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FT4 to FT3 Conversion Problem --- Doctors Do Not Order Correct Tests

Back in April 2011, I posted in a different thread that I felt I had an FT4-to-FT3 conversion
problem. My FT4 was rising, while my FT3 was staying the same. My hypothyroidism symptoms
(arthritic pain in hands, pain in knees, sluggishness, memory lapses) were bad.

Here is the thread:

http://www.medhelp.org/posts/Thyroid-Disorders/I-Stop-Taking-Vitamin-D-Free-T4-Goes-Up-Free-T3-Stays-Same/show/1500525



The poster known as gimel said that I should be tested for the following:

(vitamins A, D, B12) and (RBC magnesium, zinc, and selenium).  

gimel said that deficiencies in some or all of these can cause hypothyroidism symptoms.



I sent an email to my endo, asking for these 6 tests. The endo said that he would order the
vitamin D test but that the other 5 tests are not tests that he normally orders. The endo said
that I should ask my primary-care physician (PCP) for the other 5 tests.

I sent an email to the PCP, asking him for these 5 tests. Like the endo, the PCP said that he would
be willing to order the vitamin D test. However, the PCP wanted to see some information about the
usefulness of the other 5 tests.

So, I did some research.



I found the following website:

http://www.thyroid-info.com/articles/topsupplements.htm

This website shows the relation between thyroid function and vitamins E & D, selenium, and zinc.
The website also mentions vitamins A & C, Omega 3 & 6 fatty acids, and free-form amino acids.


I also found this website:

http://www.*************************/lab-values/

This website explains the tests for vitamin B12, ferritin, and RBC magnesium.


However, the most shocking discovery that I made was this website:

http://www.eurekalert.org/pub_releases/2009-04/arf-vdm040809.php

This website explains that, if a person has autoimmune disease, then vitamin D may make the
autoimmune disease WORSE. My hypothyroidism stems from autoimmune disease. If vitamin D will
make my autoimmune disease worse, then that may explain why my FT4 and FT3 levels went down
when I used vitamin D, even though I used vitamin D and Synthroid far apart from each other.



So, I sent an email to the PCP, telling him about all 3 websites. I said that I should
*definitely* be tested for vitamins E & D, selenium, and zinc. I said that *maybe* I should
also be tested for the following: (vitamins A, C, B12), RBC magnesium, ferritin, Omega 3 & 6
fatty acids, free-form amino acids, and the adrenal glands and stress hormones.

The PCP said that he sees no usefulness to any of these tests, other than the vitamin D test. The PCP
did, however, say that he suggests taking a vitamin and mineral supplement + vitamin E.



First of all, why did the endo tell me to ask the *PCP* for the following 5 tests: (vitamins A, B12)
and (RBC magnesium, zinc, and selenium)? If these tests are thyroid-related, shouldn't the *endo* be
handling them?

And why would the PCP tell me to take vitamins and mineral supplements without first testing me to
find out which vitamins and minerals I am deficient in? He tells me to take vitamin E without testing
my vitamin E levels. Without a blood test, how do I know how much of a dosage of vitamin E I need,
if any?

And the one test the PCP *does* want to give me is for the substance (vitamin D) that I can't
swallow, no matter what, because that substance makes my autoimmune disease worse.

What is going on here?

Thanks for any answers.



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Avatar universal
Well, about 10 days ago, I had some new blood tests.


These blood tests included five thyroid tests (TSH, Total T4, Free T4, Total T3, Free T3). My endo believes that the Total T4 and Total T3 tests give a more complete picture.


Here are the results:

TSH = 0.446       (normal range = 0.450 - 4.500 uIU/mL)


Total T4 = 9.9    (normal range = 4.5 - 12.0 ug/dL)          

FT4 = 1.41        (normal range = 0.82 - 1.77 ng/dL)


Total T3 = 106    (normal range = 71 - 180 ng/dL)

FT3 = 3.0         (normal range = 2.0 - 4.4 pg/mL)



My Total T4 level is above the middle of the Total T4 normal range, and my FT4 is above the middle of the FT4 normal range.  

However, my Total T3 is in the lower one-third of the Total T3 normal range, and my FT3 is below the middle of the FT3 normal range.

To me, this indicates an "FT4-to-T3 conversion" problem.





The blood tests from 10 days ago also included tests for Vitamin E, Selenium, and Zinc. Deficiencies in these substances could interfere with "FT4-to-T3" conversion. Since Zinc is connected to Copper, and since Copper is connected to Iron, I was tested for Copper and Iron (Ferritin) as well.

Too much or too little Cortisol also can interfere with "FT4-to-T3" conversion. I was tested for Cortisol, too.


Here are the results:


vitamin E (Alpha Tocopherol) (serum) = 7.8    (normal range = 4.6 - 17.8 mg/L)

Selenium (plasma or serum) = 161    (normal range = 79 - 326 ug/L)



Zinc (plasma or serum) = 90    (normal range = 56 - 134 ug/dL)

Copper (plasma or serum) = 114    (normal range = 72 - 166 ug/dL)

Ferritin (serum) = 276    (normal range = 30 - 400 ng/mL)



Cortisol - AM = 18.1    (normal range = 6.2 - 19.4 ug/dL)

Note: I had the Cortisol test done at my "morning awakening". Because I usually go to bed late and wake up late, my "morning awakening" was about 1:15 PM. The Cortisol test, and the ten other blood tests mentioned above, were all done with the same blood draw.



Well, the Zinc is just a little below the middle of the Zinc normal range, and the Copper is just a little below the middle of the Copper normal range. The Ferritin is in the upper one-third of the Ferritin normal range. So, the Zinc, Copper, and Ferritin levels seem to be correct.

My Cortisol level seems to be in the very high normal range. Could my Cortisol level be *too* high? Could my Cortisol level be causing "FT4-to-T3 conversion" problems?

Now we come to the Selenium and the Vitamin E. My Selenium level is in the lower one-third of the Selenium normal range, and my Vitamin E level is in the lower one-fourth of the Vitamin E normal range. So, it seems to me that my Selenium and Vitamin E levels are too low. It seems that these low levels are the most likely cause of "FT4-to-T3 conversion" problems.



Well, I was thinking that I should start taking Vitamin E supplements and/or Selenium supplements. I could start out by taking the lowest doses of these supplements (400 IU of Vitamin E and 100 mcg of Selenium), three times a week. I could take these supplements with my 1000-mcg Vitamin B12 supplements, which I also take three times a week.


However, I recently saw the following report:

www (dot) medicalnewstoday (dot) com/articles/242329.php

According to this report, people who have Selenium levels of 122 ug/L or higher, should not take Selenium supplements. Otherwise, they have a high risk of developing Type 2 Diabetes.


