Always feeling sick..

[Extreme2001]

Hi everyone, I'm new here so I'm hoping to be able to maybe get some answers since the doctors I've gone to seem to think I should be feeling fine. I was diagnose some 20+ years ago that I was Hypo/ Hashimoto's. I've been on a few thyroid meds over these years and seem to have a hard time tolerating most of them. Right now I'm on Tirosint 112mcg and the symptoms I'm having are pretty much the same as the others. (headaches, sore throat, leg cramps, stomach issues mostly nausea and bloating, loss of appetite, flushing feeling in face and a few others) My question is which is what I ask the doctors all the time is could it be the medicine or am I over medicated. They always tell me my blood work looks fine and it's all in my head. They always make me feel like I don't know what I'm talking about I should feel fine. Here's my last blood work done on Sept. 28th of 2015.

TSH- 2.42   Ref. Range- 0.40 - 4.50
Free T4 - 1.1  Ref. Range- 0.8 -1.8
Free T3 - 2.7  Ref. Range - 2.3 - 4.2
T3 Total - 85  Ref. Range - 76 - 181

Any help would be appreciated..Feeling like crap..

[Barb135]

Will look forward to hearing how your appointment goes and if you have any further questions, by all means, make sure you come back here and ask them.  The more prepared you are, the better for you.  

[Extreme2001]

Thanks, I will keep you informed. Much appreciated with all your help!

[Barb135]

There is no blood test to determine a Free T4 to Free T3 conversion rate... you simply watch Free T4 levels and if Free T3 levels don't follow suit, there's a conversion issue.  A good thyroid doctor will understand this and if your doctor doesn't or if you have to be so specific in explaining it all to him, he's not a good thyroid doctor.

Just explain to the doctor that you've been doing some research and you understand that not everyone converts Free T4 to the usable Free T3 adequately and that it appears you may be one of those and see what his reaction is.  If he gets angry or blows you off (some doctors have an ego issue and don't like patients who research), he's not the doctor you want and you're wasting your time.  If he's understanding and is willing to discuss the possibility, you're probably good to go, even though he might not be willing to prescribe T3 med, right off the bat.

I learned the calculations right here on the forum, just like I showed them to you... Again, if you have to teach them to the doctor, he's not a good thyroid doctor, but you can take that part with you if you think he won't understand it any other way...

You can tell him that your research indicates that the goal should be for  FT4 to be about mid range and FT3 should be in the upper half to upper third of its range (that's where most of us feel best)... FT3 should always be higher in its range than FT4.  If he's not willing to work toward these goals, again, he's not a good thyroid doctor and you shouldn't waste a lot of time on him.

[Extreme2001]

Also where did you learn the calculations percentages so I can explain them to him as well..

[Extreme2001]

Again Thanks.. Hopefully this doctor will be more open to suggestions to helping me feel better. Can you get a blood test to determine your T4 to T3 conversion rate to make things a little easier to determine. Hopefully I can make since to this with the doctor when I see him. Any suggestions on how I should approach the doctor so maybe it will make things easier for our visit. You guys have so much understanding on this condition then I do and I would like to finally get a doctor to be more open with options if I know what I'm talking about. Any advice would be truly appreciated. Thanks again, Glen

[Barb135]

For alternation, I'm suggesting that one day you'd take 112 mcg and the next you'd take 125 mcg for a total of 137 mcg for the 2 days; divide by 2 and you get an average of 118.5/day.  It's a very minor increase, but when we get to a certain point, that's often all we need... I've alternated various dosages over the years when one was too much and another not enough and had very good luck with it.  

To calculate the percentage (I'll do it with your FT4), subtract the lower reference range from the higher reference range (1.73 - 0.8 - 0.93); then subtract the lower reference range from your result (1.35 - 0.8 = 0.55);  divide the second result by the first one (0.55/0.93 = 0.5913).  Move the decimal point 2 places to the right and that's the percentage.  59%

Here it is all in one calculation for the FT3:

4.7 - 2.0 = 2.7
2.7 - 2.0 = 0.7
0.7 / 2.7 = 0.2592
Move the decimal point 2 places to the right (25.9%) and round up to 26%
Not a dumb question; I had to have it explained to me, as well...

[Extreme2001]

One other question which is, what math are you using to figure out the percentages. Dumb question I know, but I was terrible in math..HaHa

[Extreme2001]

Thank you, Barb135

Glad I had my blood work from back in April so you could see what's been going on. There have been times when I felt somewhat ok, that must have been when my T3 levels were higher. That being said I will suggest this to my doctor and see if he can maybe prescribe a T3 supplement like Cytomel and go from there. When you say alternate meds. are you suggesting alternating every other day between the two and what dosage would you say to start with the Cytomel.

[Barb135]

When you had your April labs, your FT4 was at 59% of the range, which was above the recommended 50% mark and your FT3 was only at 26% of its range, indicating that you don't convert well.

It doesn't look like you need a full 125 mcg of T4... you might talk to your doctor about alternating 112 mcg Tirosint with 125 mcg Tirosint for an average of 118.5.  

The problem appears to be that you aren't converting the Free T4 to Free T3, which means that instead of constantly bumping between 112 and 125, you need to add a source, of T3, such as cytomel to bring your FT3 levels up... If you don't convert adequately, simply adjusting T4 med isn't going to bring FT3 levels up to where you need them.

Cytomel (T3) is one type of treatment, other than the standard T4 treatment you've been receiving.  Desiccated hormones, that contain both T4 and T3, are another type of treatment.  Since you're already on T4, it makes more sense to, simply, add T3, at this point.

