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Am I overmedicated, undermedicated or high RT3 or?
10 months ago I became over medicated and my doc has been lowering my dose of Tirosint by 12 mcgs ever since. A week or so ago my eyes had a flare up of swelling, running and aching [have had this when under medicated too] apparently it isn't too common because I posted about this with not much response. Now I have fluid retention else where too [maybe I had too much sodium] and my digestion is slow with reflux again. I have had the jitters off and on, trembling, racing heart at times, but now feeling tired/slow,, palps have stopped. My doc lowered my dose again, 4 days ago to 88mcgs Tirosint, I was told to stay at 12.5mcgs Cytomel. Every lab done before this had had a FT4 at the very top of the range, FT3 has been at the upper 2/3 or higher, no TSH and high RT3. Here are my labs from last week, before dose lowered:
100mcgs Tirosint 12Cytomel
TSH less than 0.006
FT4 Direct 1.48 0.8-177
FT3 3.3 2.0-4.4pg/ml
RT3 24.1 9.2-24.1ng/dl
Do you think the RT3 could improve as I lower the T4? Am I over medicted or do I need additional Cytomel for the fluid, vision thing? Any opinion would be helpful! I have Hashi's and my last labs where good on iron, D etc... But I do have some low cortisol in the AM, based on saliva testing. My last labs on Cholesterol and Trigs where very high, also my A1C was high...which is unbelievable because I eat so well, so I think my thyroid meds are not working at the cellular level, hence the high RT3 [which my doc is not concerned about] She's about ready to put me on Statins and Metformin. Had none of this until my thyroid got wacked out..gained 30lbs in 3 months, the vision issue and totally debilitated from pain and my body not functioning properly. Have not been right since. I wonder if I may have Graves as well, will ask for that test! Very concerned that this is causing permanent damage to my organs and bones...put my doctor has no sense of urgency.
Thank you so much for your help!
100mcgs Tirosint 12Cytomel
TSH less than 0.006
FT4 Direct 1.48 0.8-177
FT3 3.3 2.0-4.4pg/ml
RT3 24.1 9.2-24.1ng/dl
Do you think the RT3 could improve as I lower the T4? Am I over medicted or do I need additional Cytomel for the fluid, vision thing? Any opinion would be helpful! I have Hashi's and my last labs where good on iron, D etc... But I do have some low cortisol in the AM, based on saliva testing. My last labs on Cholesterol and Trigs where very high, also my A1C was high...which is unbelievable because I eat so well, so I think my thyroid meds are not working at the cellular level, hence the high RT3 [which my doc is not concerned about] She's about ready to put me on Statins and Metformin. Had none of this until my thyroid got wacked out..gained 30lbs in 3 months, the vision issue and totally debilitated from pain and my body not functioning properly. Have not been right since. I wonder if I may have Graves as well, will ask for that test! Very concerned that this is causing permanent damage to my organs and bones...put my doctor has no sense of urgency.
Thank you so much for your help!
COMMUNITY LEADER
It sounds like you really could stand to find another doctor; yours will probably keep you very ill.
Low TSH doesn't cause osteoporosis; it's abnormally high levels of Free T3 that do that. She's also wrong that anywhere in the FT3 range is good; it's not.... we're all different and we need different levels. For instance, we have some members who need to be at the very top of the range, and some who feel better at the bottom of the range. I, personally, do best somewhere near the middle or slightly above; if I go too low, I have hypo symptoms, but if I go too high, I get the pounding heart and palps.
Low TSH doesn't cause osteoporosis; it's abnormally high levels of Free T3 that do that. She's also wrong that anywhere in the FT3 range is good; it's not.... we're all different and we need different levels. For instance, we have some members who need to be at the very top of the range, and some who feel better at the bottom of the range. I, personally, do best somewhere near the middle or slightly above; if I go too low, I have hypo symptoms, but if I go too high, I get the pounding heart and palps.