I also saw this report:

www (dot) emaxhealth (dot) com/1275/selenium-and-type-2-diabetes-have-special-relationship

This report seems to say that *low* levels of Selenium cause Type 2 Diabetes.



Thus, it appears that we have contradictory information about Selenium and Type 2 Diabetes.

So, should I take Vitamin E supplements and/or Selenium supplements?



Thanks for any information.


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649848 tn?1534633700
COMMUNITY LEADER
I don't remember the exact number of my selenium result, but it was in the low normal range. I take a 200 mcg capsule/day, which from my research is safe, even though the RDA is only something like 70 mcg.   Selenium can be toxic if taken in too large dosages, so talk to your doctor before supplementing.  

I've had the rapid, loud, pounding heartbeat a lot.  I also had a complete heart workup, because of it.  While all 4 of the valves in my heart leak/regurgitate, that is not what causes the loud heartbeat.  Mostly it's caused by anxiety and it happens even when I don't "feel" particularly anxious and even sometimes, when I'm in the best of spirits, which can also cause a form of anxiety.

Consumption of all vitamins/minerals should be separated from thyroid medication by at least 4 hours.  To be on the safe side, I take my Tirosint (T4) first thing in the morning, then my T3 about an hour later, then again around noon.  I take all vitamins/minerals at bedtime to insure adequate separation.  
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Avatar universal
Barb135 wrote:

"You can try supplementing with selenium and see if that helps bring your FT3 levels up.  I find that if I take it daily, my FT3 levels stay good, but if I slack off, they tend to drop. Doesn't mean that will hold true for everyone."


------------------


Barb, I wanted to discuss your comments about your use of Selenium.


In the summer of 2011, I was tested for Selenium and Vitamin E, two substances that aid in FT4-to-FT3 conversion. The results of the tests were as follows:

Selenium (serum/plasma) = 150 ug/L, normal range = 79 - 326, detection limit = 10

vitamin E (Alpha Tocopherol) (serum) = 7.0 mg/L, normal range = 3.0 - 15.8


Each value was within the normal range, but each value was in the lower one-third of the normal range. So, were my values too low?


When you started taking Selenium, what was your Selenium value in relation to the normal range? And what dose of Selenium do you take, and how often?





As for my heart, I previously mentioned that, back in May 2012, I took a five-day break from thyroid medicine. Shortly after I resumed taking Synthroid 125, I started feeling a loud and hard heartbeat. And I've felt this loud and hard heartbeat from time to time. I googled "loud heartbeat" on the Internet. Some said that a loud heartbeat was caused by anxiety. However, others said that a loud heartbeat indicated a possible heart problem, and my then-endo's EKG had, indeed, shown possible LVH (left ventricular hypertrophy).

My echocardiogram from mid-July 2012 seemed to show an absence of LVH. According to the report, "The LV ejection fraction is normal. The visually estimated left ventricular ejection fraction is normal at 65 to 70%."

However, the report did indicate that the atria were mildly dilated, that some 2D measurements were above normal range, and that three valves had trace or trivial regurgitation. One theory is that one or more of these things caused my loud and hard heartbeat.


Another possible cause of my loud and hard heartbeat is hypothyroidism. What is the evidence for this? Well, for starters, the loud and hard heartbeat began very shortly after I took the five-day break from thyroid medicine.

Also, I have previously mentioned my belief that Vitamin D interferes with my body's absorption of thyroid medicine. One day in mid-June 2012, I took a 1000-IU Vitamin D pill, and I felt some heart discomfort right after that. This convinced me, that the Vitamin D's interference with my body's absorption of thyroid medicine might be causing hypothyroidism, and that the hypothyroidism, in turn, might be causing the heart discomfort. So, once again, I stopped taking Vitamin D.

Furthermore, some woman said on a different message board that hypothyroidism was causing her to have "racing pulse". Well, if hypothyroidism can cause "racing pulse", then hypothyroidism can also cause a loud and hard heartbeat.




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649848 tn?1534633700
COMMUNITY LEADER
TSH "Values are highest in the early morning and lowest in the afternoon"
http://jcem.endojournals.org/content/92/12/4560.full

"Thyroid Stimulating Hormone (TSH)
An indicator of thyroid function.
Normal range for an adult: 0.4 – 5.5 mU/mL
Preparation
    This test may be measured any time of the day without fasting."
http://my.clevelandclinic.org/heart/services/tests/labtests/thyroid.aspx

"Do I need to fast before taking the test?
No. Fasting is not required before a thyroid function lab test."
http://www.thyroidcheck.com/thyroid-tsh-test-sarasota.html

"Thyroid function tests include: TSH, T4 and T3 estimations. All these tests may be measured any time of the day without need for fasting."
http://www.mediscuss.org/should-i-do-thyroid-function-tests-empty-stomach-725/
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Avatar universal
I agree with you. The only part of Mary Shomen's article that interested me occurred in the section titled "Other Findings." I've never had elevated TSH yet have had every hypo symptom and low FREEs without medication, so SYMPTOM relief is certainly paramount to me. Yet I recommend the section on TSH to those who DO have classic hypothyroidism, just as a point of information.

I always have my labs drawn at the same time of day and under the same dietary conditions...it only makes sense to me to be consistent. Otherwise it would be like that old saw, comparing apples to oranges. And I always get a copy of my labs and write my current dose of medication on it for future reference. But that's just me.
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Avatar universal
This is why SYMPTOMS are to be primary with blood labs being secondary to proper treatment.

Also most all the discussion talks about the variability of TSH.  And most of us here know that TSH is virtually totally useless and is so variable.  The discussion above is just further proof as to how variable and unreliable and obsolete the TSH test is.

As far as T4 I'm not so sure.  I would seem to make some sense that the FT4 number MIGHT be slightly higher.  After all you ARE putting medication onto your blood.  But what significant amount that would be I guess is the debatable question.  Something that we know takes weeks to stabilize in the blood would certainly suggest the single daily dose wouldn't have a very significant alteration.

T3 knowing that this is active and immediately available in hours seems clearly to suggest that T3 medication should not be taken before a test.

I think the REAL point that should be considered is that the testing time AND whether or not you have eaten and/or taken medication should be as close to 100% consistent as possible.

Then symptoms with a consistent testing lab, testing time, fasting and medication before the tests remaining constant.  Compare the symptoms with the blood tests and keep adjusting slowly the medication to alleviate symptoms is what is needed.  The lab numbers are relative to the symptoms, not the other way around.

One endo we've seen when asked about separating the medication from food said.  Sure absorption is affected. But if you take the medication and eat similarly each day, all that needs to be done is raise the dosage to make up for any loss of absorption.  In his experience he would rather have the person take thier medication when it is convenient AND consistent.  The consistency of the person taking the medication and nor forgetting or what not is dramatically decreased when it best fits in with the individual persons lifestyle.  In other words, he would rather just prescribe a higher dosage than would otherwise be necessary if the person was consistently taking their med with breakfast for example every day. Than a person who forgets every few days to take medication because they forgot to wait for X amount of time after eating etc.

