I am doing a trial of thyroid meds to see if it helps my symptoms. The biggest one is extreme fatigue,, I am barely functioning most days. I have always had "normal TSH" but my free T4 and been on the bottom of the range my entire adult life and come to find out my free T3 was just below the range. The doctor said it was not my adrenals since I passed an acth stim test and they agreed to this trial. I started in July and currently taking 75 mcg of levothyroxine. My levels do not seem to be improving, in fact they are the worst they have ever been and i can feel it. For now we are adding 5mcg of cytomel, today is my second day and I am supposed to test again in 6 weeks. Yesterday I consulted a naturepath who feels strongly that it is not my thyroid and that its my adrenals. She is recommending to get on adrenal dessicated and I should feel great in a couple weeks. She said 6 months from now I should completely off thyroid meds. My doctor told me that the acth is the golden standard for testing adrenals. I am so confused on what is happening with my body. Here is my labs. It seems like the meds are doing nothing for me but making me feel worse. I am up 12 lbs =(
Jul-13 TSH 1.49
Free T4 0.8 .8 - 1.7
Free T3 2.2 2.3 - 4.2
Total T3 67 50-170
Ferritin 44 22 - 291
Vit D 43 20 - 79
4-Sep TSH 1 0.10 - 5.50
Free T4 0.8 .8 - 1.7
Total T3 52 50-170
18-Oct TSH 1.4 0.10 - 5.50
Free T4 0.8 .8 - 1.7
Total T3 59 50-170
Ferritin 39 22 - 291
Vit D 39 20 - 79
15-Nov TSH 2.16 0.10 - 5.50
Free T4 1 .8 - 1.7
27-Dec TSH 1.92 0.10 - 5.50
Free T4 0.9 .8 - 1.7
Total T3 51 50-170
I am supplemting iron, vitd, iodine/selenium, mult vit, ca/mg
Non-thyroidal illness is also known as Euthyroid Sick Syndrome or Low T3 syndrome. Chris Kresser has an 5 part article on the subject. First article title: Low T3 Syndrome I: It’s Not About the Thyroid!
I am not a doc, but I think both are not quite accurate. I will explain.
TSH is a pituitary test. The endos seem to think this is a gold standard for thyroid, but it really only tells the doc what the pituitary is telling the thyroid. My better endo would take your T3 and T4 and and put you on thyroid. The passing of the stim test is a good indication that your adrenals are fine. Other supportive testing would also help like sodium and potassium reading as AI is a salt wasting disease so those would be off in some way. You may also have an auto-immune issue as well that is not being covered.
As for ACTH being the gold standard... I find that to be off for the same reasoning TSH is not a gold standard. It only says what the pituitary is doing. Further, ACTH is a super duper fussy test and getting an accurate test that is not low (or lowered) due to lab handling is near impossible. So now you are replacing a hormone that you don't, in high likelihood, don't need, and may have given yourself steroid induced Cushing's and that is why you gained weight.
Not everyone with thyroid issues has adrenal issues and vice versa. It could also be an unrelated issue as well.
I bit the bullet and ordered the 24 hour saliva and rt3 blood test myself. I am making my health a priority no matter what the cost. My hubs said he would get a second job, anything it takes to get me healthy again. I am going to stop the cytomel for now.
Just keep in mind that T4 (levothyroxine) can take time - lots of time - to get the right dose. So your doc may or may not have hit the right dose, and it may or may not be have to be adjusted up or down. Once it took me a whole year to get my thyroid to a nice level! Cytomel, on the other hand, is fast acting and can be used ASAP by the body. Too much and it can land you in hyper-thyroid land, so you have to really balance the both. This is not a time to rush even though having been there done that, it really bites.
If you are on an adrenal supplement, I advise to wean off slowly.
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