[Extreme2001]

You mentioned various types of treatments. What could they be other then increasing or decreasing meds. until the readings for the Free T4 and T3 levels are in the ranges that you guys say hypo patients feel the best.

[Extreme2001]

I've been on the 112 for about 8 months. Last blood work was done on 4/28/15. Test results then were:

TSH - 0.401  Ref. Range 0.178 - 4.530
T4 - 9.2  Ref. Range 4.9 - 12.9
Free T4 - 1.35  Ref. Range 0.80 - 1.73
Free T3 - 2.7  Ref. Range 2.0 - 4.7
Anti-Thyroglobulin - 221 High

That being said he always switches me from 112 to 125 depending on blood work. That's why I have 125 on hand. Only took it today being you guys said I was under medicated and needed to bring my free T4 and free T3 up. Confused!!

[Barb135]

We don't recommend self-medicating, as with the 125 mcg med that you already have on hand... I'm not sure what you have in mind with that, since you're already taking 112 mcg of Tirosint.  Self medication can get us into trouble very quickly, if we don't know what we're doing.

It takes 4-6 weeks for dosage change to take full effect in your blood, so switching to 125 mcg now, would not give an accurate reading by the time of your appointment on the 27th, which is only 17 days away.  

Recommend that you leave things as they are and if your new doctor is really as good as you say, you can discuss all of these things with him and he will be open to all types of treatment.  If he's not open to various types of treatment, the rave reviews are misguided.

It's possible that once you see him, you can increase to 125 mcg to bring your FT4 up to the mid point as recommended by gimel, then if FT3 doesn't follow suit, you can add a source of T3...

You didn't tell us how long you've been on the 112 mcg Tirosint...

We already know your vitamin D levels have been low, so that could affect the way you metabolize the T4 med.  If ferritin/iron is low also, that could have further effect.  Good to get everything tested before making a lot of changes, then it's ill advised to make too many changes at once, because then you don't know which one(s) really made the difference.

[Extreme2001]

Do you think maybe I should ask the doctor to see if he might let me try a T3 medicine to see if that might help me feel better. Being that it's the active hormone that makes us feel better. Should I maybe have him check my adrenals. Just looking for all your advice before I see him on the 27th of this month. I have some 125mcg thyroid medicine which I will take to see if it raises my T4 and T3 levels before I go and see him. I'll have him recheck my levels and post them here for your feed back. Also have him check my Vitamin D, B-12 and Ferritin levels. Again thanks for all your help along wit Gimel.

[Extreme2001]

Thanks for all your help, will keep you posted. Have a appointed on the 27th with a new doctor. He's more alternative and open minded. Heard nothing but good raves about him. Again thanks for all your help..

[Barb135]

I agree with everything gimel said... I can only add that you were diagnosed with hypo/Hashimoto's a long time ago and your body has changed since then - the main thing being that the antibodies would have completely destroyed your thyroid by now, so while it's possible that it might still have produced a small amount of hormones 20 yrs ago when you were first diagnosed, it's unlikely that it does anymore, so you are completely dependent on your medication.  That means your medication dosage must be adequate enough to do all the work... It doesn't look like yours is.

The other thing I would add is that there's a possibility that you aren't converting the Free T4 to the usable Free T3.  If you increase your dosage so your FT4 gets to the mid range point as gimel mentioned and your FT3 doesn't follow suit, you may have to add a source of T3 in the not too distant future.

Your vitamin D is still too low.  You don't know what your B-12 level or ferritin are... Vitamin D and iron are necessary for the proper metabolism of thyroid hormones, so you might want to increase your vitamin D dosage until your level gets around 60 and I'd suggest having your ferritin levels tested.  Ferritin is the iron storage hormone and will tell you what your iron stores are.

If your multi-vitamin contains niacin, that could account for the flushing feeling you have... I find that taking individual vitamins serves the purpose much better than a multi because we don't always need everything that's in a multi and some vitamins/minerals can cause adverse affects.

[Extreme2001]

Thanks you for the quick response. I do here you on what your saying, I just didn't feel this way long ago when I was diagnose with it in the first place. Just was tired all the time, that's what took me to the doctors in the first place. I take a Micellized D3 supplement now 5-8 drops a day mixed in water. Last time it was checked it was around 45 but came up from 25. I also take a Bioactive B-12 supplement everyday as well along with a Liquid all in one Vitamin and minerals supplement. All these products all from Global healing center. Great products! Never had my Ferritin checked from the blood work I'm looking at. So you're saying I should increase my dosage so my Free T4 and T3 come up some and that should decrease the symptoms I'm feeling.

[gimel]

Just because your test results fall within the so-called 'normal' range does not mean they are adequate.  Due to the erroneous assumptions used to establish ranges, they are far too broad to be functional across their entire breadth for everyone.

All those symptoms you mention can be due to still being hypothyroid,  In addition, your test results are less than what we find to be optimal for many hypo patients.  Many members say that symptom relief required Free T4 at the middle of its range, at minimum, and Free T3 in the upper third of its range, or as needed to relieve symptoms.  Your Free T4 is only at 30% of its range and your Free T3 only at 21% of its range.  

So it is clear that you are actually under medicated and need to increase your med as needed to optimize both Free T4 and Free T3.  A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results.  If your doctor is not willing to treat clinically as described, then you need to find a good thyroid doctor that will do so.  

Also, hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin, so you should get those tested and supplement as needed to optimize those levels.  D should be about 55-60, B12 in the upper end of its range and ferritin should be about 70 minimum.