Again I think that keeping everything consistent is most important.  Whether a person wants to maximize the efficiency of the medication by separation of food and timing etc is a personal decision.

A person who does NOT take medicine and fasts for an early morning blood test seems like about the most perfect consistent thing that could be done. So I see nothing wrong with this and maybe even the best thing to do.  But that may not work out for some people's life or work schedule.
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Avatar universal
I believe this is only YOUR opinion, Barb. I take T3 so I always have my labs done first thing in the morning, so it's a moot point for me personally. However the last naturopath I consulted told me neither thyroid medication should be taken before the test, and I've read differing opinions to yours as well. My doctor now prefers that I do not take either T4 or T3 before my labs, and the lab told me it's best not even to have had anything to drink before the test. Here is one differing opinion, from Mary Shoman's website:

"Usually, our doctors tell us that fasting is not necessary for thyroid blood tests, nor does it matter when tests are done -- particularly TSH tests. Only those patients taking an external source of T3 -- such as Cytomel, Armour Thyroid, Nature-throid, or a time-released T3 medication -- need to be aware of when they've taken their medication and the timing of testing, as T3 is active only for hours in the body, while T4, both synthetic and natural, has a much longer period of activity. Given that TSH tests reflect the impact of several weeks of medication, it's hard to argue that time of day or fasting would have an impact on the testing and results.
Interestingly, however, research by Scobbo et. al. in 2004 showed that TSH tests declined in 97 of 100 of the people studied -- by an average of 26.39% -- when compared to early morning, fasting, TSH test results. This resulted in as many as 6% of patients being reclassified from the diagnosis of subclinical hypothyroidism to "normal."

Researchers concluded that the diagnosis of subclinical hypothyroidism should not be made only on a fasting TSH measurement.

Implications for Patients

Essentially, these researchers retested patients later, when they could get a normal range result and declare the patients to be free of hypothyroidism.

Doing so, however -- retesting a patient without fasting, later in the day, in order to see if an elevated TSH level will then drop down to be "borderline normal" -- is questionable medicine, at best.

It's particularly questionable, given that researchers have not established that the earlier, fasting level results are any less valid than the later, non-fasting, "normal range" results. Researchers also don't even know how fasting affects thyroid function or TSH values, or why TSH values would be different based on fasting or non-fasting.

In some cases, if you are having your thyroid testing done along with other bloodwork -- such as glucose, insulin, or cholesterol levels done -- you will be asked to fast, and have your test done first thing in the morning. In other cases, your doctor may not dictate when to have your TSH test, or whether or not to fast. But be aware that if you test later in the day and you've eaten, you are likely to have a lower TSH level than if you test earlier in the day with fasting.

Other Findings

Other information actually supports the idea that patients should not take any thyroid medication the day of testing, until after tests are completed.

The Thyroid Manager online textbook mentions that

Serum T4 concentrations peak 2 to 4 hours after an oral dose and remain above normal for approximately 6 hours in patients receiving daily replacement therapy.
For this reason, thyroid expert Richard Shames, MD has the following recommendation:
I absolutely recommend that patients have any morning blood tests evaluating the thyroid before taking any thyroid medication. I have always told my patients to do it this way."

Since it is just as easy, at least for me, to go to the lab and have the draw done first thing in the morning, and since in fact when endos drew my blood in their office later in the day after I had taken my meds, my FREE T4 as well as my FREE T3 was elevated more than it was when I had the tests done in the lab before I took my meds.....and since it is easy enough already for endos to mis-diagnose labs based on their own agenda (forgive my bitterness, but this is MY experience)....I personally choose to err on the side of caution and not take my meds before the blood draw.

Because there seems to be controversy, perhaps readers should Google "thyroid blood tests" and decide for themselves. If readers want to consider actual science and not patient-oriented websites and forums, pose your question something similar to this :
"Should thyroid medication be taken before a blood test meta-analysis." By putting the words "meta-analysis" after any query you are more likely to be taken to articles in medical journals.
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649848 tn?1534633700
COMMUNITY LEADER
"ALL endos should know and should inform patients of the importance of not eating or taking thyroid meds before the blood draw."

Fasting is not necessary for thyroid blood work.  It's only necessary for such things as cholesterol, etc.  Ask your doctor whether fasting is necessary or not.

Not taking thyroid med prior to thyroid labs, applies only in the case of a T3 med, because of the short time it gets into/out of the system.  T4 meds can be taken prior because it takes them so long to reach potential.  
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Avatar universal
Silly me, of course I meant a hematologist....doi ! My B-12 and D levels were really low below range and my RBC enlarged. The hematologist diagnosed pernicious anemia. The brand of liquid B-12 she told me to take is NOW brand Ultra B-12, which you can find at Whole Foods but is cheaper at some health food stores. It contains all the B's and folic acid as well. The 5000 units of B-12 is sourced from methylcobalamin, cyanocobalamin, and dibecoside in co-enzyme form, which are synergistic. The only other brand she recommended was the Jarrow you have been taking, but she said the NOW sublingual was superior.

Sorry if the endo story was unclear. Also gratuitous no doubt, but to clarify...I got worse of Synthroid only and didn't get better until I took levothyroxine generic and Cytomel together. My TSH has never been high in range, but I had ALL the symptoms of hypothyroid, not just the few grosser ones I mentioned. After a year of complaining and hair loss, I was finally sent for an ultrasound, which showed nodules on both nodes. I was initially put on Synthroid "to control their growth." The symptoms got worse, but went away with the addition of T3. I tried Armour...it made me worse and I went back on T4/Cytomel and got better again. Then the drugstore changed the Cytomel to generic T3 and I didn't notice. 4 months later, I was sick again. I was sent to a series of endos, all who only looked at my T4 and of course did obsolete total and uptake tests. The one FREE T4 test I had showed the level to be at the bottom of the range which of course endos deem to be "fine" even if symptoms continue to worsen. My TSH went from its historic .89 up to 1.6 but this was considered inconsequential. Finally as my health continued to decline, my PCP took pity on me and let me get blood tests every 6 weeks for over a year that included FREE T3 tests (very low to start) and adjust the levels of my medications until they were in the middle (T4) to the upper 1/4 (T3) of the range. At that point my TSH was suppressed way below the range, but she felt comfortable with that after reading science from medical journals that I took her. She was appalled at my callous treatment by the various endos, as she watched me gain 15 lbs of edema in 3 weeks after they lowered my meds because of my TSH. It seemed pretty clear to me that I was dealing with a conversion problem, and she agreed. But then I started to gain weight and had a gradual resumption of some symptoms such as edema of the extremities and abdomen, hair loss again, leg cramps, foot spasms, and more. I went and had rT3 tested and it was high-out-of-range and with a low ratio to T3. So I had to go off levothyroxine completely for 3 months and have blood tests again once a month until the rT3 cleared. During that time, I had to take extra T3 to try to make up for the deficit. Blood tests showed my TSH still low (but this is to be expected after having it surpressed for a long time) my FREE T4 below the normal range, and my FREE T3 at the very bottom number of the range. The last endo I saw did not see fit to remark on this. Now I am back on a low dose of T4 and my usual dose of Cytomel for one month. I have to wait 2 more weeks, then go in for a new blood test and see where I am. Feeling really awful...the edema went away after a week off T4, but now has returned in spades, worse than before. Both my antibody tests have always been normal. I will test PTH at the next blood draw.....had it done only once back in 2005 when I first went to an endo. I hope that clears things up.

