Hashimoto's

[Jolene1984]

I have Hashimoto's, I take 125mcg levo and 5mcg T3 twice daily. My endo has asked me to increase my levo dose to 150mcg and keep the T3 at the same dose. I am wondering why my endo is not increasing the T3 because to me the T3 dose seems low compared to the levo one.

My symptoms are:

Difficulty swallowing - treated with proton pumo inhibitor lansoprazole
Tiredness
Weak legs
Constipation
Heavy periods
Irregular period
Joint pains
Hair loss
Eyebrow loss
Eyelash loss
Loss of sweating
Low blood sugar
Dry skin
Cold intolerance

My endo is saying that although my latest results are in range they could be better. She is aiming for a TSH <2 and free T4 and free T3 in the upper thirds of normal range. Is she correct and is she doing the right thing in increasing the levo and not the T3? I am very confused. Thank you in advance. :)

May 2016 (125mcg levo and 10mcg T3)
Serum TSH - 3.2 (0.2 - 4.2)
Serum free T4 - 13.9 (12 - 22)
Serum free T3 - 4.2 (3.1 - 6.8)

March 2016 (100mcg levo and 10mcg T3)
Serum TSH - 6.4 (0.2 - 4.2)
Serum free T4 - 12.8 (12 - 22)
Serum free T3 - 4.9 (3.1 - 6.8)

January 2016 (75mcg levo and 10mcg T3)
Serum TSH - 0.07 (0.2 - 4.2)
Serum free T4 - 22.6 (12 - 22)
Serum free T3 - 5.4 (3.1 - 6.8)

November 2015 (175mcg levo and 10mcg T3)
Serum TSH - <0.02 (0.2 - 4.2)
Serum free T4 - 20.8 (12 - 22)
Serum free T3 - 5.6 (3.1 - 6.8)

October 2015 (175mcg levo and 10mcg T3)
Serum TSH - <0.02 (0.2 - 4.2)
Serum free T4 - 20.6 (12 - 22)
Serum free T3 - 5.2 (3.1 - 6.8)

August 2015 (150mcg levo)
Serum TSH - 1.25 (0.2 - 4.2)
Serum free T4 - 19.3 (12 - 22)
Serum free T3 - 4.2 (3.1 - 6.8)

May 2015 (125mcg levo)
Serum TSH - 5.31 (0.2 - 4.2)
Serum free T4 - 13.4 (12 - 22)
Serum free T3 - 4.3 (3.1 - 6.8)
Thyroid peroxidase antibodies - 235 (<34)
Thyroglobulin antibodies - 269.3 (<115)

March 2015 (100mcg levo)
Serum TSH - 3.6 (0.2 - 4.2)
Serum free T4 - 13.8 (12 - 22)
Serum free T3 - 4.3 (3.1 - 6.8)

November 2014 (75mcg levo)
Serum TSH - 7.10 (0.2 - 4.2)
Serum free T4 - 14.9 (12 - 22)
Serum free T3 - 4.1 (3.1 - 6.8)

September 2014 (50mcg Levo)
Serum TSH - 2.86 (0.2 - 4.2)
Serum free T4 - 15.7 (12 - 22)
Serum free T3 - 4.6 (3.1 - 6.8)
Thyroid peroxidase antibodies - 161 (<34)

June 2014 (25mcg levo)
Serum TSH - 6.01 (0.2 - 4.2)
Serum free T4 - 19.2 (12 - 22)
Serum free T3 - 6.2 (3.1 - 6.8)

April 2014 (when I was diagnosed)
Serum TSH - 31 (0.2 - 4.2)
Serum free T4 - 10.3 (12 - 22)

[gimel]

If the 3000 IU dose of D3 resulted in a D level of 73, then that dose should be reduced.  I don't know if 800 IU is adequate.  You need to re-test and find out.

B12 should be in the upper end of the range, so there was no need to stop supplementing.  Your ferritin level may well have been high due to the intravenous iron.  That effect should have diminished by now, so I suggest that you should test and find out what it is now and see if daily iron supplements are required.  

[Jolene1984]

Thanks Gimel, will do this. :)

[gimel]

I agree with your assessment.  Free T3 is used by every cell in your body.  Also, Free T3 correlates best with hypo symptoms, while Free T4 and TSH do not correlate well at all.  Your Free T4 is only at 12% of its range, when  optimal seems to be mid-range, at minimum.  Your Free T3 is only at 30% of its range.  It needs to be in the upper third of the range, or as needed to relieve symptoms.  So I would push to get both increased.  

In addition, hypo patients are frequently too low in the range for Vitamin D, B12 and ferritin.  Low levels can also cause symptoms that mimic hypothyroidism.  You should also make sure to get those tested and then supplement as needed to optimize.  D should be about 55, B12 in the upper end of its range, and ferritin should be about 70.  

One last thing for now, is that I suggest that you should also ask to be tested for Reverse T3, when next tested for FT3 and FT4.  Reverse T3 is a mirror image molecule of T3.  It is a normal product of the conversion of T4 to T3; however, under some unusual conditions excess RT3 can be produced and that can block the effect of FT3.  So it is good to get a baseline test for RT3, to determine if excess RT3 is a problem or not.  

[Jolene1984]

Thank you Gimel. I have had vitamin D, vitamin B12 and ferritin checked and they are all above the levels you have stated.

Latest results:
May 2016
Total 25 OH vitamin D - 73 (>75 adequate vitamin D) this might be lower because my endo told me the supplement dose I take is toxic (3000iu) and I switched back to the 800iu the doctor prescribed me.

Serum ferritin - 195 (15 - 150) I have microcytic anaemia and this was treated in March 2016 with intravenous iron.

Serum vitamin B12 - 523 (191 - 663) I used to take a B12 supplement for this but my levels went over range and it was almost 700 which made me panic so I stopped taking this about 3 weeks ago. I have no idea if having over range vitamin B12 levels is unhealthy or not.

Would any of these levels dropped substantially by now?