FT3 not improving??

[Klax79]

I know Hashi's usually don't convert well, mine is really not improving much. My symptoms r not that bad yet, coz I caught this problem early. Crazy weight gain & poor recovery after workouts are the main concerns. The nagging pain at my elbow was gone once I started the meds.

Jul'14
FT4 - 13.38 (9.0-19.0)
FT3 - 3.58 (2.63-5.7)
TSH - 6.59 (0.35-4.94)
-> On 5mcg Cytomel + 50mcg T4 in the morning

Sep'14
FT4 - 14.90 (9.0-19.0)
FT3 - 3.60 (2.63-5.7)
TSH - 2.14 (0.35-4.94)

Doc seems pretty happy with the ratio. I agreed that my FT4 is in the good range now but FT3 still quite ****** (it technically didn't "budge" at all). She's maintaining the T4 dosage & I managed to convince her to up the T3 (she prescribed 7.5mcg).

Looking at the results, my body's not converting any more FT3 with the increase in FT4. Is splitting Cytomel dosage the only way? I've never really asked abt NDT meds coz she wasn't really keen during my 1st visit. Any other possible reasons for the poor conversion? I'm already taking 200mcg Selenium & doc seems surprised that this is not even helping.

[gimel]

There are claims, based on anecdotal information, as yet unsupported by valid scientific data, that gluten molecules escaping the gut cause the immune system to produce antibodies to attack and destroy.  Further claimed that the gluten molecule has the same appearance as thyroid tissue, so the antibodies also attack the thyroid gland.  Of course that doesn't explain why there are two different antibodies TPO ab and TG ab that can be associated with Hashi's.  Going gluten free seems to be the latest big thing, and if beneficial, go for it.  Even if claims about antibodies are true, going gluten free does not cure whatever damage previously occurred, so thyroid med is still required for that, at the least.

As for a ratio of T4 to T3 ratio, You'll run across that concept occasionally.  I find no evidence of its importance.  If you think about it you could have a good ratio with both T4 and T3 at the low end of their ranges, and a similar good ratio with both at the high end of their ranges.  I sure would not expect similar effect on your body.  

Our experience has been that hypo patients find that their optimal levels to relieve symptoms are usually Free T3 in the upper end of the range, and Free T4 around the middle of its range, at minimum.  Your Free T4 is adequate.  Your Free T3 is only at 37% of its range.  Plenty of room to raise your Free T3 if you still have hypo symptoms.  

Also, since hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin.  You should make sure those are optimal also.  D should be around 55-60.  B12 is best in the very upper end of its range.  And Ferritin should be about 60 minimum for women.  

Your doctor also needs to understand that a hypo patient taking thyroid med often has suppressed TSH levels.  That does not mean hyperthyroidism, unless hyper symptoms are present due to excessive levels of Free T3 and Free T4.  If you need references to scientific data that support that, in order to convince your doctor, I can provide.  

[Klax79]

Apr'15
FT4 : 14.11 (9.0 - 19)
FT3 : 3.79   (2.63 - 5.7)
TSH : 0.217(0.35 - 4.94)

On 75mcg T4 & 10mcg Cytomel (split 5mcg 2x daily). Managed to get the FT3 back up but prob still not at the optimal range yet (my highest ever FT3 was only 3.84). Doc was thinking of cutting back the T3 but I gave her a very HORROR reaction. LOL

She said smt about the T4 T3 ratio is at a pretty good level, so she'll keep back the same dosage & MIGHT drop a little of T3 next round. I have NO idea wat ratio that is.

[Klax79]

So, my GI test came back and woah….my doc wasn't expecting that much issues going in my gut.

1. Need a further Urea Breath test for Helicobacter Pylori as antibodies were found

2. Entamoeba Histolytica and Tapeoworm antibodies detected

3. Elevated Intestinal Lysozyme & Alpha Anti-Chymotrypsin levels (indicating ongoing colonic inflammation)

4. Tested Positive (SIgA) for Gliadin, Milk, Soy & Egg (Food sensitivity to ALL four is CRAZY!!)

It's going to be a LONG road to healing the gut and hopefully once the gut gets rebooted, it will somehow help with the Hashis.

I read from sources that our immune system starts with the gut. Since Hashis is a AI disease, I think getting a GI test & knowing what's going "haywire" 's a good start to getting it under control.

[gimel]

Be aware that hypothyroidism can cause low stomach acid levels and thus poor absorption of vitamins/nutrients.  

