Should I increase my T4, T3 medication or both?

Question

I am a 57 year old female who has had hypothyroidism for 20 years. I was diagnosed with Hashimoto's 14 years ago. 

My medications were changed a year ago and my symptoms of poor memory, brain fog, low energy and insomnia are worse. Also  I have had Weight gain of 11% .

Current medications                                         Previous medication (was on this for 3 years)
Synthroid/T4  50mcg
Cytomel/T3.   15mcg.   (5mcg 3xday)              Cytomel 25mcg.  (10mcg 2xday + 5mcg once a day)

Lab Values Feb 2022
TSH.  1.29
FT4.   8.4.     (10.6 - 19.7)
FT3.   2.79.   (2.6 - 5.8 )

Any insights would be appreciated

gimel · Accepted Answer

Even the ATA recommends  that the morning dose of thyroid med should be delayed until after the blood draw, to avoid false high results.    So your FT4 is probably even lower than the test result.  

With your symptoms and those test results it is very clear that you need to increase both T4 and T3 dosages gradually to get your levels closer to mid-range, and adjusted from there as needed to relieve symptoms.    That has to be your goal, symptom relief, not specific targets for FT4/FT3 levels.   Everyone is different, and may need to be at different levels for symptom relief.

In addition to needing adequate levels of FT4 and FT3 to relieve symptoms, you need Vitamin D at least 50 ng/ml, and ferritin at least 100, for best effect.  B12 should also be in the upper part of its range to help with fatigue.    Ferritin affects conversion of T4 to T3.  Ferritin needs to be adequate in order to successfully raise FT3 levels.    So even though you need to increase your T3 dose, I would want to see a ferritin test result first.    Also need test for Vitamin D, and B12.  

If you have trouble getting a doctor to do the  tests and increase your med dosages, give a copy of the link I gave you above, and say that you want to be treated clinically, as described in the link.

gimel · Answer

From those test results I am not surprised you would have hypo symptoms.  Your FT4 is below range.  Your FT3 is only at 6% of its range.So you need a dose increase for both T4 and T3 med.  Med dosages should be increased as needed to relieve hypo symptoms without going so far as to create hyper symptoms.    Med dosage must never be determined by your TSH level.  You can read all about this in my paper in the following link.  

https://thyroiduk.org/further-reading/managing-the-total-thyroid-process/

It is also very important to get your Vitamin D to at least 50 ng/ml, B12 into the upper part of its range, and ferritin to at least 100.  If not tested for those you should make sure to do so and supplement as needed.

gimel · Answer

First thing I need to ask is if you took your thyroid med in the morning before the blood draw for those results?

Second is I don't understand what you have listed for your T3 med dosage.   It looks like you have listed two different dosages.

Should I increase my T4, T3 medication or both?

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Opinions about my bloodwork results please.

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FT3 Won't Budge

Adding a bit of T3 to Levo

Opinions about my bloodwork results please.

Should I lower my thyroid med?

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