And yes, endos seem to always say that symptoms must be caused by something else. The last one, based on talking to me for 1/2 an hour at most, suggested I might be bi-polar (funny how my therapist never thought so..you know, the one I saw for several years for the severe depression and panic attacks that went away as soon as I took Cytomel, or the other one who said in her opinion my problem was hypothyroid)  and he also posited that I was suffering from heavy metal poisoning because I take vitamins. Because he ignored my latest blood tests and ignored historic ones and because he also referred to me as both "Carla" and "Lisa" (nither of which is my name) in the letter he sent to my PCP (who couldn't believe it and told me to try to find another one) I intend to report him to my State medical board.

Meh. Lucky I had a PCP who is willing to deal with me and prescribe what I ask her for according to my blood tests, but she feels uncomfortable about it because (especially with rT3) she's exceeded her medical knowledge...she's an internist with a specialty in nephrology ! What does she know from the cursory classes in medical school long ago ? One would think that in a big city such as Los Angeles, with me being at one of the best hospitals in the city and with a PPO so I can go outside the hospital if necessary, that I could find a decent endo who would take my insurance.  But NOooooooooo, apparently not.

Happy New Year. Wishing you well.
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Avatar universal
Hi, artfemme.

Every thyroid blood test that I've had, was administered to me BEFORE I took my thyroid medicine and BEFORE I ate anything.

I'm sort of a night owl. I go to sleep late and wake up late. I have thyroid blood tests done between 12 PM and 2 PM.



Now, the story that you tell about your own dealings with a bad endo is a little hard to understand. A little clarification may be helpful. You say that you experienced cessation of T4 and extra supplementation of T3. So, does that mean that you stopped taking T4 medicine (such as Synthroid) and started taking T3 medicine (such as Cytomel)?

Also, you say that your TSH was sub-normal. So, was the TSH value higher than the normal range? Or lower than the normal range?

And you say that a phlebotomist prescribed Vitamins D and B12 for you. Since phlebotomists (people who draw blood in blood tests) are not doctors and can't prescribe anything, I'm assuming that this phlebotomist simply advised you to take these vitamins. Is that the case? If yes, that would be kind of unusual. In my experience, phlebotomists usually do not offer any medical advice. In fact, one of my phlebotomists even told me that she had no idea was TSH meant. :)



As for your endo's saying that your macroglossia, hoarse voice, and partially missing eyebrows were caused by something other than hypothyroidism (presumably because your thyroid test results were within a certain "normal range"), that seems to be a common practice among endos. My current endo said the same thing. She, too, doesn't know what "else" could be causing these symptoms. She simply told me to talk to my PCP.

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Avatar universal
Hi, subire. Thank you very much for the kind words! I really appreciate them!



As for Vitamin B12, the website www (dot) stopthethyroidmadness (dot) com/lab-values
states that, for a normal range similar to (180 - 900), a good value for B12 is 800 or higher. After taking 1000-mcg Methyl B12 lozenges (made by Jarrow Formulas) every day, from mid-September 2011 to early February 2012, my B12 level in early February was 887 (normal range = 211 - 946).

However, Endo 1 (my current endo's immediate predecessor) advised me to take the B12 lozenges only three times per week, which I've been doing since mid-February 2012. As a result, my B12 level dropped. The B12 level was 637 (normal range = 211 - 946) in mid-April 2012, and 626 (normal range = 180 - 933) in late October 2012.

Maybe I should go back to taking the B12 lozenges every day.



You mentioned Liquid B Complex, and I found a Liquid B Complex product on the following website:
www (dot) gnc (dot) com/product/index (dot) jsp?productId=11535359

But this product includes Vitamin B6, and I have heard that Vitamin B6 may cause people to have intense dreams. Supposedly, Vitamin B6 helps with amino-acid production for neuro transmitters like serotonin and melatonin, which regulate our sleep and dreams.

Also, the B12 in this Liquid B Complex product is Cyanocobalamin, as opposed to Methylcobalamin, which supposedly is absorbed better by the body.

So, Liquid B Complex may not be the right product for me.



As for liquid Vitamin D, I remember finding such a product, but I think it had calcium or soy. Calcium and soy interfere with the absorption of thyroid medicine into the blood.



Once again, subire, thank you very much for your words of encouragement!
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Avatar universal
Dear Bird,

If there was ever an example of the Chinese adage "perseverance furthers", it's you ! Lots of good info for everyone in this thread, glad it's still going and that you've been so exact with your data.

Just a thought : Do you always have your blood drawn at the same time of day and without eating prior to the the draw ? It's very important to be consistent when you're comparing your tests and best to have them drawn first thing in the morning. It's shocking, but my first 5 endos never told me that, and many of them drew the blood right there in their office without regard for when I had taken my meds. Of COURSE my FREE T3 levels were always high right after taking it, and then the endos would lower my meds based on their inaccurate testing (which because of my suppressed TSH, never elevated in the first place, convinced them that despite my radical hypo symptoms I shouldn't really be on thyroid meds at ALL. I obviously have a conversion problem according to every bit of research I've been able to find about what a profile like mine indicates....It's not that common, but it's been in the literature for decades. Lazy a-holes and their worship of the TSH test.)

ALL endos should know and should inform patients of the importance of not eating or taking thyroid meds before the blood draw.