I have noticed that when hypo, I get acne and if you noticed a sudden increase in skin wrinkling? This has happened to me when I first got hypo and continues..acne comes and goes as levels change, oh and hot flashes and hot when trying to sleep too. All stop when i get the T3 in a better range. Any one else?
Thanks
Thanks
Thanks for your help. My doc won't let me go up on the T3, but I'm so bad off that I will do it anyway. She had prescribed 15mcgs and I've cut the pills and I'm only at 12.5, will go up by another 1.25 for 3 days and if no improvement go to the whole 15mcgs. She wants my TSH to raise, she thinks I'll get Osteo and also believes that people do well anywhere in the FT3 range. I don't buy this and I've been sick too long to follow this advise. I took a prescription water pill on Tues and by Wednesday, my eyes weren't puffy and achy anymore so this just screams Hypo! I too, have a heart that is sensitive to the T3 increases which makes it difficult to raise. Small doses of Propranolol helps that somewhat. I do believe this fat in the stomach is related to the higher blood sugar, but I did have the high sugar for over a year, but didn't get the fat until my thyroid went out..so who knows for sure. As for RT3, I guess I'll just see what happens as my T4 drops. Oh, throughout this whole ordeal, my eyebrows never have regrown and about 1 yr ago my tongue got swollen and it never leaves. I use Rogain to have fill in my eyebrow. I know it shouldn't be that way if my dosage was correct. The dizziness is back for 2 days now didn't have it when my FT3 was 3.7 last month.
COMMUNITY LEADER
I went back to my calculation of your FT3; the 57% was a typo; it's actually only 54%.
Because T3 med works quickly, it's always best to raise it slowly, in order to keep from getting it too high. I, personally, wouldn't increase more than 2.5 mcg at a time.
Metformin is a standard script for Type II diabetes, so if you can prevent that, you're ahead of the game. I've seen a lot of people lose quite a bit of weight once they get on it, though. I wouldn't mind giving that a try, but my doctor doesn't want to go that route yet, because my blood sugar levels are still in the "pre-diabetes" stage.
Typically, the damage to bones, heart, etc is from having too high levels of FT3, not low TSH. While your FT3 may have been too high, at one time, it isn't now, unless you feel like you're having hyper symptoms. Not everyone needs FT3 high in the range. Mine's at 3.4 (2.3-4.2) and I do get some palps and pounding heart once in a while; when that happens, I have to back down the T3 med for a couple days, then I'm okay.
I was diagnosed with Metabolic Syndrome, because I have all of the components of it, which are high blood pressure (or being treated for it), high cholesterol/triglycerides, insulin resistance/high blood sugar, overweight around the middle. Having just one of the components doesn't constitute metabolic syndrome, but 3 does. I have all 4.
I was slim and fit for 58 yrs of my life, so I know how to eat right and exercise, as well, but once we get a certain set of issues, a lot of things we did before fly out the window. I have a family history of both Type I and Type II diabetes and heart issues, etc, so I guess I should have seen some of this coming.
It's possible that the RT3 issue is a big part of your problem - may be some of mine, as well, but my doctors don't test for it and I haven't made up my mind to spring for it, out of pocket yet; however, insulin resistance also wreaks havoc with your metabolism (insulin is often referred to as the "fat storage" hormone). It's more difficult when you're fighting something on 2 different levels.
The hair on my head has mostly grown back, and overall, I feel pretty good; I've even gone for a couple months, now, without needing a nap in the middle of the day. The weight issue is the main thing I deal with now and I believe my cholesterol level is tied to that, as well. I feel relatively sure that if I could lose 10-15 pounds cholesterol would come back into normal ranges.
Will be interesting to see what your doctor says.
Because T3 med works quickly, it's always best to raise it slowly, in order to keep from getting it too high. I, personally, wouldn't increase more than 2.5 mcg at a time.
