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[Moog77]

Joziel ranges are as follows:

TSH 2.72 mIU/L (.27 - 4.2) 62.3%
Free T4 (fT4) 15.9 pmol/L (12 - 22) 39.0%
Free T3 (fT3) 3.4 pmol/L (3.1 - 6.8 ) 8.1%

On 100 of Levo they arent great and certainly enough to feel off. I tend to feel better at at TSH around 1 and with FT4 higher.

Funnily enough i tend to be quite erratic with eating too but its not deliberate Im just not very organised. I need to make sure I am eating 3 meals a day.It definitely makes me feel better.

[joziel]

So looking at those labs, your T3 is the most important active thyroid hormone. Your body should convert T4 into T3 (although some people convert better than others).

Your T4 (which comes from your levo you are taking) is only 15.9, which really isn't high in that range. You should be able to ask for an increase in your levo. That will give you higher T4 - which hopefully your body will convert to more T3. Your doctor should be very happy to increase your levo if you ask and point out that you still have symptoms and that your T4 is not that high in the range. (NICE guidelines say that if you still have symptoms you should be increased.)

If you try increasing the levo and your T4 goes higher but your T3 doesn't really change, you might need some T3 directly. That will be very hard to get on the NHS. But an increase in levo should be easy.

[Moog77]

I dont convert well and FT3 stays around 4.5 even on a higher levo dose - however that was pre HRT so maybe it might be different now I dont know. I started a small dose of T3 after those bloods but suspect it needs raised. I definitely need more levo though. Bloods taken today to see where I am at now but suspect FT4 might even have dropped lower.

I wish it was easy to get a levo bump but as long as I am in range then my GP is reluctant so probably need to go back private again for that (deep sigh).

[joziel]

I highly recommend Dr Momi at Functional Thyroid Care if you want to go private. He does online consults and is happy to prescribe T3. He does not go by TSH but by your other thyroid labs. And he's really nice and friendly and kind.

Levo is actually really cheap privately. I think about 3 months of levo costs me £19. T3 is more expensive.

[Wrensong]

Hi Joziel

I think intermittent fasting and erratic eating was causing my low thyroid function. I have fixed all this by eating consistently, 3 meals a day, loads of protein, loads of veg - and doing a reverse diet up to 2200 calories. (I had got stuck where I couldn't eat more than 1200 or less calories a day because my body had adapted to this low level of calories.) Anyway, I've fixed all that by gradually increasing my calories 100 every 2 weeks

I'm relieved to see you've turned a corner by increasing calories.  As we'd talked about the importance of getting enough calories for thyroid health on the thyroid issues thread (& probably on other threads) some time ago, the dieting history you mentioned there was why I was concerned about your trialling T3 with no evidence of thyroid disease (by which I mean from memory your antibodies were fine), but more what seemed a metabolic adaptation.  As you know, sometimes thyroid hormone production is reduced to protect the body in a perceived starvation state & I often worry that if women feel pressure to lose weight via extreme low calorie diets, they may be unaware of how this can skew thyroid levels & give a misleading picture.  I hope you're now on the right track & with support coming off thyroid meds, that you'll find your body reverts to producing adequate levels of thyroid hormones for you. This must have been a difficult situation for you & I think you deserve credit for turning it around. 

Sorry this has continued to go off topic, but sometimes it feels important to deal with a serious matter where it arises.
Wx

[joziel]

Thanks Wrensong. I haven't been trying to lose weight, I'm a normal BMI and happy there. But in the past, if I ate any more, I gained weight. So I was stuck eating about 1200 calories a day and didn't know how to get out of it.

I found this great podcast (which others might want to check out) called Metabolism and Menopause. It has details on how to do a reverse diet. With a reverse diet, you figure out your current maintenance amount of calories (what you can eat without gaining or losing weight) and then you eat that consistently every day. Then you increase by 100 calories every 2 weeks. It is such a small increase that your body doesn't 'notice' that you increased and you don't gain weight. (You might gain a small amount over the entire reverse diet but not much.)

So I've been doing that and I'm now up to 1800-1900 calories. I haven't gained any weight, in fact I lost 3lbs when I first started because I began a bit too low - my metabolism sped up as soon as I started to eat regularly and I didn't increase until I was due to... I only weigh myself once a week because it's just one metric.

I'm also doing strength workouts about 3-4x a week using the Caroline Girvan app (highly recommend) and I'm eating about 120-150g of protein a day.

When I fold my arms, my biceps surprise me. My glutes are now a little shelf.... So... even if I do gain weight, it is highly likely muscle now.

So the plan really is to increase like this up to 2200 calories - which is where I should be - and then to come off thyroid meds. Exactly how to do that (fast, slowly, T3 first and then T4 or both together) and whether I should temporarily cut calories whilst I do, I'm still figuring out...

With the thyroid meds, I do think that taking a very low amount of T3 only (15mcg) worked well for me and boosted my own T3 without suppressing my TSH. But my stupid doctor (who is supposed to be an online thyroid specialist - this is not Dr Momi, it was who I saw before him) freaked out because that low amount of T3 sent my T4 below range. So then she insisted I also take 50mcg T4 and convinced me that this was highly likely the cause of my insomnia and awful night time symptoms (that were destroying my life). So of course I took it. And that (along with the 15mcg T3) was enough to suppress my TSH and make me need a full replacement dose.