So far I've been to 6 endos in Los Angeles....in my opinion, all of them have been incompetent if not outright criminally negligent. The last one, who I consulted a few weeks ago at the insistence of my PCP following an rT3 problem way above the norm with a ratio of 10 that caused a surge in hypo symptoms including spastic feet, hair loss, painfully dry skin and drastic weight gain and edema, decided after talking to me for 1/2 an hour and asking NO questions and in the face of two recent blood tests following cessation of T4 and extra supplementation with T3 that showed still-subnormal TSH but also subnormal FREE T4 with FREE T3 at the bottom number of the range....decided (after referring to me in a letter to my PCP as both "Lisa" and "Carla", neither of which is my name...after stating that he "suspected" I purposely did not include thyroid anti-body testing in my "sample" of labs brought to him when there were in fact 4, all negative, included in the COMPLETE health record of 6 years of testing I took to him, collated in folders by year....after saying he "suspected" I must have been referred for FNA of the nodules on my thyroid after I had not been, and that he "suspected" for some reason I had not followed that instruction (why ?? also, the nodules reduced 2 years in a row after I went on T4/T3)....after never ASKING me whether I'd had antibody testing, or if any endo had ever suggested FNA....after belittling me for taking the VIT D and B-12 supplements prescribed for me by a phlebotomist after I tested very low and was bruising and had enlarged RBC...after saying the drastic lowering of my cholesterol and glucose and normalizing of creatinine, BUN, and eGFR and blood pressure after changing nothing except taking T4/T3 therapy initially were "probably coincidental and would have happened anyway...after dismissing ALL my symptoms including macroglossia and hoarse voice and missing outer 1/3 of eyebrows by saying they must be caused by "something else" but refusing to say what...and despite the opinions of 3 psychotherapists that my previous panic attacks and severe depression were due to hypothyroidism after they saw them recur every time my meds were lowered) declared to my PCP that I would benefit by the administration of not one but TWO bi-polar medications and that he wouldn't be surprised if all my problems were not caused by heavy metal poisoning from my vitamins.

At what point is there a class action suit against these bozos ? My PCP just shook her head.

In any case, Bird, don't eat or take your meds before your blood draw, and try to have them done at the same time of day so they aren't affected by the daily fluctuations in metabolism.

Merry Christmas / Happy Holidays.
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649848 tn?1534633700
COMMUNITY LEADER
As learned from an echocardiogram I had done about 4 years ago, all 4 of the valves in my heart have some regurgitation/leakage.  In spite of the leakage, it wasn't bad enough to worry about at that time (I can't remember the exact percentage of function, but it seems like it was around 58%.  Because I haven't had an echo since then, I have to go in on Jan 3 for another, to see if the leakages have gotten worse or remained the same.  You can live very will with only a percentage of heart function..  It's my understanding that almost no one's heart functions 100%.

You can try supplementing with selenium and see if that helps bring your FT3 levels up.  I find that if I take it daily, my FT3 levels stay good, but if I slack off, they tend to drop. Doesn't mean that will hold true for everyone.

I won't say that endo # 2 is a "bad" doctor; she just might not be what you need. The only thing I don't like about her is that she appears to focus too much on TSH.  You tend to analyze every aspect of every test and every symptom;  most doctors just don't do that.  Even if a test result is out of range, it may not always be a big deal (for instance, my B12 sometimes is above range, but I need it there in order to feel well). It always depends on the test and how out of range it is; in addition, it's okay for some tests to higher than normal, but if they are lower than normal, it's a concern and visa versa. We have rules of thumb for thyroid function, but not all lab tests have to be mid range, upper range, etc.  Likewise with symptoms; not every ache/pain, or other symptom is thyroid related, and since many doctors aren't even aware of all the hypo symptoms, it's very likely that symptoms will get passed off as being caused by something else.
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Bird, I had this up to read because it had a lot of good information and the stuff you have gone through, can help clarify things for other people on what to do and how to do and etc. I skipped to the end from about the middle because I wanted to see how you were doing and what was up now. I want to say that I am INCREDIBLY sorry that you have not found a doctor that will fully listen to you. I know how frustrating this is, I know how it weighs on you. I want to offer you hugs and support and let you know that you are doing incredibly well! You're a tough cookie!
There ARE many different reasons for similar symptoms. I know you have previuosly checked out your b12, but my level was 296. Technically normal. However, I started a liquid b complex and wabam, stiffness went down and pain went down. I am incredibly low in vitamin d, I start it, and my twitching goes away, shaking, heart palpitations aren't as bad, etc. I know you have issues with vitamin d. I believe you on those. Some people have incredibly funky systems (what I said is just the tip of the ice burg, ugh!) and I'm one of 'em, I know how things are when something doesn't work properly for you. I would say that she is correct in doing a daily dose instead of a long term dose, not only is it better for you, but you do not have a Large amount of vitamin d, and then it slowly decreases and you possibly have low vitamin d by the time you take the next dose. Have you thought of trying the liquid vitamin d? It's possible it'll get into your system sooner and thus less time to interfere. Hugs!
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(Continued from the post immediately above)


I began this new dosage six weeks ago. During these past six weeks, I have continued to feel hypo symptoms: ice-cold hands, memory lapses, sluggishness when going up the stairs, pain in my knees.

On a few occasions, I felt some "pulsating" in the arm. But I had the same reaction when I first started taking thyroid medicine in the summer of 2009 (50 mcg of levo per day). Also, I felt "pulsating" in one of my butt cheeks on one occasion, and I felt "pulsating" in one of my legs on a different occasion.

I have also felt some chest/heart discomfort, but that may be because I've been going to bed very late and possibly not getting enough sleep.



I had some blood tests a few days ago (mid-December). These tests were done at Endo 2's clinic, and here are the results:

FT4 = 1.32 (normal range = 0.82 - 1.77)

FT3 = 2.7  (normal range = 2.0 - 4.4)

TSH = 0.531  (normal range = 0.450 - 4.500)

Vitamin D = 11.0  (normal range = 30 - 100)



The FT4 value is in the middle of normal range, which is good.

But the FT3 is way too low. The FT3 should be in the upper one-third of normal range (3.6 - 4.4), but the FT3 is only 2.7, 25% below 3.6. Also, the FT3 is much lower than the FT3 of late October (3.2), even though the amount of Synthroid that I've taken since late October has *increased*. So there may be an "FT4-to-FT3 conversion" problem. There may be deficiencies in Selenium and Vitamin E, which help in conversion.

My Vitamin D level is very low as well.



So what does Endo 2 say about all of this?

She believes that my TSH, FT4, and FT3 labs are good, and that there must be non-endocrine reasons for my symptoms (cold hands, memory lapses, etc). She wants to keep the Synthroid dosage the same because the TSH is on the lower end of normal. She says that the FT3 swing from 3.2 to 2.7 is simply one of the day-to-day variations in FT3 levels. She said she could order Selenium and Vitamin E tests, to check for conversion issues.

She also said that I should take 1 50000-IU Vitamin D pill per week, for 8 weeks. I told her that, as I have learned repeatedly, Vitamin D interferes with my body's absorption of thyroid medicine. I said I wanted to get my thyroid levels up before taking Vitamin D. I also told her that I had heard bad things about the 50000-IU pill and that, if I were to resume taking Vitamin D, I would take a smaller dose. In response, she said that I should take 2000 IU of Vitamin D per day.



