Also: headaches, but they don't seem to last long, and scalloped tongue- I only started noticing this in early December and I don't think it's all the time but I noticed it this morning. And it could be just because I'm anxious over my labs but I currently feel like I'm about to jump out of my skin (even though I'm sleepy). This is not a frequent symptom for me, though.

I need a bit more information to give my best commentary and you'll find questions as I share my thoughts.

Firstly, please understand that our bodies produce varying amounts of rT3 throughout the day so measuring that level is truly meaningless.

Also, antibodies stay in the bloodstream for 2-3 months so, measuring them any more frequently than every 6 months isn't too helpful.

And, TPOab's are actually markers of thyroid inflammation. Yes, studies have shown that selenium can reduce TPOab's but, things as "simple" as a virus, exposure to smoke, etc. can cause an increase. I've read that it can take easily 6 months to experience the benefits of going gluten-free.

Please know that we don't "feel" our levels until after they "hit". You see, first we need to have adequate blood levels of hormone. Then, that hormone needs to get to every single cell in the body....in the amounts and with the frequency that every cell needs.

It can take easily 3-4 wks. or more to "feel" optimal levels. In the meantime, we'll still have symptoms but those final symptoms will slowly ease.

Your FT3 level in December and again in February would be considered pretty much the same. FT3 is measured in much smaller units than FT4.....kind of like FT3 is measured in ounces and FT4 in pounds.

How many hours were there between your last intake of levo/Cytomel and your labs?

Now, your FT4 level did increase between December and is now at a level that many people would find comfortable.

Question of the day.....when exactly did you start the 100mcg levo dose along with the 5mcg?

The answers to those questions play a big part in being able to comment on your thyroid labs..

Ooops....in re-reading your post, I realized I forgot to ask yet another question: What time of day do you usually take your levo and what time(s) of the day do you usually take your T3?

The timing of your meds could be a factor in the morning fatigue.

To answer your questions, I began my current dosage in the beginning of November, so it had been 3 months by the time these labs were drawn. I take my levo. at bedtime, which I started a month or so ago, because I have an easier time getting to an empty stomach at night than waiting to eat when I get up. I and NOT a morning person, so having to get up extra earlier to get ready in the morning doesn't agree with me. I haven't noticed any changes in how I feel since making that change, though.

I take the T3 first thing in the morning, around 6 am, and then again around 1:30-2:00 pm.

The day I had the labs drawn I had taken my levo. the night before and T3 in the morning, and the labs were drawn around 12:30 pm, so it had been over 6 hours since T3 and about 14 hours since T4. And I had not eaten since breakfast around 7 that morning, if that makes any difference.

Thanks for the clarifications!

Well, the timing between your last meds intake and your blood draw would result in accurate levels so, I can only speculate a few things....

First is that the increase in your FT4 level means that either your needs for thyroid hormone decreased a little (unlikely right now if you live in a colder climate) or your thyroid function improved a bit (this can happen but it can be temporary). It's also possible that your FT4 level most recently is artificially elevated due to proteins.
A final possible effect on your FT4 level could be related to sex hormones.....if you stopped taking female hormones of any type, the FT4 level can decrease....with DHEA, the FT4 level can increase.

As mentioned earlier, the slight increase in your FT3 level is marginal since FT3 is measured in very small units.

I do believe the reason you're not feeling more relief is due to the fact that your body went through quite the adjustment process in a relatively short period of thyroid time......and also the amount of time it takes for the body to adjust to the new normal.

It took a full 4 wks. for my final symptoms to dissipate after my levels optimized and I know it's taken longer for others.

Your current levels would be perfect for someone like me.....a bit too high for others.....and a bit too low for a very small number of people.

If you weren't taking your levo at night, I would have speculated that the morning fatigue might be blamed on that.

I suspect the reason you feel better in the afternoon could be due to the fact that you definitely have your AM dose of T3 in you....and possibly the PM dose.

I'd be inclined to give it 4 more weeks at maintaining the status quo since you are reporting improvements.

If you backslide at all, I'd be inclined to get new labs and decide from there.

You might need to change the timing of your T3 doses (most people do well with your current dosing schedule but some fare better with dosing at night)

And, it's possible that you might be one of "those people" who needs over-range levels to feel well. It would then be appropriate to ask the doctor about VERY small dose increases - nothing more than 6.25mcg T4 or 2.5mcg T3.

Still, I'm continue to come back to "wearing" your current levels for awhile.....

And, if your iron levels don't improve, you might want to consider supplementing. Iron is a vital part of thyroid hormone metabolism and lower levels could very well be the reason why you're not feeling better with your current thyroid levels.

Best of luck to you moving forward! You've made amazing progress in a relatively short time.

Thanks for your help, cd. I actually managed to get in to my doctor today, and I came out feeling pretty encouraged. She said she is happy with my levels where they are (yay for a doc who isn't scared of low TSH or slightly above-range frees!!) so she is not changing my dosage. She is switching my to name brand cytomel at my request because I have been on generics and my pharmacy has been switching around manufacturers on me lately. When I told her I've been tired all morning and much better in the afternoons she agreed that adrenals might be the culprit so she gave me the saliva test kit so we can check that out.

I forgot to mention before that at my last appointment 6 weeks ago she ordered a thyroid ultrasound just to make sure we weren't missing anything. She assured me today that the results didn't give her any concerns. My thyroid is a bit enlarged, but not significantly, and no masses or anything. I said "so it's angry, but nothing else to worry about at this point?" She laughed and said she had never though of it that way, but that was a perfect description.

All in all I feel pretty positive today. I think the doc. and I are both pretty happy with how quickly my levels have improved, and I feel good going forward that she is going to help me feel my best, whatever we need to do to make that happen.

And having read so many horror stories on here, I can't tell you how thankful I am to have found such a great healthcare provider on just my second shot (first was my pcp who was useless... and is no longer my pcp as a result of that waste-of-time appointment)!

I'm glad you mentioned your adrenals because I forgot to do so :)

Without a doubt, adrenal issues can cause morning fatigue.

However, they also make it VERY difficult for people to adjust to thyroid meds.

I'm thrilled for you that you found quite the caring and thyroid-savvy doctor on the second try!!

I must admit I'd love to add your doctor's contact info to the email folder I maintain with this type of information. I do so in the hopes of helping others who might be looking for a thyroid-savvy doctor.

If you are willing to share, please feel free to do so here or in a message to me.

me again (sorry)

If you were doing well on the first generic T3 you were taking, it's entirely reasonable for your doctor to indicate the manufacturer of the product and "medically necessary" on new Rx's.

Pharmacists are very much aware of the narrow therapeutic range for thyroid hormone and know they must fill Rx's as prescribed.

I don't know about your situation but, my insurance charges $200 for a 90 days' supply of brand name thyroid hormone meds.

I prefer to pay the $30 my mail-order pharmacy charges for the brand of generic T3 that I've been successfully taking for more than 3 years.

And, if I wasn't so unhappy with the lack of efficiency at my local Walmart pharmacy, I could get 90 day's worth of T4 for $10. Instead, I pay my mail-order pharmacy whatever the going rate is for 90 day's worth of my current dose size. Last time I filled the Rx, it was less than $14.

Yeah Scrivener!