Thyroid Disorders Community
Advice please here are my test results
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Advice please here are my test results

I started out having graves disease and had RAI treatment. After that I was put on 50 mcg Synthroid for a year and that was when I started having severe depression. I have been on 150 mg zoloft for close to a year now. My psychiatrist basically said that my depression has nothing to do with my hormones or lack of it. I decided to dose myself recently with 112 mcg Synthroid and after about 3 weeks into it my brain fog cleared and my depression is 90% better. I recently had bloodwork done and here are my results: Some background information on me---I'm 5'0 and weigh 118 lbs.

TSH, 3rd generation        0.02               range 0.40-4.50
Free T4                            2.2                 range 0.8-1.8 ng/dL
Free T3                            3.3                 range 2.3-4.2 pg/mL
Total T3                           95                   range 76-181 ng/dL
Reverse T3                     52                   range 11-32 ng/dL

My questions are: Why is my reverse T3 so high? What is the cause of it and what can I do to treat it or counteract it? My doctor wants to lower my dosage, but I don't want to get the brain fog and depression symptoms again. Is it a good idea to have T4 meds lowered and request for Cytomel to go with my T4? How much do you think I should have my T4 lowered to? 100 mcg? 88 mcg?
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Avatar_m_tn
To my knowledge there is no way to determine the specific cause of excess RT3 levels.  In this link you will see that stress is one of the most common causes.  There are also others that are listed, including deficiencies in many vitamins and minerals.  Probably a good idea to get those tested, just to rule them out, or in the equation.   If it is stress  related, I'd have to believe that getting your thyroid hormone levels improved, as you have done, has to be beneficial for you.  If that is the case, then the level of RT3 should improve given some time for your body to heal from being hypo.

http://www.custommedicine.com.au/health-articles/reverse-t3-dominance/

If your doctor wanted to reduce your meds based strictly on TSH level, I would disagree.  Many patients taking significant doses of thyroid meds will have their TSH suppressed.  This does not mean that you are hyper.  You are hyper only if having hyper symptoms due to excess FT3 and FT4.  For example my TSH has been about .05 for well over 25 years without ever having hyper symptoms.  

I do agree that your meds need to be revised to reduce your FT4 level.  There is no need for FT4 to be much higher than midpoint of the range, in conjunction with FT3 high enough to relieve symptoms..  Based on your symptoms, you likely need to supplement your meds with a source of T3.  This can be either an addition of Cytomel, or you could substitute NDT thyroid (T4/T3 combo) for the Synthroid.  Your next dosage needs to be discussed and agreed on with your doctor.  

For that discussion, you might like to have this bit of info in your pocket.  This quote is from a letter written by a good thyroid doctor for patients that he consults with from a distance.  The letter is sent to the patient's PCP to help guide treatment.

"The ultimate criterion for dose adjustment must always be the clinical response. I have prescribed natural dessicated thyroid for your patient (Armour or Nature-Throid). These contain T4 and T3 (40mcg and 9mcg respectively per 60mg). They are more effective than T4 therapy for most patients. Since they provide more T3 than the thyroid gland produces, the well-replaced patient’s free T4 will be around the middle of its range or lower, and the FT3 will be high-“normal” or slightly high before the AM dose.'

The quote is from this link.

http://hormonerestoration.com/files/ThyroidPMD.pdf
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Avatar_f_tn
Thanks for the reply gimel. I have an appointment with my doctor on June 22 and I'll request for T3 to be added to my meds plus a reduction in T4. I'll keep you posted on my progress.
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Avatar_f_tn
I had an appointment with my endo today and she lowered my Synthroid to 100 mcg and added 5 mg cytomel. I'm getting retested in 5 weeks. My question is with T3, can it be taken once a day yet have its effect last for at least 24 hours?
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Avatar_f_tn
I also want to add that my depression was really bad when I was on the generic brand. When I switched to brand name Synthroid my depression got better so it may matter for some people whether they take brand or generic. I'm just grateful that I found out where the problem lies from reading everyone's posts. This website has helped me learn so much about my condition.
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Avatar_m_tn
T3 is very fast acting, so it would be better to split the dose and take half in the morning and the other half in the early afternoon.  
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Avatar_f_tn
Wow, I feel so much better after one dose of 5 mcg of Cytomel. I have better mental clarity and more energy. I even feel happier. This is what I've been missing all along. I'm thinking of taking one 5 mcg of Cytomel twice a day everyday until I get my labs done.
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Avatar_m_tn
Better take it a little slower, just to be a bit cautious.  T3 has a half life of about one day, so it takes about 5 days for a given dosage to build up to about 95% of final effect on blood levels.  So I'd wait for a week and see how you are feeling at the time.  If you feel there is more to be gained with a dosage increase of T3, then a discussion with your doctor would be in order.  Since the doctor is being very cooperative in trying to adjust your meds to relieve symptoms, you want to make sure you maintain a good relationship there.  
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Avatar_f_tn
You're right. I need to give this some time to try out the 5 mcg a day. I'm going to split the pill in half, take 2.5 mcg twice a day, and see where it goes.
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Avatar_f_tn
Here is a recent update of my lab results:

July 13, 2011 - 15 mcg Cytomel, 112 mcg Synthroid  
Free T4     1.97     (0.82-1.77)
Free T3     0.008   (0.450-4.500)
TSH          5.7       (2.0-4.4)

Sept. 1, 2011 - 10 mcg Cytomel, 100 mcg Synthroid  
Free T4     1.67     (0.82-1.77)
Free T3     0.006   (0.450-4.500)
TSH          3.7       (2.0-4.4)

My endo and I are still in the process of adjusting my meds. We decided to keep Cytomel the same, but we are lowering the Synthroid slowly to raise the TSH higher. I have no symptoms or side effects with my TSH being at the range it is in. I have no hyper symptoms what so ever.