I just hope my own thyroid comes back online fine and that whatever this miracle is which is letting me eat so much every day continues, even when I am off thyroid meds.

[Moog77]

Joziel

I think I know the doctor you are referring to before you spoke to Dr Momi...I looked to go there a while back but just wasn't convinced by her at all so cancelled appt. T3 can absolutely reduce FT4 levels and how she didn't know this is concerning for an expert.

I have a private GP who offers prescribing service for a relatively inexpensive fee for a thyroid consultation so will revert back to her for more levo. She too doesn't really pay too much attention to TSH but the ft4 and ft3. Apparently if you are on thyroid meds and start HRT you will likely need an increase and I suspect that's what's happening with me. Definitely a levo bump and more than likely more t3.

I have Dr Momi in my back pocket should I not get a resolution with the private GP but she is refreshingly forward thinking and understands that TSH is not necessarily a good marker to gauge if you are sufficiently medicated. Really a bit of a find to consult with something who understands this.

[joziel]

That sounds good, having a supportive doctor is so important/essential.

Yes the doctor I was first seeing was a Dr C..... Her whole thing is thyroid stuff. But the thing about the thyroid is there are so many ways it can play up and manifest and sometimes doctors just know the main/core stuff about it all and not much about the more complex cases.

I'm trying to be positive about it all and getting off meds but it would have been much easier if my TSH hadn't been suppressed.

These were my results on no meds at all, with a quite low T3 and a high rT3:
TSH        1.37        (0.270-4.2)
free T3    3.9        (3.1-6.
free T4    18.6        (12-22)
rT3            32            (8-31)

Then just 15mcg of T3 did this - sent my T4 below range, but did not suppress TSH, boosted my T3 and got my rT3 right down:
TSH 1.15
free T3    4.3    (3.1-6.
free T4    9.7    (12-22)
Total T4    54    (59-154)
rT3            15    (8-31)

Then she made me add in 50mcg T4 and boom...
TSH        0.026    (0.270-4.2)
free T3    5.1         (3.1-6.
free T4    13.8        (12-22)
rT3            20            (8-31)

After that, I ended up increasing the T3 because I still had the night time symptoms (which were never anything to do with thyroid, but were hormone related) and my metabolism was really slow (because I wasn't eating consistently and enough - but I thought that could be caused by thyroid). So I'm now on 45mcg T3 along with the 50mcg T4.

I have to figure out how to best get off now.

[Moog77]

Yes Dr C.

I'm quite shocked you were given any thyroid meds with those initial numbers. I personally don't hold much weight in RT3 myself - just my opinion! - it may have been wiser for Dr to ask you to retest in 3 months time but I totally understand that if you are feeling awful then you are desperate for any possible resolution - it can feel quite lonely.

I think if there is no underlying thyroid condition you should bounce back. I guess it's the in-between part now to stopping the meds and best way to do it.

It's weird the t3 didn't suppress your TSH but T4 did.....but everyone's different and when you throw HRT in there well it can get very complicated. I absolutely need more levo and wish I'd pushed for that instead of jumping on the option to get T3. Sometimes - and I'm being a wee bit cynical perhaps - I wonder if it's the better money spinner. That's maybe a bit cruel but I'm so fed up just now I'm viewing everything quite negatively.

What I do know is when I was 3 pumps of green oestrogel and 100 levo last summer I felt great and I suspect all the faffing I have done - with gel to patch due to the outrageous gel bottle issues and now on to sandrena - hasn't helped but I've now been on HRT long enough for Thyroid meds to be affected. So hopefully a levo increase is the answer. I'm not sure I even need T3 but will see.

Hope you get the answers for reducing meds. It sounds like you don't need them after all. Hormones are such a pain. I'm finding this out with testosterone just now as well. It helps so many but for me personally have found it makes me really poorly.

[joziel]

Yes, I know. My initial thyroid numbers just showed a conversion issue. This was probably caused by my very erratic eating and crap diet. The clue here is that I actually did a test about 3 months before that first test, so also not on any meds, which was:

TSH 3.16
free T3 4.92 (3.1-6.
free T4 16 (12-22)

This test was done during a very strange week when I was on holiday with my partner. Because we were on holiday, I was eating regularly. We were still in the UK, so at the end of the week, I did the bloods and posted them to Medichecks. The interesting thing is my T3 is much higher. rT3 wasn't tested. But I think the thing to focus on, is getting T3 up and rT3 will look after itself. If T3 is high/decent, rT3 is not likely to be high or to be causing problems. My TSH is on the high side but it looks like my body was demanding more thyroid hormones and my T3 had gone up accordingly.

Despite also having this test, I was still prescribed T3. I don't mind being prescribed the micro top up dose of 15mcg - but suppressing my TSH and giving me the 50mcg of T4 was just wrong. She was so convinced this was the cause of my night time symptoms. I haven't been back to her since, I lost all faith and switched to Dr Momi.

I was already on HRT before all this but I have increased doses a lot whilst being on thyroid meds (of HRT).

[Moog77]

The impact of HRT on thyroid meds is really important and I'd bet my house that my GP would not be aware of it if I was to see her.

I find that quite scary. How many are struggling because of this?

Such a balancing act.