Blood Testing Protocol

[FancyPants54]

I take 60mg (1 grain) of Armour Thyroid at 8am with either 37.5 or 50mg of Levo. I take 50mcg Levo 3 days a week. I take a further 60mg of Armour Thyroid at 5pm.

I want to do a blood test that will show me (not a doctor) what my common levels are during the day. I'm not trying to preserve a dose or get an increase. I want to know what I'm like for a big part of the day. Because right now something is not right and I don't know if it's too much or too little.

Any suggestions as to the best protocol to find out if I need an increase or a bit of a decrease? Normally I take my bloods 13-15 hours after my second dose of Armour, timed so that I'm drawing the blood around 8.15am.

I am so sad and tired and miserable. But I've had my beta blocker doubled to reduce my fast AF recently and so I can't just wallop my thyroid meds up as it always increases my heart rate.

[Regenallotment Ambassador]

The ideal with blood test and dose timing is to aim for consistency, so I’d suggest keep doing the same as you were before , as this gives you something to compare to.

If you wanted to try a new technique/protocol you would need to start and then repeat to know more. So less helpful short term. 🌱

[FancyPants54 in reply to Regenallotment]

Good thinking. That makes a lot of sense. I think I just need to assume my FT3 results will be a bit on the low side to what's actually going on.

[SlowDragon Administrator]

I would test at as previously ….around 8am before taking morning dose Levo and NDT

Are you also testing vitamin levels

What vitamin supplements are you taking

Which beta blocker are you taking

[FancyPants54 in reply to SlowDragon]

I'm not doing vitamins this time. I do those twice a year for my private endo visit. This is an interim test of thyroid only. I take Nebivolol beta blocker.

[tattybogle]

Hiya fancypants , sorry to hear you're having a tough time .

this is how i would think about it , however it's a bit erm ...unconventional :

if you wanted to get an idea of the peak levels that fT4 and fT3 briefly get to in the blood , i'd test about 3 hrs after morning dose NDT and 50 levo.. ie. 11am ish. (but remember this would show TSH toward it's lowest,

if you wanted to know the lowest that fT4 and fT3 are ever getting , you'd test as you currently do .

if you wanted to get an idea of mid/ average level for fT4 / fT3 , i'd take morning NDT + levo and test maybe 3pm - 4pm (before pm dose) ~ and as above , TSH would still be around it's lowest

if you wanted to see an "8 .30 am TSH" with "mid / average fT4 /fT3 levels" on same test ~ you'd have to take a grain of NDT and some levo about midnight and test 8.30am .

[FancyPants54 in reply to tattybogle]

Different. And food for thought. I will review this in the morning as it's bedtime now.

[mistydog in reply to FancyPants54]

Bear in mind that TSH fluctuates throughout the day naturally.

[FancyPants54 in reply to mistydog]

I don't really bother with TSH. It's the FT3 and FT4 I'm most interested in because I don't do well with low T4 but I need not to go over with the T3 either. It's hard doing this with permanent atrial fibrillation.

[FancyPants54 in reply to tattybogle]

I have been thinking about this hard and I think I'm going to have a go at one of your ideas. Normally I'm very consistent with testing. I don't get consistent results mind you! But I take the test meticulously so that I can always compare them.

However, right now I start falling into micro sleeps around 11-11:30 am every day and that carries on for a couple of hours. Later on in the day it happens again. I want to know what the hormones are doing when that happens. So I'm going to go for peak levels testing around 11-11:30am after taking my 1 grain Armour and (tomorrow will be 50mcg) Levo at 8am as usual. TSH is not a good indicator for me ever, so I don't need to worry about that. I need to see if my hormones are peaking and then converting into something inert because the dose is too concentrated for me.

I'm hoping I can make sense of the results! Thank you for the ideas.

[FancyPants54 in reply to FancyPants54]

tattybogle I should also have said that on Levo alone my maximum dose as 125mcg a day. I didn't like going over that. Yet now my daily dose is:

T4 - 113.5/126mcg plus

T3 - 18mcg

That's a lot more equivalent hormone to be feeling so exhausted. Looking back at my notes, the extreme tiredness became more noticable when I pushed up to 50mcg a day of Levo for 3 days a week. It may have been starting before that, but that was the more noticeable start.

God this is so hard. I seem to be very sensitive.

