Menopause Discussion > Other Health Discussion
Thyroid issues & support
Wrensong:
Helly, thanks so much for coming back with the detail, that's so helpful :). I hate to ask you for more, but if not too much trouble could you please give the dates & ref ranges for both the recent TFTs & sex hormone tests you've given results for, so we can see them in relation to each other & how they relate to the increase in Lenzetto?
I have to rush out now but will try to come back to you later. A lot to think about after just an initial scan of your post, so I'll need to give more thought when more time, but initial thoughts . . .
1) Is 53 your oestradiol level on 3 pumps of Lenzetto? If so it is very low, so you are not getting much from it in the way of oestrogen replacement. Sorry if I have missed something here - in a rush!
2) Yes, maybe the continuous release of an oestradiol patch would suit you better & importantly give you better absorption. Lenzetto has come to be regarded as quite a weak method in terms of uptake of oestradiol for some women, but as always with HRT response varies.
3) if you are taking your 5mcg Liothyronine first thing in one dose as I do, the worsening in some of your symptoms later in the day (e.g. exhaustion, low mood) could be due to its effects wearing off to some extent; as you'll know it has a short half life & I notice a difference mid-afternoon. Are you prescribed the 5mcg tablets that you could halve to take in 2 doses, or are you already having to split higher dose tabs to get the 5mcg dose?
That said your last TSH (if 0.03), is suppressed, suggesting you are getting ample thyroid replacement overall & perhaps a little too much, which can also cause a sense of burn out, though the 12-ish T4 that you give with that is not high.
Sorry - another question: when were both TFTs done in relation to that day's dose of thyroid medication i.e. do you defer your day's dose until after the blood's drawn for TFT?
Sorry to ask for more. Will try to come back to you later.
Wx
Helly1977:
Hi Wrensong, thank you for taking the time to work this through. Bloods and ref ranges below.
3rd December.
TSH 0.03, RR 0.35-4.94
t4 14.9,RR 9-19
t3 5.68,RR 2.6-5.97
progesterone 0.4, RR not given
oestrogen 53 RR not given
testosterone 2.98 RR 0.5-1.7
24th feb
TSH 0.03
T4 12.6
Increased to 3rd spray 10th feb
T3 started oct ( sorry it’s actually 10mcg/half 20mcg tab) endo said I could try the other half tab at lunch but to be honest, I did t want to mess about too much!
Bloods taken lunchtime and meds taken early in the morning, 6-6:30am
CLKD:
:bouncing: for New Members
Wrensong:
Hi Helly, thanks for the additional detail which is very helpful :).
Because your TFTs were carried out within a few hours of your having taken your morning thyroid meds that recent influx of hormones will be reflected to some extent in the results, making it more difficult to get an idea of your background thyroid status. For this reason many Endocrinologists, mine included, like patients to defer that day's dose until after testing. I realise this may not be practical if you are working & need to fit a TFT into your lunch hour, especially given the advice to avoid taking thyroid meds close to any mealtime means you would possibly have to go to work without breakfast in order to attend at early morning TFT. If your Endocrinologist has advised to test after that day's dose, then obviously follow his/her advice.
Bearing in mind the likely influence of that day's dose on the results making them more difficult to interpret, it does nevertheless look from both tests as though your thyroid replacement dose may be a little high, as your TSH @ 0.03 is suppressed, below bottom ref range.
Your FT4 in both tests is not high, but your FT3 was towards top of ref range in the Dec test, so it may be that the 10mcg dose of T3 is too much for you, taking your TSH right down.
The
--- Quote ---disturbed sleep, Waves of complete exhaustion . . . Excessive worrying . . . Poor concentration . . . Irritability
--- End quote ---
could be signs of too much thyroid replacement but they are also aspects of menopause for many of us. I would certainly not feel well with a TSH as low as 0.03, but we are all different, you are younger than me & at your age I did need my TSH to be somewhat lower than is optimal for me now. That said, we are usually advised not to remain on a dose that gives a suppressed TSH for any length of time as this can be detrimental to heart, bones etc in the long term.
Though most of the symptoms you list in your earlier post are not classic for over-treatment, if you have a fast pulse rate, feel too hot much of the time, pass high volumes of urine, have overly fast gut transit (possibly loose bowels, or even dehydrated stools if you are peeing excessively), racing thoughts, anxiety, unreasonable hunger, weight loss/inability to gain weight, I think it would be sensible to talk to your GP or Endocrinologist about having 5mcg T3 tablets prescribed instead of your 20mcg tabs & possibly reducing your current 10mcg T3 dose to 5 or 7.5mcg daily. If you were to reduce to 7.5mcg, you could take the 2.5mcg in the afternoon, to reduce potential for adverse effects on your sleep.
If you don't feel you are over-treated, an alternative is to discuss with your Endocrinologist or GP possibly splitting your T3 into 2 x 5mcg doses, one first thing & one mid-afternoon - not too late in the day as again that could make it difficult to get to sleep.
The irritability could be due to too much thyroid hormone, but perhaps more likely too much testosterone & this would tie in with your 2.98 Dec result being quite a bit above top of ref range. You may need to reduce your Tostran dose/dosing frequency, or ask to change to a weaker formulation such as Testogel. If you have a look at this link from the British Menopause Socy they recommend using Tostran only on alternate days:-
https://thebms.org.uk/wp-content/uploads/2022/12/08-BMS-TfC-Testosterone-replacement-in-menopause-DEC2022-A.pdf
As you've not had oestradiol tested since increasing to 3 sprays of Lenzetto, you won't know how well you are absorbing that until your next oestradiol test. Can I ask how many sprays of Lenzetto you were on when your oestradiol tested at 53 & how long you'd been on that dose? You say you started HRT in June last year but I think not whether that was on 1 or 2 pumps of Lenzetto. Please don't worry if it's a pain to post that info, but in the absence of a recent oestradiol test it would give us an idea of how the Lenzetto might be performing now you've been on 3 pumps for a while. As I mentioned earlier 53 is pretty low on replacement oestradiol & it's unlikely you will feel the benefits of HRT until your level is considerably higher.
Sorry this is a long reply but I hope something in it might help.
Wx
Wrensong:
Hi Helly1977, just wondering how you are & whether anything in my posts made any sense in relation to your situation. If you're reading, please let us know at some point how things are.
Wx
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