the late reply I live in NZ..Thanks for the reply Pennyannie, Ferritin 429 ( 20 -450 ) Vit B12 384 (170-800) . I havent done vit D as is not subsidise. Yes i did all the fasting prior my test. Just getting worst . Is is safe to increase my dose back to 100mcg daily. ? Or stick with the plan as above. I started the new dose last december 18, 2024. I will be doing my 8 week blood test on 2nd week of Feb 2025.. I havent done stomach absorption , per nicious anemia and celiac disease< --- what tests is this can you tell me about it more i will tell my GP

[pennyannie in reply to Kramyy]

Do you have an inflammation reading as well please ?

Your ferritin is very high and almost over the range - this could be caused by inflammation - hence the question above :

Your serum B12 is low - are you supplementing - needs to be a good 500 ++ -

Your folate is over range - if supplementing reduce down and aim for around 20 -

and we have no vitamin D reading :

You should follow your doctor instructions but imagine you will be put to 100 mcg T4 daily when the next set of blood tests are run.

Well I don't know that I can tell you more about the tests for pernicious anemia and celiac - other than they are other AI diseases that are commonly found in people who have an AI disease and need to be ruled out - as can affect stomach absorption issues :

Your dose of T4 is not excessive and would have thought if you were absorbing and utilising the Synthroid well your T3 and T4 would have been higher in the ranges :

Hope that helps a bit -and once you T4 starts building up in the range, hopefully your T3 will build into the range as it is too low a level of T3 for you that causes all the debilitating symptoms of hypothyroidism.

[Kramyy in reply to pennyannie]

By the way im doing OMAD (one meal a day fasting) I dont have CRP test for inflammation I will do it once i see my GP as well as Vit D . I dont take any supplementation for Folate, i only take vitamin c , apple cider vinegar and aged kyolicgarlic supplements. Any advise for vitamin b12 supplements? I dont have hx of celiac or pernicious anemia that im aware of..

[pennyannie in reply to Kramyy]

I don't think fasting is a good idea - the body needs a regular supply of healthy good nourishment in the form of protein rich and nutrient dense - food - cooked from scratch - and no processed foods -

Why are you taking ACV - is this for low stomach acid ?

What is the kyolicgarlic for ?

What do you mean when writing hx?

I don't know what supplements are available in NZ - use pure ' A 'grade quality individual supplements from a recognised and acknowledged good company -

[Kramyy in reply to pennyannie]

i have been in Omad for almost 3 years now. I dont think i can stop this i feel better when i maintain my weight. Now i am hypothyroid its hard to lose weight . I will get rid all of the supplements that i have left. Im planning to take vitamin b12, vitamin d and vitamin c supplements. Any supplements should i take? thanks for the respone pennyannie really apreacite it. God bless

[pennyannie in reply to Kramyy]

How much you need to supplement depends on the strength of the supplement you purchase - sorry I can't advise what I do not know -

though I think I've already detailed my aim to maintain levels - ferritin around 100 - folate around 20 - active B12 125 ( serum B12 500++ ) and vitamin D around 125.

[Tina_Maria]

The main reason why hypothyroid patients cannot lose weight is, if their thyroid hormones are too low. Especially T3, which is the active hormone, is responsible for our metabolism and regulates many processes in our body, such as glucose and lipid metabolism. If you do not have enough T3 available, your metabolism is slowed down and your liver cannot process glucose and cholesterol accordingly, and as a result these levels will rise and you will gain weight as these are stored in the body. I guess that your cholesterol levels are elevated as well.

This is not a dietary problem and reducing calories too much is counterproductive, as your body is already struggling. In addition, you need calories (carbohydrates) to convert the inactive T4 (levothyroxine) to the active T3. So I would definitely ask for an increase in levothyroxine, as your T4 and especially T3 are low.

Have you done an iron panel? As pennyannie has mentioned, you could have high ferritin but still be deficient in iron, as ferritin could be falsely elevated, if you have inflammation present in your body (measured as C-reactive protein or CRP). I would get that checked. Iron also helps with the conversion from T4 to T3, so good levels are important especially as your T3 levels are very low.

Many patients here supplement with a good Vitamin B complex, e.g. I take Igennus Super B complex, which is available on Amazon in the UK, perhaps in NZ as well? I would also advise you to check your Vitamin D level, as low Vitamin D can also impact on how well you can utilise your T4 from your medication. If your level of Vit D is low, you should also consider supplementing. Most people take at least 3000IU per day, but it needs to be taken with Vitamin K2 (MK-7) to direct your dietary calcium to the bones (combination supplements are available on Amazon as well). If you take this with a good Magnesium supplement (bioactive forms are mg-citrate, mg-taurate, mg glycinate or mg-maleate), it helps with the absorption of Vitamin D.

It can all be a bit overwhelming at the beginning, but once you are on the right track, you will see an improvement.

[Kramyy in reply to Tina_Maria]

Very well informative Tina Maria. Thanks heaps. I havent done the Iron Panel , and CRP I will do that together for my 8th week blood test when I get back to my GP. Yes im planning to take all the supplements as above. Its just taking too long to become euthyroid with these whole scenario. But still praying God willing everything will work out well.

[Tina_Maria in reply to Kramyy]

It can be a long process, so try to be patient and stay with it. Insist on testing your thyroid levels 6-8 weeks after an increase in medication, so you can adjust it upwards, if your levels are still low. It may also be that your TSH will go below the range when increasing your medication, but this should not be of concern, as really your FT4 and FT3 levels should be the guide for your treatment, as should your symptoms! I hope it all works out well for you.

[Kramyy in reply to Tina_Maria]

Would you think if My FT4 and FT3 would be on optimum range . Will these Tinnitus and lack of energy would god away? Tah

[Tina_Maria in reply to Kramyy]

An optimum range would be, when your symptoms improve considerably, but this is a very individual thing and we are all different, so it is difficult to say what would be an optimum level for you. In general, most people feel well when their T4 and T3 are at least 70% through the range (some may need higher levels) and the TSH is around 1 or below.

The lack of energy would definitely improve or even go away, if you have more thyroid hormones available, as your metabolism would be more active. I cannot comment on your tinnitus, as I have no experience, if that would help improving it. I'll keep my fingers crossed though! 🤞😉

[Kramyy in reply to Tina_Maria]

Thank you for taking time answering all my questions Tina_Maria. Good night its already past mid night here.

[Tina_Maria in reply to Kramyy]

No worries! 😉 Hope you sleep well!