[tattybogle in reply to FancyPants54]

yes it's very hard i agree , i'm not having much fun trying to get doses right . just had flu or something nasty for last 3 wks , only just starting to feel human again which hasn't helped with knowing what to do with levo / T3 doses . I'm taking less levo now (87.5mcg + 8mcg T3, used to be on 112.5mcg levo only) , but am deliberately trying to keep T4 as low as possible and use T3 to make up for it cos i'm still dealing with BCC (fairly innocuous form of skin cancer) on my eyelid and T4 looks like it 's capable of encouraging it to grow. I'm not enjoying my T3 use so far tbh, no significant improvements , well , my tongue looks much healthier i suppose , but i was hoping for more stable levels of stamina/ energy ... so far i've just got more ups and downs .....but will carry on trying cos i'm now more bothered about having a top end T4 than i used to be .

But if i lower levo too much like i did when i started T3. (i lowered it to 75mcg) i feel really weird/ hollow/ unstable . and yet i only seem to tolerate a very small amount of T3 before it give me feelings of 'brain going too fast'

"work in progress" very much applies .

i really struggle with the lack of daylight from nov -feb . i would like to move to the west coast of scotland , but i daren't cos i think i'd really struggle with more weeks of low light, i can 'just about' handle it where i am.

[FancyPants54 in reply to tattybogle]

T3 on it's own with Levo sounds like it acts for me the way it's acting for you. Speeds things up too fast and wears off too soon. Up and down like a yo-yo. The T3 in NDT doesn't behave like that at all. It's even.

I suspect I may just be taking too much of it all now and my body it converting it to something inert. The trouble is it really does take many, many weeks to creep up on me when things are going wrong. This tiredness I've been putting down to the stressful time I had in November/December. But perhaps it wasn't that. I usually sleep well. But I'm not at the moment. It's taking too long to go to sleep and I'm waking up tired. I'm not reading. I love reading, but it's taking me weeks to finish a book. My legs and feet are terribly painful and walking is almost impossible. But it's all crept up on me slowly. I might order in another test kit and repeat a test next week looking for the mid/average levels of the day just before the second dose. Those 2 sets of results would give me a very different picture to what I usually test on. But will I understand what's happening any more than I do now? Who knows!

I'm sorry you are struggling too. You are so experienced with it and have had to fight it for so long. It's really not fair that no one is doing sensible, well funded, research into our issues and trying to help us properly. It's wall after wall and expense after expense for us.

[tattybogle in reply to FancyPants54]

yes ,i reckon it's possible you might be on a bit too much overall , after you've tested maybe lower levo a bit for a few wks and see if it feels better or worse ~ i found not sleeping well and painful tight legs/ feet , and exhaustion were present ( amongst other things) when overmedication on levo gradually crept upon me.

all this testing and theory is one thing , but at the end of the day ,even if we had access to hourly testing of T4/T34 levels in the blood, it would still come down to 'suckit-and-see' cos we're all different and none of us know what T4/T3 levels our body was happiest with when it was in charge of things .

if in doubt whether symptoms are due to slightly undermedicated? / slightly over medicated?, to me it usually seems wisest to try 'down a bit' first.

[Wua13262348 in reply to FancyPants54]

Could your micro sleeps be a reaction to food you have eaten before the urge to sleep? I am intolerant to eggs and cows milk. Before I discovered this via a food intolerance test, a 3 egg omelette with a dash of milk acted like a sleeping tablet! I would fall asleep immediately after eating it, and really had no choice in the matter.

[FancyPants54 in reply to Wua13262348]

No. That is not it.

[Wua13262348]

You mention feeling "so sad and tired and miserable". Could SAD (seasonally affected disorder) be playing a part i how you currently feel?

Sleep cycle and melatonin are part of trying to achieve optimal thyroid -wise. In this I fail miserably, as I am a life long night owl (even when I was healthy), and have never been a morning lark. I am attempting , currently, to tackle this. I don't know if you have problems with your sleep/wake cycle or not.

I have just purchased a Lumie sunset/sunrise alarm to wake up to light. You can read the blurb on what features it has re. light, sounds etc. Possibly the light aspects of the product might have an effect on your mood.

I am now religiously using "Luminettes" which Jaydee mentioned on the forum a few years back to get light exposure on rising. Again , this is light therapy for SAD and sleep/wake cycle.

A forum member recently mentioned "grounding bedlinen" which has silver threads woven through it to ground you. I have purchased some , but not yet tried it out.

None of these suggestions involve medication. They may not be approaches that appeal to you, and you may already have a perfect sleep/wake cycle etc. , but I thought I would mention them in case you felt they could benefit you in any way.

[FancyPants54 in reply to Wua13262348]

I do suffer fom SAD and have a light therapy lamp on my desk. I forget to put it on. I can't use a light alarm clock thing, my husband would hate it.

We are both night owls and I always have been. I get up earlier in summer. I hate the lack of daylight at this time of year. It certainly doesn't help but I've been struggling with it for decades so that doesn't explain why I feel worse right now.