Metformin is a standard script for Type II diabetes, so if you can prevent that, you're ahead of the game. I've seen a lot of people lose quite a bit of weight once they get on it, though. I wouldn't mind giving that a try, but my doctor doesn't want to go that route yet, because my blood sugar levels are still in the "pre-diabetes" stage.
Typically, the damage to bones, heart, etc is from having too high levels of FT3, not low TSH. While your FT3 may have been too high, at one time, it isn't now, unless you feel like you're having hyper symptoms. Not everyone needs FT3 high in the range. Mine's at 3.4 (2.3-4.2) and I do get some palps and pounding heart once in a while; when that happens, I have to back down the T3 med for a couple days, then I'm okay.
I was diagnosed with Metabolic Syndrome, because I have all of the components of it, which are high blood pressure (or being treated for it), high cholesterol/triglycerides, insulin resistance/high blood sugar, overweight around the middle. Having just one of the components doesn't constitute metabolic syndrome, but 3 does. I have all 4.
I was slim and fit for 58 yrs of my life, so I know how to eat right and exercise, as well, but once we get a certain set of issues, a lot of things we did before fly out the window. I have a family history of both Type I and Type II diabetes and heart issues, etc, so I guess I should have seen some of this coming.
It's possible that the RT3 issue is a big part of your problem - may be some of mine, as well, but my doctors don't test for it and I haven't made up my mind to spring for it, out of pocket yet; however, insulin resistance also wreaks havoc with your metabolism (insulin is often referred to as the "fat storage" hormone). It's more difficult when you're fighting something on 2 different levels.
The hair on my head has mostly grown back, and overall, I feel pretty good; I've even gone for a couple months, now, without needing a nap in the middle of the day. The weight issue is the main thing I deal with now and I believe my cholesterol level is tied to that, as well. I feel relatively sure that if I could lose 10-15 pounds cholesterol would come back into normal ranges.
Will be interesting to see what your doctor says.
Switching to dessicated is not gong to fix things for you.
There is lots of good info available that says that serum thyroid hormone levels may not reflect tissue thyroid levels. Further, that the very best measure of tissue thyroid levels is the ratio of Free T3 to Reverse T3.
Understand that Reverse T3 is a natural result of conversion of T4. Under some conditions, the body will convert too much T4 to Reverse T3. Excess Reverse T3 is a mirror image molecule of T3, but RT3 is biologically inactive. When RT3 is excessive, it tends to offset the effect of Free T3. If the ratio gets too low, then the result can be hypothyroid symptoms.
When taking a T3 type med such as Cytomel, it is hard to know what a representative result is for Free T3. It depends a lot on when you took the med and when blood was drawn for the test. That is one of the reasons that it is recommended to wait until after blood draw to take T3 meds.
If I assume that your Free T3 is a representative result, your FT3 to RT3 ratio is about 1.36 (3.3 divided by 24.1, times 10). The recommended level is more like 1.8 or higher. There are several ways to treat this. Your case is quite like mine from some months ago. My ratio was too low, mainly due to high RT3. My T4 dosage was reduced, so there was less T4 available to convert to RT3, and my T3 med was increased to raise my FT3. This worked very well. My ratio is now well above the range, and I feel better than before.
Not saying that the FT3 to RT3 ratio is the sole issue for your weight gain, but if you get it to the right level it will certainly be a good start.
There is lots of good info available that says that serum thyroid hormone levels may not reflect tissue thyroid levels. Further, that the very best measure of tissue thyroid levels is the ratio of Free T3 to Reverse T3.
Understand that Reverse T3 is a natural result of conversion of T4. Under some conditions, the body will convert too much T4 to Reverse T3. Excess Reverse T3 is a mirror image molecule of T3, but RT3 is biologically inactive. When RT3 is excessive, it tends to offset the effect of Free T3. If the ratio gets too low, then the result can be hypothyroid symptoms.
When taking a T3 type med such as Cytomel, it is hard to know what a representative result is for Free T3. It depends a lot on when you took the med and when blood was drawn for the test. That is one of the reasons that it is recommended to wait until after blood draw to take T3 meds.