It would have been reasonable if Endo 2 had said the following: my FT3 is bad, my symptoms are bad, BUT she has concerns about increasing the Synthroid in light of my heart discomfort and the regurgitation and atrial dilation shown in my echo. However, the fact that she thinks that 2.7 is a good FT3 result, the fact that she believes my symptoms to be non-endocrine, and the fact that she does not want to increase the Synthroid because she is worried about TSH, make me believe that she is not a good doctor. What is really puzzling is that she did increase the Synthroid in late October, when the TSH was 0.24, *below* the normal range (0.40 - 4.00).

Three TSH-obsessed doctors treated my thyroid problem before I met Endo 2's predecessor Endo 1, and Endo 2 seems to be like them.

Endo 1 was recommended on the following website:
thyroid-info (dot) com / topdrs / illinois (dot) htm

But even Endo 1 was a bit too concerned about TSH, in my view.

In addition to being TSH-obsessed, Endo 2 doesn't seem to listen to me. After I explained that Vitamin D interferes with my body's absorption of thyroid medicine, she ignored that and simply said that, instead of
taking the 50000-IU pill, I should take 2000 IU of Vitamin D per day.



So here are my questions:

1) Is my echocardiogram indeed "normal"? How concerned should I be about the trivial or trace regurgitation and the mild atrial dilation? How careful should I be about increasing the Synthroid dosage?

2) Why did the FT3 plunge from 3.2 to 2.7? Is there a conversion problem? I had Selenium and Vitamin E tests in the summer of 2011, and my levels were normal.

3) Is Endo 2 a bad doctor? Should I find a new doctor?



Thank you for any information.



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Well, it's been seven months since I posted anything to this thread. Some new developments have occurred, and I'll give you guys an update.

When I last posted (mid-May 2012), I had just taken Liothyronine (generic for Cytomel) for three days (in conjunction with Synthroid 125), had developed a bad reaction to the Liothyronine (chest pains, feeling too hot, etc), and had accumulated an excessive amount of thyroid hormone in my body. On advice from my then-endo (let's call him Endo 1), I did not take ANY thyroid medicine for five days. The purpose of skipping the thyroid meds for five days was to get rid of excess thyroid hormone.

After those five days, I resumed taking Synthroid 125 (but NOT the Liothyronine). For a week, I took the Synthroid 125 every other day. Then I started taking it every day. About 10 days after I resumed the Synthroid 125, I had some thyroid blood tests. Here are the results:

TSH = 2.150 (normal range = 0.340 - 5.600)

Free T4 = 1.14 (normal range = 0.61 - 1.81)

Free T3 = 2.3 (normal range = 2.3 - 4.2)

After five days of no thryoid meds, these low FT4 and FT3 values were expected.



In late May 2012, I had a second thyroid ultrasound. The first one occurred in June 2010. For both ultrasounds, there were no nodules and no calcifications. Everything was normal. The only "problem" was that, between June 2010 and May 2012, my thyroid became significantly smaller. Endo 1 said that a likely reason for this was that my immune system was destroying my thyroid. My hypothyroidism is autoimmune in nature, after all. Endo 1 said that he was not worried about the shrinking thyroid.



At the end of June 2012, Endo 1 moved to another state. His successor at the clinic became my new endo. Let's call her Endo 2.





In mid-July, I had an echocardiogram (echo, for short). Back in mid-May, right after I had taken Liothyronine for three days, Endo 1 gave me an EKG. The EKG showed "voltage criteria for left ventricular hypertrophy (LVH)". He strongly suggested that I have an echo.


The results of my echo are very detailed; so I'll give you guys a brief summary.

My echo showed that three valves (mitral, tricuspid, and pulmonic) have trace or trivial regurgitation. The left atrial area and the right atrial area are mildly dilated.

For the 2D measurements, some values are above normal range.

The LV ejection fraction is normal. The visually estimated left ventricular ejection fraction is normal at 65 to 70%.


My primary doctor (PCP) declared that this echo was "normal".





In late October, I had been feeling symptoms of hypothyroidism for a few months. I was feeling the following: cramping in my feet, sensitivity to the cold (especially since the arrival of cold weather in the fall), pain in my knees, pain in my back (near the kidneys), memory lapses, and a decrease in the sharpness of my mind.

Endo 2 ordered some blood tests.


Because one of the tests she ordered was Magnesium RBC, I had to have all the tests done at a nearby hospital. This hospital's thyroid tests were kind of unusual.

My FT4 was 1.1 (normal range = 0.7 - 1.5). The other normal ranges that I've experienced over the years are (0.71 - 1.81), (0.61 - 1.81), and (0.82 - 1.77). The lower limit of the hospital's normal range (0.7) is in line with the lower limits of the other normal ranges, but the upper limit of the hospital's normal range (1.5) is much smaller than the upper limits of the other normal ranges.

I've read in this forum that a person's FT4 should be in the middle of the normal range, and my FT4 value (1.1) is right in the middle of the normal range (0.7 - 1.5). However, this normal range (0.7 - 1.5) seems to be much narrower than the other normal ranges.

My FT3 was 3.2 (normal range = 2.5 - 3.9). This normal range is in line with the other normal ranges that I've experienced over the years. However, the hospital analyzes the FT3 test via a method called "dialysis".

My TSH was 0.24 (normal range = 0.40 - 4.00). This normal range is in line with the normal range at Endo 1 and Endo 2's clinic (0.450 - 4.500). However, the hospital calls this test "TSH - 3rd Generation", whatever "3rd Generation" means.


So, bottom line:

FT4 = 1.1 (normal range = 0.7 - 1.5)   Normal range may be too narrow.

FT3 = 3.2 (normal range = 2.5 - 3.9)   Analyzed by "dialysis".

TSH = 0.24 (normal range = 0.40 - 4.00)   "3rd Generation".  


One interesting note:   In mid-April, my Vitamin D was 18.6 (normal range = 30 - 100). In mid-June, I stopped taking Vitamin D supplements. In late October, my Vitamin D was 21.6 (same normal range). One would expect the Vitamin D to be lower, not higher.



Well, Endo 2 told me that my echocardiogram was "normal". However, Endo 2 also said, that the echo indicated that any increase in thyroid medicine would have to be VERY GRADUAL. And I desperately wanted an increase in Synthroid because of my hypo symptoms.

Endo 2 did increase the Synthroid, from (Synthroid 125, every day), to (Synthroid 125, 6x/week) and (Synthroid 137, 1x/week). I went from 875 mcg/week to 887 mcg/week. It was a very gradual increase, although Endo 2 was reluctant to increase the Synthroid at all.


(Continued in the post immediately below)

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Avatar universal
Interesting. Barb, I know that you have no problem with generic Cytomel but many patients, myself among them, have documented adverse reactions. It seems to be very individual, from all the posts I've read. And there is the fact that not only do fillers vary from generic to generic....sometimes even containing CALCIUM carbonate, which of course binds the thyroid medication, gaaah !....and thus vary in the rate of dissolution in the gut, but also that the FDA approves all generics to vary plus-or minus from the brand by up to 10%. While this might not be a huge deal in SOME medications, I think in a fast-acting medication like T3 that it can be a very big deal indeed.

