Hashimoto's - TSH suppressed but still feeling unwell

[Petals2214]

I have Hashimoto's. I was diagnosed with this 2 years ago. I take 75mcg T4 and 10mcg T3 but I want to raise this on alternate days with 100mcg T4 and 15mcg T3. My endo does not yet know I want to do this because I'm worried she will think I'm doing something silly.

I have had my thyroid function test done last week and the results have come back but I'm not being told what they are until I get it in writing. The endo wants my TSH to come back up to 2.5.

Symptoms I have:

Goitre (ultrasound says thyroid is swollen but no nodules)
Difficulty swallowing
Ongoing cough
Headaches
Joint pains
Dry eyes
Dry ears
Dry mouth
Constipation
Itchy feeling in throat (front of neck where thyroid is)
Hair loss
Heavy periods
Painful periods
Pale skin
Dizziness when standing
Fatigue
Peeling skin
Peeling nails

November 2015
! Serum TSH level: <0.02mpmol/L IU/L (0.27 - 4.20)
Serum Free T4 level: 19.8pmol/L (12.0 - 22.0)
Serum Free T3 level: 5.2pmol/L (3.90 - 6.70)

October 2015
! Serum TSH level: <0.02mIU/L (0.27 - 4.20)
Serum Free T4 level: 20.5pmol/L (12.0 - 22.0)
Serum Free T3 level: 5.0pmol/L (3.90 - 6.70)

August 2015
Serum TSH level: 1.30mIU/L (0.27 - 4.20)
Serum Free T4 level: 17.1pmol/L (12.0 - 22.0)
Serum Free T3 level: 4.1pmol/L (3.90 - 6.70)

May 2015
! Serum TSH level: 5.61mIU/L (0.27 - 4.20)
Serum Free T4 level: 18.1pmol/L (12.0 - 22.0)
Serum Free T3 level: 4pmol/L (3.90 - 6.70)
! TPO antibodies: 275IU/L (<34)

March 2015
Serum TSH level: 0.41mIU/L (0.27 - 4.20)
Serum Free T4 level: 13.2pmol/L (12.0 - 22.0)
Serum Free T3 level: 4.2pmol/L (3.90 - 6.70)

Thank you :)

[gimel]

The 210 mg is a huge dose, if that is the actual amount of iron.  My ferritin was about 40 when I started on 25 mg of ferrous fumarate.  I increased to 50 mg and rechecked ferritin and in 3 months it had gone up to 78, as I remember it.

[Petals2214]

Thank you Gimel. I have got ferrous fumarate but  this is a high strength iron (210mg) and this has caused me problems. It has given me upset stomach even when added with vitamin C and fruit juice. Not only that but I felt overwhelemed by the doctor's instructions in needing to take it 3 times a day.. With the stomach upset I get is there something I'm not doing properly or is the ferrous fumarate too strong for me?

[Petals2214]

Thank you for this flyingfool. So I could reduce the T4 to 50mcg and the T3 to 15mcg?
I will look at a B12 supplement since this is low.

[gimel]

In addition to the info from flyingfool, you need to supplement with iron to raise your ferritin up to 70 minimum.  Some good iron supplements are ferrous bisglycinate, ferrous fumarate, ferrous sulfate, and ferrous glutamate.  I expect that you will need to start on about 25 mg and work up to about 75 mg to adequately raise your ferritin level.  

[flyingfool]

With your numbers.

B-122 is WAY too low.  Needs to be well up towards the top of the range.

As far as thyroid dosage.  First you being in the UK and even finding a Dr who would prescribe T3 medication is rare!

That said, your Dr is worried more about your TSH level than with how you feel.  And it is likely that the T3 medication along with your high level of T4 is causing the TSH to be suppressed.  It is not unusual for TSH to be suppressed when properly treated and is almost to be expected with T3 treatment.

My thought with your numbers in Novemebr would be to REDUCE the T4 dosage and INCREASE the T3 dosage.

T3 is to be taken daily and probably best split in half.  T3 is used up within hours. So alternating days would do nothing but possibly make you feel like a yo-yo.

Reducing your T4 would help get that back in line with the middle of the range.

However It seems you need the T3 as it appears that your body does not want to convert the FT4 into usable T3.

It is possible but not a for sure thing that if you reduce your T4 levels, then the TSH will creep up.  But with 15 mcg of T3 daily I'm not sure that your TSH would do much of anything.  It may go up or it may remain suppressed.

[Petals2214]

Hi Gimel, and thank you.

I am still waiting on the latest ferritin and B12 results but B12 and vitamin D were last done at the start of last year.

Vitamin B12: 382pg/L (191.00 - 663.00)
25 OH vitamin D (total): 61.4nmol/L (>75 adequate vitamin D)

Ferritin was checked in September and was in range and my MCV was just out of range. Everything else in the full blood count was normal.

Serum ferritin: 21ug/mL (pre-menopausal range 15 - 150)
! MCV: 78.1fL (80.00 - 96.00)

Cortisol was checked 2 years ago.

Cortisol: 339mmol/L (140 - 700)

[gimel]

I can certainly understand your intent to do something, with all those symptoms; however, your T4 is higher than the minimum recommended, which is middle of the range.  Your Free T3 is only at 47% of the range, which leaves a lot of room for an increase.  A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results, and especially not tSH when already taking thyroid med.  You can get some good insight from this link written by a good thyroid doctor.  
http://www.hormonerestoration.com/Thyroid.html

Even if your Free T4 and Free T3 levels were optimized, there are other factors that can affect how your body metabolizes thyroid hormone.  If not tested for Vitamin D, B12, ferritin, cortisol, and Reverse T3 it would be a good idea to do so.