Low FT3 levels while on Synthroid & Cytomel

[biznitch]

Dr. Lupo,

I was diagnosed with sub-clinical hypothyroidism over a year ago.  My labs were FT3 3.0, FT4 1.2, TSH 4.2.  I had all the symptoms fatigue, dry skin, weight gain, and swelling.  I was started on Synthroid 25mcgs and am now on Synthroid 75mgs.  Additionally, Cytomel was added 3 months ago at 5 mcgs and increased 6 weeks ago to 25mcgs.
I know that I feel much better with the addition of the T3.  I have much more energy.  My current labs were FT3 2.85, FT4 .9, and TSH .009.  I had a little beat of heat intolerance but it has since past.  The only thing is I am having this nagging ankle swelling that continues to come and go.  Oh, and a little bit of acne which I don't have usually at all.  I mean it can change my weight by at 5 pounds in a couple of days.  Does this mean my medication levels are still not correct?  Additionally, my FT3 is decreasing (has been overtime) and the doctor said it needed to be at least around 350 for metabolism to increase.  

I noticed that when I drink caffiene I tend to swell which is weird.  Do you think I could have some adrenal issues as well?  Here are some labs results, please let me know if you see anything else or have any ideas.

(diagnosis to now)
Total cholesterol 240 to 172
HDL 84 to 70
LDL 131 to 91
Trig 95 to 59
Potassium 4.2 to 4.4
Sodium 139 to 138
DHEAS 65 (tested once)
Progestrone <.5 (low was on Ortho Tri Lo)
Estradiol 114
Testos 27
Glucose 78 to 79
CO2 27 both times
WBC 6.2 to 5.7
Platelets 270 to 219
MCV 93 to 94
RDW 12.70 to 12.20
Blood type A+
37 years old

Thanks, any advice would help.
Shelley

[kitcurious]

Overdoses of thyroid medication can cause heart damage, bone loss and some people actually gain weight when overdosed.

[TXchic]

I go back to the doctor this week and decreased the Cytomel dose on my own.  I have been taking 12.5 mcg of Cytomel for the last 3 days.  I don't feel bad in general, it is just that I have had this annoying ankle swelling every day this week.  I had the swelling really bad right before diagnosis.  Guess that is what bothers me the most, well besides the problem with losing weight.  I follow a good diet and exercise at least 5 hours a week.  I just would like a solution to the edema.

[Mark Lupo, M.D.]

Your TSH is too low - you are on too much medication - 25mcg of cytomel at once is too much for most patients and the total dose equivalent is 175mcg of T4.  T3 levels will fluctuate so would not pay close attention to this w/ exception of a 2-3 hour post dose T3 level to make sure it is not too high.

No convincing data in good human studies w/ ferritin levels and thyroid hormone activity.

[biznitch]

Yes, that is correct that was my last lab test result.  

[kitcurious]

I am not a doctor, just a thyroid patient asking if you wrote your labs as you intended them to appear. Did you mean to say a TSH of .009?

[biznitch]

I forgot to mention my Ferritin level as well it is 34 and hasn't changed.  I take B12, magnesium, selenium, and Vitamin C.  I heard that sometimes until your Ferritin levels reach at least 70 you are not able to get the true benefits of your thyroid medications.  I was boderline anemic years ago.