First lab results after returning to T4 mono therapy. Comments and suggestions welcome.

[Koola]

On 18 December 23, after two and a half years on T4 / T3 dual therapy, my lab results were:

TSH: 0.604 mU/l (Range 0.2 - 5) 8.42%

FT3: 3.04 pmol/l (Range 1.8 - 4.5) 45.93%

FT4: 12.7 pmol/l (Range 7 - 20) 43.85%

I had been on 75 T4 and 10 T3 for six weeks (and 88 /6 or 12 for months before.)

I stopped T3 and took 88/91 for ten weeks. On 29 February 24, my lab results were:

TSH: 1.319 mU/l (Range 0.2 - 5) 23.31%

FT3: 3.14 pmol/l (Range 1.8 - 4.5) 49.63%

FT4: 12.4 pmol/l (Range 7 - 20) 41.54%

They are very similar to labs I had before T3/ T4 combo. Except for TSH that used to be somewhat higher, ft3 & ft4 were always around 40 / 50 percent.

First question: why did FT3 go up after stopping T3?

Background: The reason I returned to T4 only is because I was feeling much better on it two and a half years ago.

(This is my second trial. The first time I stopped T3, I took more T4, 100, mcg and felt so rotten I had to stop after 10 days. This time, I upped by 12mcg, 88 T4, and felt better for about three weeks. But then the usual sh... hit the fan .)

In previous T4 only days, with a low TSH I would've reduced T4 dosage by 12 mcg. So, now, theoretically I should take 75 instead of 88.

I used to do well with 40/50 percent ft3/ft4.

I want to add that on combo, I often had results deemed very good -- i.e. ft3 & ft4 up in 70% and 60% and very low TSH -- because many have found their sweet spot with these results, unfortunately I felt terrible and got worse.

Meanwhile, I learned from wise folk on the forum that we have individual, tailor-made ideal percentages, and no one size or lab-result fits all.

Recap questions: should I take less T4, 75 instead of 88?

Wondering why FT3 is higher now than when I was taking T3. And why FT4 doesn’t seem to change much. And… why, among a billion and a half other symptoms, do I feel so d... exhausted!

Again, will be grateful for all comments and suggestions.

Thanks in advance. 🙂

[SlowDragon Administrator]

What are your vitamin levels like

You look like you need dose INCREASE in levothyroxine

[Koola in reply to SlowDragon]

All good.

Thank you for replying.

[J972 in reply to Koola]

It *is* intriguing how your FT3 has increased after stopping T3. Be interesting to see what the wisest of sages think about that.

[Teddyandolive]

No expert here Koola but, with ongoing struggles myself, the way I understand it is - introducing T3 lowers TSH which down-regulates conversion of T4 to T3. The lowered conversion rate has the potential, paradoxically, to result in a lower overall FT3 despite the introduction of liothyronine.

[Koola in reply to Teddyandolive]

Hi Teddyandolive,

I’m starting to think that we each convert individually, as well…?

Six weeks after starting on Combo, my results were:

7. July 2021

TSH: 5.36 mU/l (Range 0.2 - 5) 107.50%

FT3: 2.77 pmol/l (Range 1.8 - 4.5) 35.93%

FT4: 9.33 pmol/l (Range 7 - 20) 17.92%

(My previous TSH on T4 only was also elevated.)

But after four months of T3 12 mcg, here were the results:

8.October 21

TSH: 0.80 pmol/l (Range 0.2 - 5) 12.50%

FT3: 5.64 pmol/l (Range 1.8 - 4.5) 142.22%

FT4: 9.42 pmol/l (Range 7 - 20) 18.62%

I reduced T3 to 6 mcg,

Eventually, FT3 and FT4 evened out, first to 40 and 50 % then higher etc.

Hope I didn’t overload you with info. I know that our ailments are not as interesting to others as they are to ourselves, lol. I’m just glad because for two days I couldn’t find my file with carefully recorded labs “before and after combo”, so I have to put it to use!

[Minimol]

Hi Koola, for me 6 weeks isn’t quite long to reflect what’s going on. I need something closer to 3 months to know what I’m feeling. I also wonder if either FT3 or FT4 were ever high enough to help you feel good (not just OK)? And when you say FT3 went up when you dropped T3 it looks a rather negligible difference to me.

[Koola in reply to Minimol]

Hi Minimol,

I suppose the 6 weeks you’re referring to was back in summer 2021. I usually wait longer except when my whole body & mind are hollering at me This ain’t working! Lol. In summer 2021 I was not okay let alone good, but not as bad as now, and also curious about how FT3 looked like on paper,

As I mentioned in first part of my posts, I’ve had high FT3 & FT4 in 60s and 70% but whatever FT3/ FT4, or TSH levels have been and are now, I ‘m going from “worse to worser”.

You’re right that the difference is small but according to “all the books”, after quitting T3 for 10 weeks, it should’ve gone down not up.

Theory only seems to be helpful up to a certain point, since we don’t know what our natural or healthy levels were before we got ill, and we all had different ones,

[Buddy195 Administrator]

Your results look like you would benefit from an increase in Levo Koola. I think I would add 12.5mcg per day. I’d also recommend you wait full 8 weeks on a consistent dose before retesting levels, as I’ve found that retesting at 6 weeks is too early for me; seems to take a couple more weeks for my system to adjust!

What is smallest dose of Liothyronine you have tried? Some people benefit from adding just 5mcg to their Levothyroxine dose. Maybe one to consider if trial of slight increase in Levo doesn’t alleviate adverse symptoms.