When I was switched by the pharmacy from Cytomel to a generic and didn't notice, after a few months I started to have heart palpitations, dizziness, shortness of breath, and panicky sensations. Since extreme panic attacks had put me in the hospital prior to being put on T3 (I seem to have secondary hypo and my TSH is now non-existant), I was frightened by the return of this symptom. When I questioned the pharmacy and my doc, I was told the medications are exactly the same but that wasn't so for me. I was not yet even on the amount of Cytomel I am on now, which has put my FREE T3 test in the proper range. I was also on a much lower dose of T4 than I am now and my other metabolic labs were still screwy. Now all my labs are fine....cholesterol especially significant.

My T3 dosage was cut and I immediately became severely hypothyroid again. I won't bore you with the saga of getting my labs into the proper ranges, but it took me finally sitting down and making a chart of ALL my labs (going back to 2005), including metabolic and CBC, and including the doses of thyroid medications I had been on, to finally see that the moment I started having problems was directly correlated to the switch from Cytomel to the generic. I insisted on being changed back and began to recover again.

Recently, after over a year of taking my care back from the endocrinologists and having my PCP test my blood every 6 weeks and change my prescriptions accordingly, I became stable enough to order my medication in 3 month supply from Express Scripts. Although my doc prescribed Cytomel, she forgot to check the box that said brand only and I received generic Paddock-manufactured T3 in the mail. It could not be more different from the brand.  

Because it was going to take some time to have the correct medication shipped, I had to substitute 2 Paddock pills per day in lieu of 2 Cytomel to stretch my medication until the new shipment arrived. I take six 5 mcg Cytomel a day to equal 30 mcg. I also take 150 mcg generic T4 and have no problem with the generic for that slow-acting medication. I am lucky in that I have no problem taking all my Cytomel in one dose without adverse effects and don't notice any significant fatigue at the end of the day. I know this is not the case for many.

In fact, I have tried taking two of my Cytomel sublingually in the morning to put it right into my blood stream, swallowing the rest. It didn't seem to make any difference, so I went back to just swallowing them. Cytomel doesn't dissolve readily under my tongue.( I DO take estradiol sublingually and am able therefore to reduce the mg's I take while keeping my labs in a good spot while also avoiding processing that drug through my liver.)

As an experiment, I tried taking a Paddock T3 sublingually. It is a much larger pill than the brand and it dissolved almost instantaneously ! It makes perfect sense then that it would dump the T3 right into the body and perhaps cause a problem for someone who is sensitive to that hormone yet still needs it. And this is one reason why it is especially important for those taking generics to have their doctor specify on their prescription that it must come from a SPECIFIC manufacturer, never change, and have their bloood tests balanced to that specific medication. I always have my T4 filled from Mylan and sometimes have had to wait a day or two to get it because the drugstore only had Paddock or some other manufacturer's product on hand. It is astonishing to me that doctors and pharmacies either don't understand or don't care about the extreme importance of continuity in  medication for hypothyroidism. It is even more important in a fast-acting medication like T3.

I WISH I could take generic T3. For a 3 month supply (in my case that's 540 pills) of the generic with my insurance, I'm charged $10.70. For the same amount of the brand I'm charged 10 times that much, $107.00. Criminal.





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Several other people have related issues of intolerance when starting T3 medication.  it seems more prevalent when starting at or above the 10 mcg level.  Some people are more sensitive.  As Barb stated because T3 is fast acting people are best to take two doses a day.  

It may be possible that you needed to start out at 2.5 twice a day.  But you should never "fool with" heart issues so caution may well be in order.

What concerns me a little is that you report that you also stopped taking your T4 medication.  if you did not have these heart symptoms prior to taking T3 med, why would you stop your T4 medication?  Are you thinking that eliminating T4 will help "clear out" the Reverse T3 problem as there will be less and less T4 to be converted to RT3?  This may work but understand this may only work by allowing yourself to become pretty significantly Hypo.  And that is no fun either!

Adrenal issues can also affect Reverse T3. have you looked into that possibility?
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649848 tn?1534633700
COMMUNITY LEADER
Cytomel (or generic T3) should be taken at regular intervals in order to keep your levels at a constant level.  Some people find that splitting the pills and taking 2.5 in the morning and 2.5 around noon, or so, works best. Taking it every other day or every few days is, basically, useless.  Cytomel is usually contraindicated in someone with a heart issue.

The generic T3's are not stronger than brand name cytomel.  A med that dissolves sublingually, might work faster, because it's going directly into the blood stream via capillaries under the tongue vs having to be swallowed, dissolved, then taken into the blood.

Not all T3 meds dissolve well, sublingulally.  That would depend on the fillers/binders used to make the pills and all manufacturers use different ones. I used to take my cytomel sublingually, but the generic pills I have don't dissolve well enough, so I swallow them.  I've read of some people chewing their pills; never tried that.  
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(Continued from the post immediately above)



I should mention a few more things. First of all, even before I took the Cytomel, whenever I took a warm shower, after the shower I would experience pains in my chest, and sometimes in the back and in the arms as well. I thought that, since I had a sensitivity to cold temperatures due to my hypothyroidism, my taking a warm shower and then exiting the bathroom into cooler temperatures was causing these pains. But now I wonder, are these pains the sign of some heart problem?

Also, I have read that people who do athletic activity may get voltage criteria for LVH on their EKGs. Just hours before my EKG, I carried a somewhat heavy professional bag to work, and from work to the doctor's office. So, would that kind of exertion just before an EKG cause voltage criteria for LVH?

And then there's the issue of what kind of Cytomel I took. I was under the impression that the endo was prescribing a brand-name drug. The bottle I saw at the pharmacy said, "Liothyronine 5 mcg". I thought that Liothyronine and Cytomel were 2 names for the same *brand-name* drug. However, after taking the pills, I took a closer look at the bottle, and the label said in small print, "Generic for: Cytomel". The pharmacy confirmed that the Liothyronine that I had was a generic for the brand-name Cytomel, and that the prescription allowed for a generic.



The manufacturer of the generic Liothyronine is Paddock, and a google search showed the following online discussion of the Paddock generic:

www (dot) musclechatroom (dot) com/forum/showthread.php?19010-generic-liothyronine-a-BAD-experience

In the discussion's first post, the poster (username "era") states the following:

"When I take a Cytomel tab sublingually, it dissolves at a fairly slow rate. However, the generic liothyronine tabs are very soft, dissolving almost instantly in the mouth."

This person implies that the generic Liothyronine works much faster than the brand-name Cytomel.



