Does combination therapy help for autoimmune thyroiditis?

Question

Hi doctor,

I am 38 years old and have been on 100 mcg of Levothyroxine for five years. My last TSH was 4.9 mIU/L, free T4 was 0.8 ng/dL, and TPO antibodies were elevated. Despite this, I have fatigue, cold intolerance, and weight gain. Should I be tested for free T3 or reverse T3? Would switching to combination therapy help? Does autoimmune thyroiditis affect fertility or other hormones? How often should laboratory tests be monitored in cases like mine?

Thanks.

Answer 1

Hi,

Welcome to icliniq.com.

I can understand your concern.

Even on Levothyroxine, your TSH (thyroid-stimulating hormone) is still high, and your free T4 (thyroxine) is low-normal. That explains why you are still feeling so poorly. Here is my approach:

Do not jump to T3 (triiodothyronine) - Let us first increase your Levothyroxine dose slightly to bring TSH down. Many feel better once TSH is optimal.
Autoimmunity matters — Elevated TPO (thyroid peroxidase) antibodies mean Hashimoto’s. This can affect fertility by disrupting ovulation cycles and progesterone balance. We would check other hormones if conception is a goal.
Laboratory tests every eight weeks until your TSH stabilizes in range, then every six months.
If symptoms persist after TSH is optimal, then we would consider free T3 testing or adding a small dose of T3.

I hope this information will help you.

Thanks.