Under medicated?

[Indigo19]

I have Hashimoto's. I have had my latest thyroid function test results back. My endo has no plan to increase T3 from 10mcg but will increase T4 to 100mcg from 75mcg.

TSH: 6.70 (0.27 - 4.20)
Free T4: 12.8 (12.0 - 22.0)
Free T3: 4.1 (3.1 - 6.8)

Symptoms:

Difficulty swallowing, choking fits, goitre (confirmed on ultrasound), constipation, heavy periods, depression, weight gain, joint pain, pale skin, puffy eyes, hair loss, dry skin, dry eyes, dizzy spells, ringing and rumbling in ears.

Thank you

[Barb135]

With Hashimoto's, it's very common to have to increase medication dosages, periodically, to compensate for destruction of thyroid tissue.  When taking, both T4 and T3 meds, the first line of action is to increase T4 med, especially when FT4 is on the floor of the range, as yours is...

In my opinion, your endo is doing the right thing, because even if you "can" convert FT4 to FT3, you have no FT4 "to" convert...

Rule of thumb is for FT4 to be about mid range and FT3 in the upper half to upper third of its range.  Your FT4 is only at 8% of its range, so you have a long to go to get that to the 50% point.  Once FT4 is at mid range (that would be 17, according to the range used above) and FT3 isn't following suit, then it would be appropriate to increase T3 med.

Increasing the T4 med from 75 mcg to 100 mcg could very be the boost you need to help decrease or alleviate a good share of your symptoms... If that doesn't bring your FT4 to mid range and/or help your symptoms, you may even have to increase T4 med to 112 mcg, but you should test every few weeks to see what your levels are and to make sure your FT3 is tracking your FT4 up...

[Indigo19]

Thank you Barb. I have been on as much as 175mcg T4 and that was before the T3 was prescribed to me. Even back then the free T3 was at the bottom of its range and my symptoms were pretty much the same.

Before the T3 was introduced:

June 2015
TSH: 1.44 (0.27 - 4.20)
Free T4: 20.8 (12.0 - 22.0)
Free T3: 4.2 (3.1 - 6.8)
I was on 175mcg T4

March 2015
TSH: 6.51 (0.27 - 4.20)
Free T4: 15.3 (12.0 - 22.0)
Free T3: 4.1 (3.1 - 6.8)
I was on 150mcg T4

December 2014
TSH: 7.2 (0.27 - 4.20)
Free T4: 14.7 (12.0 - 22.0)
Free T3: 4.5 (3.1 - 6.8)
I was on 125mcg T4

September 2014
TSH: 3.8 (0.27 - 4.20)
Free T4: 16.8 (12.0 - 22.0)
Free T3: 4.3 (3.1 - 6.8)
I was on 100mcg T4

May 2014
TSH: 8.3 (0.27 - 4.20)
Free T4: 18.3 (12.0 - 22.0)
Free T3: 4.1 (3.1 - 6.8)
I was on a starter dose of 25mcg, then 50mcg and then 75mcg T4 at the time

March 2014
TSH: 18 (0.27 - 4.20)
Free T4: 11.4 (12.0 - 22.0)
Free T3: 4.2 (3.1 - 6.8)
TPO antibody: 375 (<100)
TG antibody: 566.3 (<115)
This was before any T4 was given to me