I am currently on 88 mcg Synthroid and 5 mcg Cytomel twice a day. I will get tested again at the end of Oct. 2011, and will post up my latest lab results.

I have slowly tapered off of Zoloft, and have been depression med free and depression free for a few weeks now.  
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Avatar_m_tn
I see that you reversed the Free T3 and TSH results, but no problem.  Be aware that TSS is frequently suppressed when taking large doses of thyroid meds.  That does not automatically mean that you are hyper.  You are hyper only if you have hyper symptoms, due to excessive levels of Free T3.  

I am so glad that you have benefitted so much from your meds increase.  Now you need to make sure your doctor does not get over excited by your TSH and want to reduce your meds too much and bring back hypo symptoms.  That said, it does appear that your Free T4 could be reduced a bit without jeopardy to your symptoms.  

Thanks for posting the good news.  
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Avatar_f_tn
Oops, thanks for catching that. Let me repost my lab results correctly just in case other members are viewing my posts also.

July 13, 2011 - 15 mcg Cytomel, 112 mcg Synthroid  
Free T4     1.97     (0.82-1.77)
Free T3     5.7       (2.0-4.4)
TSH          0.008   (0.450-4.500)

Sept. 1, 2011 - 10 mcg Cytomel, 100 mcg Synthroid  
Free T4     1.67     (0.82-1.77)
Free T3     3.7       (2.0-4.4)
TSH          0.006   (0.450-4.500)

I actually did not want to have my Synthroid meds decreased since I feel perfectly fine at the level it is at, but since my doctor thinks that my levels are too high based on the TSH, I'm willing to work with her on it. I figured as long as the decrease in Synthroid does not lower my Free T3 level  (my theory is that my body only converts to a limited amount of T3 from T4 regardless of the T4 amount in my body, and so I think whether I am on Synthroid 112 mcg, 100 mcg, or 88 mcg my body will still convert to the same amount of T3 unless I reach a low enough Synthroid dosage to make a difference. I guess I'll see if this theory is reasonable or not when I get my new lab results) and I continue to be symptom-free (no hypothyroid symptoms: depression, dry coarse skin, aches, brain fog, etc.) then I am okay with the decrease.

I'm glad my doctor is sensitive toward my concerns regarding the decrease in my T4 medication. We are approaching this situation carefully by decreasing Synthroid by 12 mcg at a time, and waiting 6 weeks before doing lab tests. I can't wait to see how much of a difference can a Synthroid 12 mcg decrease make on my lab results.




          

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Avatar_f_tn
I just got my latest lab results:

Oct. 13, 2011 - 10 mcg Cytomel, 88 mcg Synthroid  
Free T4     1.43     (0.82-1.77)
Free T3     3.8       (2.0-4.4)
TSH          0.006   (0.450-4.500)

The TSH and Free T3 is approximately the same as the last lab results. The Free T4 is lowered. For some reason since the last decrease in Synthroid I've been feeling very fatigued every day. I fell asleep while driving a couple of days ago. There are days when I would sleep for 7-8 hours at night and wake up for 3 hours in the morning and find myself falling asleep for another couple of hours again. I've never been the type of person who take naps during the day at all. In addition to the constant fatigue, since the addition of Cytomel I've been getting my period every month up until this most recent Synthroid reduction that I stopped getting my period this month. On top of that my skin is showing signs of dryness again, and I've been getting cramps in my legs everyday.

Do you think the reduction in T4 could contribute to my hypo symptoms returning again?

I have an appointment with my endo on Monday, Oct. 24 and I will discuss with her about going back to Synthroid 100 mcg and Cytomel 10 mcg again. The decrease in Synthroid did not have much effect on the TSH, but seems to make a big difference in my hypo symptoms returning again.
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Avatar_m_tn
When symptoms get worse, you should certainly focus your suspicion on whatever changes were made.  In your case, the only change you have indicated is the reduction in your Synthroid.  You were feeling good previously, yet your doctor insisted on reducing your Synthroid, because of unnecessary concern about your low TSH.  How many times have we heard this on the Forum.  My own TSH has been .05 or lower for well over 25 years, with no hyper symptoms.  In fact I continued having lingering hypo symptoms all that time.  After finding this Forum and learning about the importance of  FT3 mine was tested and confirmed to be low in the range.  After changing my meds to a T4/T3 combo type and some tweaking, my FT3 is not 4.0 and I feel best ever.  

You are going to have to get your doctor off the TSH concern.  I will send a PM with a link that I can't post here.  The link will give you some great info to give your doctor.
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