If I assume that your Free T3 is a representative result, your FT3 to RT3 ratio is about 1.36 (3.3 divided by 24.1, times 10). The recommended level is more like 1.8 or higher. There are several ways to treat this. Your case is quite like mine from some months ago. My ratio was too low, mainly due to high RT3. My T4 dosage was reduced, so there was less T4 available to convert to RT3, and my T3 med was increased to raise my FT3. This worked very well. My ratio is now well above the range, and I feel better than before.
Not saying that the FT3 to RT3 ratio is the sole issue for your weight gain, but if you get it to the right level it will certainly be a good start.
I must have figured out the FT3 wrong, being 75% of the range? If I could relieve my symptoms, by upping the T3 I'd be so thrilled! How much would you suggest? Then I could run it up the flag pole!
I'm not about to try Statins again..no way and Metformin..would be a last resort! I think the doc needs to get to the bottom of this, the hypo or hyper could be doing all this.
My concerns are about my bones and possibly my vision from being over medicated for so long, also my heart and my liver has mild diffuse fat now. She says I'm nearly Type 2 and I'm concerned about that. Been borderline since 2009, sometimes the tests shows diabetes sometimes not. I do believe this is Metabolic Syndrome..having all these issues. I think it's probably that I'm resistant to insulin. I can't lose the fat in my midsection. Exercise regularly when not laid up from symptoms. Had been slim and fit my entire life and everything went haywire. I know how to eat and be fit, was for 46 yrs. I did see my Cholesterol drop by 50points in one month when on Armour and it has plateaued now. I hear the main cause of heart attack is inflammation, namely C- Reactive protein. Have known of several people with perfect cholesterol having blockages and heart attacks.
How were you diagnosed with Metabolic Syndrome?
Well Barb, we have certainly been through the ringer! It sound like you are on top of things and fighting the good fight!
I have had hair regrowth and a significant increase in energy. Don't know about weight, afraid to look, but I seem some smaller in some places.
I keep reading that a switch to Dessicated would fix all this..just don't know what to do.
This is my 4th Endo and they just seem to be clueless on some things and there is no sense of urgency to get me well. But, after all these years and blood draws sometimes monthly and all the issues, I have become fearful of having some of the testing and have put it off for months. Sometimes I just can't take anymore bad news. That must sound ridiculous!
I'm not about to try Statins again..no way and Metformin..would be a last resort! I think the doc needs to get to the bottom of this, the hypo or hyper could be doing all this.
My concerns are about my bones and possibly my vision from being over medicated for so long, also my heart and my liver has mild diffuse fat now. She says I'm nearly Type 2 and I'm concerned about that. Been borderline since 2009, sometimes the tests shows diabetes sometimes not. I do believe this is Metabolic Syndrome..having all these issues. I think it's probably that I'm resistant to insulin. I can't lose the fat in my midsection. Exercise regularly when not laid up from symptoms. Had been slim and fit my entire life and everything went haywire. I know how to eat and be fit, was for 46 yrs. I did see my Cholesterol drop by 50points in one month when on Armour and it has plateaued now. I hear the main cause of heart attack is inflammation, namely C- Reactive protein. Have known of several people with perfect cholesterol having blockages and heart attacks.
How were you diagnosed with Metabolic Syndrome?
Well Barb, we have certainly been through the ringer! It sound like you are on top of things and fighting the good fight!
I have had hair regrowth and a significant increase in energy. Don't know about weight, afraid to look, but I seem some smaller in some places.
I keep reading that a switch to Dessicated would fix all this..just don't know what to do.
This is my 4th Endo and they just seem to be clueless on some things and there is no sense of urgency to get me well. But, after all these years and blood draws sometimes monthly and all the issues, I have become fearful of having some of the testing and have put it off for months. Sometimes I just can't take anymore bad news. That must sound ridiculous!
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