latest test results - I'd welcome some observations, thanks :-)

[Caradoc1a]

I've just had these through today.

I increased Levo 50% from 25mcg - 37.5mcg at the end of Dec 24 but my FT4 is still the same. I also take 20mcg T3 per day.

Should increase the Levothyroxine to 50mcg per day and then retest. Or does it matter given that my FT3 is 70% through the range, which it is meant to be. Would increasing the Levo T4 lead to inflated T3 and pose concerns regarding my osteoporosis?

4 days ago I began 50mcg Levo and 37.5mcg every other day, aiming to get to 50mcg each day in about 3 week's time. I was hoping to speak with Endo soon but I've just been informed that follow up appointments in endocrinology are 56 weeks behind!! Nightmare.

I'm still cold and got painful ankles and backs of calves. Also got the rash back!! Could be shingles again or allergy (to smoked paprika) and mast cells going bonkers due to B12 healing.

All tests done as per protocols specified on here.

Serum free T3 level 5.6 pmol/L (3.1 - 6.8)

Serum free T4 level Low 7.3 pmol/L (11.0 - 22.0)

Serum TSH level 1.47 mu/L (0.30 - 4.20)

25-OH Vitamin D 103.0 nmol/L (50.0 - )

Serum vitamin B12 High >2000 ng/L (180 - 640) ( I self inject B12)

Serum folate 17.4 ug/L (3.0 - 20.0)

Serum iron level 20.5 umol/L (5.0 - 30.0)

Serum transferrin 2.54 g/L (1.73 - 3.60)

Serum TIBC 63.8 umol/L (47.0 - 70.0)

Transferrin saturation index 32.1 % (16.0 - 50.0)

Serum ferritin 102 ug/L (28 - 200)

Previous tests November 24:

Serum free T3 level 3.9 pmol/L (3.1 - 6.8)

Serum free T4 level Low 7.2 pmol/L (11.0 - 22.0)

Serum TSH level High 4.53 mu/L (0.30 - 4.20)

Serum ferritin 123 ug/L (28 - 200)

Serum vitamin B12 334 ng/L (180 - 640)

Serum folate 9.3 ug/L (3.0 - 20.0)

Sodium 137 mmol/L (133 - 146)

Serum Potassium 3.9 mmol/L (3.5 - 5.3)

Urea 5.5 mmol/L (2.5 - 7.8)

Creatinine 67 umol/L (45 - 90)

eGFR/1.73m*2 81 ml/min (60 - )

AKI warning stage NA ( - )

Serum cortisol 391 nmol/L ( - )

[GlowCoach Administrator]

FT4 is below range which isnt surprising since you're on such a low dose of Levo. Most people need int he region of 100-125mcgs Levo on a combination dose.

You may well need to drop T3 a little to be able to raise FT4. Not many people need 20mcgs T3.

Suggest that over time you drop 5mcgs T3 and then add in another 25mcgs Levo.

Vitamins are looking good.

[Caradoc1a in reply to GlowCoach]

Thanks Glowcoach💐💐This is the reply from my Endo via his secretary:"He has said that your thyroid levels are stable and even though your T4 is below the normal reference range, your TSH is within range which is the most important. Your T3 is also within normal range. You medication is currently doing its job and he recommends that you stay on your current dose."

I'm frustrated by his response. 🙄

There is 56 week wait for an actual follow up appointment!!

Various questions spring to mind.

Is it OK to have low T4 - I know some people on this forum only have T3 supplements? (I don't have a functional thyroid due to RAI 12 months ago)

What brand of T3 comes in splittable tablets? I have only have capsules with powder inside.

The past week I have upped my T4 to 50mcg/37.5mcg alternate days. I think my tinnitus is lower and my ankles/calves are less swollen and painful. But I worried about too much T3 as I have osteoporosis. Is this something to be concerned about?

Thank you!!

[GlowCoach Administrator in reply to Caradoc1a]

You have an Endo thats treating you by TSH which isnt going to work. Suggest you find a new one or go privately if you want to be well.

You can email [e-mail] for a list of T3 friendly Endo's. Pick a few and post asking for feedback on them.

Alternatively you could try Roseway prescribing service or self source.

You dont need to worry about osteoporosis. Thats a myth. thyroiduk.org/further-readi...

[Caradoc1a in reply to GlowCoach]

Thank you!!

[Tina_Maria]

What was your actual levothyroxine dose before starting T3? And how do you currently feel? Do you have symptoms?