[Klax79]

Well, she "stuck" to 10mcg coz her last official dosage was 7.5mcg (I tweaked it up to 10 on my own). I tend to dose myself these days, so she sorta letting me run the show unofficially. My Cytomel is specially compounded at 5mcg per cap, so I'll test out 15mcg per day & see how it goes.

My Naturopath doc doing a full panel GI test coz she suspects my gut is causing the malabsorption issue.

[gimel]

Why didn't the doctor increase your T3 med.  Doesn't matter where the T3 went, you need more.  Looks like you need T3 to raise your Free T3 level, more than increasing T4.  With that Free T3 no wonder you would be tired and losing hair, among other symptoms like low metabolism, I am sure.

[Klax79]

Been on the split dose for the past 6-8wks. So it really baffled both my Endo and I that the FT3 dipped so drastically this time round (all time low).

With Duramine, it's hard to gauge my energy levels. I don't take it on weekends, and I tend to feel sleepy even after 10hrs of sleep when I'm just lazing ard at home. My hair fall rate seems to be picking up too.

[gimel]

How long have you been on that dose, and splitting the dose?  How are you feeling?

[Klax79]

Hi Gimel,

Tried splitting the T3 dose, 5mcg AM & 5mcg noon. My current results dumbfounded my Endo coz she just don't understand where all my T3 went. LOL

Jan'15
FT4 : 15.45 (9.0 - 19)
FT3 : 3.06   (2.63 - 5.7)
TSH : 2.627 (0.35 - 4.94)

For now, she's increasing my T4 to 75mcg & T3 at 10mcg daily, which I'm not sure if its addressing the right problem. I myself am surprised that the results got worse this round, my FT3 is at the LOWEST of all time.

My naturopath doc suspects my gut is not functioning well, so she's getting me to do a GI health panel.

[Klax79]

Thanks gimel. I'll try to split the dose and see if helps.

[gimel]

The usual recommendation is to fast before the blood draw.  Also, I frequently read that symptom relief typically requires Free T3 in the upper part of its range, and when you have not taken the med before blood draw.  Your practice of  taking all your meds in the morning really stretched out the time without meds before blood draw, and would lead to lower than expected Free T3 levels.   For best results and for purposes of comparison to levels that seem to work for many people, I suggest that you split your dose and take half in the morning and half in the afternoon.  Then skip your morning dose before blood draw.

[Klax79]

Hi Bearika!

Since my Endo started me on Duramine from Sep onwards, the weight gain has stopped. Fatigue wise it's pretty much the same, not much difference since Sep, but definitely better than back in March when I was diagnosed with Hashi's. I still can't recover fast enough after exercise, & it takes considerable effort just to finish my workout. I used to do weight training for Strongman, so I'm now tapping into my mental endurance just to finish an hour of yoga.

And my cycle has not kicked back in since Jan. My symptoms are probably considered mild compared to other members in this forum. Should I be less greedy? LOL

[Bearika]

Hello!

I just switched from natural (Armour) thyroid to a combo of the 2 medications you are on (at the same starting does you were on - 5mcg generic Cytomel + 50mcg T4 in the morning ).

Just curious, aside from the blood tests did you see any improvement in the weight gain and/or fatigue since starting in September?  Thanks!

[Klax79]

It's Liothyronine Sodium from Keifei Pharma, which is the same as Cytomel based on Wikipedia. Per tab is 25mcg, coz that's the smallest dose per tab my friend could get his hands on (I actually wanted 10mcg/tab).

I think it would b interesting to test out my GP's recommendation to do a blood test 2hrs after taking T3 to see how much my FT3 numbers will look like. That might prob b a good indicator if I'm at the recommended upper range with T3 in my system. Coz the "fasting" blood draw apparently don't paint a true picture if I'm not really converting.

[gimel]

Sorry, that should have been "from a blood draw 27 hours later."

[gimel]

I would think that 25 mcg of T3 (if it really is that) would also have more noticeable effect.  Which makes me wonder is it really T3 and really 25 mcg of T3?  Any way to confirm that?  

Another thing regarding it showing up in your test results, I think it may be that you are taking all of the med in the morning.  So It will largely have dissipated within the next 8 hours or so and would reflect that in the test result from a blood draw 15 hours later.  

[Klax79]

I usually take T3 ard 6.30am once i wake up. Blood tests are typically done in the morning ard 9.30am & I only take my T3 for the day after that.

My thought was probably that with 25mcg daily, it might somehow help raise the FT3 numbers over time even though it doesn't stay in the blood stream for long periods.