So, are Cytomel and Liothyronine supposed to be taken sublingually?

I took Liothyronine and Synthroid at the same time, by swallowing them. Was I supposed to swallow the Synthroid and then take the Liothyronine sublingually?

And does Liothyronine, indeed, work faster than Cytomel?  If yes, then perhaps *that* is why I was feeling so bad after taking Liothyronine? Perhaps Cytomel would have worked slower and would not have given me chest pains, or at least would have given me chest pains to a much lesser extent?



So, it is 5/14/12 as I write this, and I have not had any thyroid medicine since the Synthroid of 5/9/12. I've had some chest discomfort and shortness of breath during the past few days, but these conditions seem to be improving. I definitely feel better today than I did on 5/8, 5/9, and 5/10.

I have not yet visited my primary doctor to check my current EKG against the last two EKGs, but I will probably do this soon.

But the biggest question I have is, what went wrong? Was I supposed to use the brand name of Cytomel, as opposed to generic? Was I supposed to use a smaller dose, like 2.5 mcg every few days instead of 5 mcg every day? I know that a lot of you on this forum have taken Cytomel. So, I'm hoping that you guys can provide some answers.



Once again, thank you very much in advance for any information you can give me, and I look forward to hearing it.






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Hi, everyone. It's been about three months since I posted anything, and I wanted to give you guys an update. It is a bit long, but trust me, it's very interesting. :)

Back in February 2012, my new endo thought that my FT4 was too high and that my FT3 might be too low. He wanted to lower my FT4 (and
probably my FT3 in the process) before giving me Cytomel to raise the FT3. So, the endo lowered my Synthroid. I went from 150 mcg
3 times per week and 137 mcg 4 times per week, down to 125 mcg every day.

So, from mid-February 2012 to mid-April 2012, I took the following:

125 mcg of Synthroid in the morning, every day

1000 IU of vitamin D and 1000 mcg of vitamin B12, about 12 - 16 hours after the Synthroid, three times per week



In mid-April, I had new blood tests, and here are the results:

TSH = 0.224 (up from 0.063 in early February), normal range = 0.450 - 4.500

FT4 = 1.36 (down from 1.53 in early February), normal range = 0.82 - 1.77

FT3 = 2.8 (down from 3.3 in early February), normal range = 2.0 - 4.4

Total T3 = 102, normal range = 71 - 180    (no Total T3 test in early February)

VIT D, 25-HYDROXY = 18.6 (up from 16.5 in early February), normal range = 30 - 100

VITAMIN B12 = 637 (down from 887 in early February), normal range = 211 - 946



The FT4 value (1.36) was at about the middle of the FT4 normal range. However, the FT3 value, in my opinion, was way too low. I've read that the FT3 should be in the upper one-third of normal range, which in this case would be 3.6 - 4.4. My FT3 value (2.8) was 22% below 3.6.

And my hypothyroidism symptoms matched the low FT3 value. I was experiencing pain in my arms and legs, sensitivity to cold temperatures, trouble remembering things, constipation, etc.

However, my new endo seemed to be balking at giving me Cytomel. He said in a letter that my TSH (0.224) showed that I was hyperthyroid. He insisted that I discuss the issue with him in person. Well, I went to see him, and he agreed to give me Cytomel.

He wanted me to take 10 mcg of Cytomel per day (in 5-mcg pills). I would take the first 5-mcg pill with the 125-mcg Synthroid in the morning (I would swallow both pills at the same time). About 6 hours later, I would swallow the second 5-mcg pill. I would do this every day. However, to acclimate my body to the Cytomel, I would spend the first four days taking only one
5-mcg Cytomel pill, in the morning with the Synthroid. If all went well, I would start taking two 5-mcg pills on day 5. As for vitamins D and B12, I would take them about 12 - 16 hours after the morning Synthroid, three times per week, just as before.



So, on 5/6/12, a little more than 3 weeks after the mid-April blood tests, I started the Cytomel. After the 5/6/12 Cytomel pill, I felt hot to some extent, and I felt some tightness (or pain) in my chest and in my underarm areas. Those feelings continued after I took the 5/7/12 Cytomel pill. After the first two Cytomel pills, the feelings of heat and pain were mild, and these feelings were at a level that I thought I could handle.

However, after the 5/8/12 Cytomel pill, my feelings of heat and pain increased, and I felt bad. I woke up on 5/9/12 still feeling bad. So, on 5/9/12, I took the Synthroid but skipped the Cytomel, and I told the endo how I felt. He said that I was becoming hyperthyroid and that I should stop the Cytomel, and I agreed.

On 5/10/12, I was still feeling bad. So, I skipped BOTH Cytomel AND Synthroid, and I went to work (some light acting in an industrial video). After work, I visited the endo, and he gave me an EKG. The EKG was normal (no arrythmia, no heart attack, normal heart rate), EXCEPT for the fact that I had "voltage criteria for left ventricular hypertrophy (LVH)".

LVH is the thickening of the heart's left ventricle, and the EKG showed that it was *possible* that I have it. The endo said that, if I do have LVH, the LVH was NOT caused by the Cytomel. However, the Cytomel (or any other source of stress) would aggravate the LVH (LVH plus stress = chest pains). The endo also said that, if I had LVH, the LVH criteria would show up on an EKG whether stress was present or not. I told the endo that my previous two EKGs (July 2009 and October 2011) were totally normal (no LVH criteria), which meant that I did not have LVH in July 2009 or in October 2011. The endo said that it would be highly unlikely for
LVH to materialize between October 2011 and now. However, he still recommended that I have an echocardiogram and/or a stress test to
test for LVH conclusively. He also said that I should go back to my primary doctor and check the current EKG against the two previous EKGs. It is entirely possible that all three EKGs match and that the "voltage criteria" in the current EKG are simply a part of *my* normal EKG.

During this visit, the endo admitted that the Cytomel dose of 5 mcg per day was too high and that the FT4 level should have been reduced even more. The endo reiterated that I should stay away from Cytomel for the time being and that I should stay away from Synthroid for a few days.



(Continued in the post immediately below)


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1756321 tn?1547095325
Hi, yes sublingual is amazing! :) I use 2000mcg daily of sublingual B12 spray for my juvenile pernicious anaemia.  I use the cyanocobalamin form of B12 as methylcobalamin sublingual B12 spray isn't available where i live.  I have read methylcobalamin is a better form of B12 however both forms boost B12 levels. I have antibodies to intrinsic factor and parietal cells and the only way my B12 is optimal is because of my B12 sublingual! :)

I also have Hashimoto's thyroiditis. I have read 50% with autoimmune pernicious anaemia have elevated TPO antibodies. Figures i'd be the 1 in 2.  The 100 per million chance of having juvenile pernicious anaemia wasn't enough apparently. Why can't i win lotto instead lol.
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