We seem to see it quite a lot that endocrinologists slash the dose of levothyroxine quite low and prescribe a quite high dose of T3. I think the more scientific and logical thing to do would be reduce the levothyroxine gradually and then slowly introduce the T3 and titrate up.

There are of course people who do not tolerate T4, so they end up on T3 only, but many patients find that they need some T4 in the mix. Your T4 is quite low and some people would be symptomatic with that. Given that you felt better when you increased your levothyroxine, this suggests that you do need more T4 in the mix.

If you see that the T3 is going too high or you are getting symptoms, you can always reduce your T3 accordingly, but as you are probably taking T3 because your conversion is not good, your T3 might actually not go up by that much through your intake of T4 - I would keep an eye on your numbers and test privately so you can see any changes. It seems that your endocrinologist is not of much use, as first of all dosing by TSH is a nonsense (especially when taking T3) and he should have questioned the low T4.

[Caradoc1a in reply to Tina_Maria]

I was given T3 20mcg in May 24 alongside T4 25mcg after I had adverse reaction to 100 and 50 mcg T4. (Ischaemic irregularity) Before that I was hyperthyroid then had RAI. It seems that I convert T4 to T3 well as the 50% T4 increase (25 - 37.5) only led to T4 increasing from 7.2 to 7.3.

My hypo symptoms seem to have improved this past week on 50/37.5 on alternate days. Dry eyes gone, hangover feelings in the morning gone, plantar fasciitis and lower calf pain reduced, less cold.

Talking it out yesterday with my partner I decided to continue 50/37.5 for 8 weeks and retest. Have GP appointment next week and will discuss this. She may not react positively as she's already fed up with me as I self inject B12. (Another story!!) I'll ask for splittable T3 tablets. Any ideas which brands? I might do a different post about this.

Thanks for your help!!

[Tina_Maria]

Is that correct that you were originally on 100 mcg T4, then 50mcg T4 and your T3 was kept at 25mcg?

This seems very odd to me, a 75mcg T4 drop in a fairly short period of time is an awful lot and would very much overshoot where you probably need to be. I believe that when you were on 50mcg T4 you were probably already showing signs of under-replacement, which can actually be mistaken for over-replacement, as they appear quite similar, and reducing further most likely exacerbated the symptoms.

If you have started improving on the 50/37.5, that is a good sign, but keep an eye on your levels and you might need to increase again, as this is still a very low dose and won't likely raise your low T4 by much. But in any case, it is good to go slow so your body can better adapt.

I am afraid I am not familiar with T3 brands, as I am on levothyroxine only, but will tag Regenallotment and SlowDragon which might be able to advise you on T3 brands that have tablets that can be split.

[Caradoc1a in reply to Tina_Maria]

It was all very sudden. I had a massive hypo episode on a walk, almost collapsed, about 4 months after RAI. Felt fine when I set out walking. That's when I got given 100mcg and ambulance took me to A&E the first day of taking it with suspected heart attack. Was told to not take any more for a week and then try 50mcg. But I experienced chest pain so stopped. Then given 25mcg with 20mcg T3. All this took place in about 6 weeks.

[Tina_Maria in reply to Caradoc1a]

OMG. Did they not monitor your thyroid levels after your RAI?? I would have thought that this is a given and that you would be prescribed medication since probably most of your thyroid was destroyed? Your levels were probably very low, hence you had such a bad reaction to the 100mcg levothyroxine - which is a massive amount when you have been deprived of it for some time.

I hope you can tolerate your current regimen a bit better. Still, I would be vigilant though and test after 6-8 weeks and then increase again. It might take you a while to get you to your replacement level, as you go up in small steps, but perhaps once your vitamins and minerals are improved you might be able to tolerate a bigger increase? It will take a while probably to get sorted, but don't despair, you are on the right track now and already seeing some improvements. And be kind to yourself, we can often get a bit impatient with ourselves when things are not as they should be, but small steps add up to a big one over time as well! Good luck 😉

[Caradoc1a in reply to Tina_Maria]

Thank you. I've worked hard at increasing vits and minerals as I had no idea that the RAI would deplete them. It's all ongoing!!

[SlowDragon Administrator]

T3 options on NHS

20mcg tablets - can be cut into 1/4’s with sharp scalpel

10mcg tablets and 5mcg tablets much more expensive

Prices NHS pays here

healthunlocked.com/thyroidu...

20mcg tablets

Teva - lactose free

Morningside available as 20mcg, 10mcg or 5mcg

[Caradoc1a]

Thank you. I'm on Roma × 10mcg capsules at the moment.