Weird thing is, I don't feel a BIG difference in energy levels btw 7.5mcg & 25mcg. Just wondering where did all that T3 go. LOL

[gimel]

Recommended method for taking a T3 med is to split the dose and take half in the morning and the other half in the early afternoon.  That is because T3 gets into the blood so quickly compared to T4.  From what I have read T3 reaches max effect in about  3-4 hours and then gradually diminishes over the rest of the day.  I really don't recommend taking the whole 25 mcg at once.

When have you previously taken your T3 med relative to the time when blood was drawn for tests?

[Klax79]

Thanks gimel!

My doc was out of compounded T3 for a while, so I managed to get T3 from a friend who's in bodybuilding. The tabs came in 25mcg, so I did some trial & error cutting up the pill and testing out incremental doses (to make sure I don't get heart palpitations or other overdose symptoms).

Technically, I've been on 25mcg daily in the morning for 6wks prior to the blood test.  I don't get particularly hyper in the morning but slightly better than when I was on 7.5mcg. So I was a little surprised that at such dosage my FT3 only increased slightly.

Will try to get a Ferritin test on my next visit (Jan'15). My GP (not Endo) was telling me to try take a blood test 2hrs after taking my 25mcg T3 med to see how it affects the reading. She's interested to know how the FT3 numbers look like with the med at such a high dosage.

[gimel]

Your Free T4 is about 55% of its range.  Your Free T3 has increased to about 39 % into the range.  Many members say they needed Free T3 to be in the upper part of the range.  It really depends on how you are feeling.  If still having symptoms, there is plenty of room to raise your T3 med some more.  

B12 is fine.  D could be a bit higher, to a recommended level of 55-60, so you could supplement again, but go back on a lower dose of D3.  Those iron tests are okay, but I would like to also see a ferritin test done at next opportunity.  I say that because ferritin is somewhat of a precursor to serum iron levels.  Low ferritin can affect conversion of T4 to T3, plus a deficiency can cause symptoms as well.

[gimel]

Copied and pasted your latest post below so that all info is in one place.  

Klax79 | 1 hour
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Requested to test for Iron, Vit D & B12 since I'm not converting well. FT3 hovers between 3.6-3.8 regardless of how much Cytomel I'm taking. Been taking 50mcg T4 & 7.5mcg Cytomel.

FT4 : 14.45 (9.0 - 19.0)
FT3 : 3.84   (2.63 - 5.70)
TSH : 1.36 (0.35 - 4.94)

Iron : 20 (11 - 27)
TIBC : 59 (39 - 60)
% Fe Saturation : 33 (14 - 50%)

B12 : 704 (138 - 652)
Vit D : 40.2 (30 - 99.9)

Doc said Iron, B12 and Vit D all look good. I have been taking Vit D (5000iu) & B12 (5000mcg) daily even before I was diagnosed with Hashis. Stopped for 2 weeks before taking these tests to get a more accurate reading. Do I still need to supplement for Vit D and B12??

[flyingfool]

We are not Dr's so we won't generally advise anyone on specific dosages.

An increase from 5 to 7.5 mcg of cytomel is a normal jump. yes it is small, but T3 is pretty powerful stuff.  They say T3 ijs 4 times or 400% more effective than T4.  So while the increase is small, it can pack some punch.  It is usually always better to go up slow.

This is a small bump.  And you will have to wait a couple weeks to get blood drawn again to see what it is doing.  One thing you can do is pay close attention as to how you are feeling.  And the next time you get tested and talk with your Dr tell the Dr that the increase made you feel better (unless it makes you feel worse).  This will give some credibility to you and some confidence on the Dr's part to be open and least potentially to another small increase.  If you say it did nothing then your Dr will most likely look at you and tell you "told yo so" and stiffen in their opposition to further adjustments to increase.

I can't remembner if you split your dose.  But now that you are on 7.5 daily. It gives you the opportunity to take the 5 mcg in the morning and the other 2.5 mcg in the afternoon maybe between 1 to 3 PM.  Having this 2nd dose may allow you to feel better later in the day and in fact be a felt improvement.

Hope this helps.

[Klax79]

Anyone has an idea what kind of T3 dosage I should be asking for? I think 7.5mcg is still insufficient…..

[Klax79]

She felt that my latest bloodwork's "ratio" is pretty good, so she was ok to up my T3 a TINY little bit (duh). My numbers and symptoms are probably not that BAD enough to warrant a higher dosage of T3, so she's rreeeaallly conservative on upping the med.

My FT3 are not even in the mid range right? Hopefully we can identify the cause of non conversion from the tests and work from there, and at the same time bug her for more T3!