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Getting FT3/FT4 levels up dilemma
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Getting FT3/FT4 levels up dilemma

Got recent labs after adding additional 5 mcg T3 in afternoon. Was previously taking 50 mcg Levothyroxine and 5 mcg T3 in am. Dr. had added additional T3 with no change in Levo to see if any improvement in well being/weight loss as FT3 levels in lower range.  Lab results showed very little increase in FT3 and FT4 dropped out of lower range. How do you ever get FT4 in upper range taking T3? And is it worth trying to get FT3 mid range? No major improvement with symptoms since going on medication 3 yrs ago but also have very mild symptoms ie bloating, 6-8 lb weight gain and cold hands/feet. Is this as good as it will get or worth trying to increase FT3/FT4 levels to see if these symptoms would be eliminated. Would be fighting with Dr. who believes these numbers are perfect. Appreciate any help!

6/13 labs                                       8/13 labs

FT4  .84 (.82-1.77)                    .77
TSH  2.1 (.45-4.5)                    1.33
FT3  2.4 (2.0-4.4)                      2.6
8 Comments Post a Comment
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Avatar_m_tn
It is absolutely worth fighting for.  Your Free T3 and Free T4 are far too low in the range.  The ranges are not functional for many people due to the erroneous way they were established.  Many of us say that symptom relief required Free T3 in the upper part of its range and Free T4 around the middle of its range.

A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  You can get some good insight into clinical treatment from this letter written by a good thyroid doctor for patients that he sometimes consults with after initial tests and evaluation.  The letter is then sent to the participating doctor of the patient to help guide treatment.  In the letter, please note the statement, "the ultimate
criterion for dose adjustment must always be the clinical response of the patient."

http://hormonerestoration.com/files/ThyroidPMD.pdf

So if you want to present to your doctor scientific evidence that medicating a hypothyroid patient based on TSH doesn't work, I can provide that.  If you want to present him with scientific data that concluded that the reference ranges should be about 50 % of what they are, I can provide that.  If you want a link to a scientific study that concluded that Free t3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate at all. I can provide that as well.

I should also add that hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin also.  If not tested you should insist on those also.  
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Avatar_f_tn
Since you are taking T3 and T4 as separate medicines you should theoretically be able to adjust the doses individually as necessary to raise T3 and T4 each to a comfortable level. Yes, some of the T4 you take will convert into T3, but you should be able to eventually get to a point where T4 is in the upper half of range and T3 is in upper 2/3 of range. This is the range in which many of us hypo patients started to feel good. I am here to tell you that it is absolutely worth it and possible to raise FT4 & FT3 to a level where you will feel a difference. Once I got my numbers up and started taking meds containing enough T3 I stopped feeling cold all the time for the first time in at least a decade. My acne subsided, periods lightened, and I stopped yawning all day long. I know it can be terrible making dose changes without seeing any effect, but hang in there. Your FT4 is abysmal at the moment, not in range at all, suggesting you need to up your dosage of Levothyroxine. You may end up needing to double your current dose, or more, but it's best to raise T4 somewhat slowly since it takes 6-8 weeks for the meds to build up in your body. Your FT3 is at 25% of range, which is also pretty bad. Time to raise T3 as well-- again, start out slowly, perhaps initially adding another 2.5 mcg over the course of the day, or half of that if it causes you to feel shaky or have heart palpitations. If you find your doctor is resistant to the idea of raising your current prescription, I recommend being assertive and doing your best to impress upon him or her that, while your numbers are indeed "in range", they are obviously not in the correct part of the range since you continue to feel just as poorly as you did before treatment. If this fails to convince, time to find a new doctor.
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649848_tn?1357751184
I do agree with, both, gimel and ahmee, that your levels are totally dismal, but I, totally, disagree that both T4 and T3 meds should be raised simultaneously.  You should never make more than one change at a time, or you will find yourself on a roller coaster that doesn't stop. Making multiple changes at the same time, leaves you not knowing which change actually made the difference.

Because your FT4 is below the reference range, I'd suggest increasing that first, retest after 5-6 weeks, then go from there. Once your FT4 is around mid range, which is the "rule of thumb", you can start working on the FT3, depending on how much FT4 you convert. It's recommended for FT3 to be in the upper half to upper third of its range.
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Avatar_f_tn
Thanks everyone for all the input! Just not understanding why adding cytomel has made so little difference in the labs. Started 5 mcg in 11/10 just to try it and just added the additional 5 mcg in June and labs have never shown anything higher than 2.4 and the most recent 2. 6 after doubling it. In this same time period the FT4 has remained between .68-.94 and now .77.

Dr. did suggest trying to go back to T4  only and increasing it a bit. Is that the better route? Thanks again for all the help!

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649848_tn?1357751184
I was on 5 mcg of T3 for well over a year before, my FT3 levels started coming up and I could tell a difference in whether or not I took it.

I don't think going back to T4, only med is the right choice; I simply think your doctor isn't raising T4 med enough.  It takes FT4 to be converted to FT3, but if your FT4 level is too low, you have nothing to convert.

Since you're currently on only 50 mcg T4 (which is often considered a "starter dose"), you might talk to your doctor about increasing to 75 mcg, along with your current 10 mcg of T3.  

Are you taking the T3 med all at once?  Many/most of us find it beneficial to split that dose into more than one.  I, personally, take my first dose of 5 mcg before/around 7:00 am, then a second dose of 5 mcg around noon.
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Avatar_m_tn
I agree 100% with Barb.  Raise T4 only. and keep taking the T3 in two dosages a day.

By raising the T4 you may see a response and be an indication of your ability to convert the T4 into T3.

A complete guess that seems reasonable as to why you don't see any response in the FT3 level is that your body's cells are so starved for T3 that when some becomes available it immediately uses them up.  So the remaining FT3 that is being measured is what is left over from being produced by conversion.  Just a wild guess.  But if you have a dry sponge, when first adding water it takes a while for it to feel like it is wet.

Has taking the T3 helped you feel any better?

Most people start out with T4 only and then keep slowly increasing until the FT4 levels get to about 50%.  At which point if the FT3 levels are still not above 50% to 67% the addition of T3 is done in small dosages until you get it to those levels or you feel good, whichever comes first.

But since you are already on T3 I'd stay on it.  And raise th FT4 slowly until you get to 50% of the FT4 range or you feel better.
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Avatar_f_tn
Thanks for all the replies- really appreciate the help!  Did begin in 2009 with only T4 and got to 88mcg after 6 mos but Dr. pulled me off with TSH of .005 (.45-4.5) while my T3 was 3.6 (2.3-4.2) and T4 1.68 (.8-1.8) but didn't know then what I think I know now :). I was still in shock from the hypo diagnosis (found with Lyme Disease) and felt better before I started all the meds :(.

Changed Dr's to current one in 2010 who has kept me on 50 mcg T4 and let me try T3 but have been on it for almost 3 yrs and never seen labs above 2.6 (2.0-4.4) and my T4 has never been higher than .99(.82-1.77). Thought for sure doubling the T3 this last time would make more of a difference. Which got me wondering about going back to T4 only if it will get my T4/T3 levels up again.
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649848_tn?1357751184
Some people actually feel better on the lower numbers, than they do with  higher levels.  

IMO, try to get your doctor to increase your T4 med and leave the T3 as is, for now.  You can always change it later; it might actually be doing more than you think it is.

Don't let them pull you off or decrease your med because of TSH.  TSH neither causes nor alleviates symptoms.  My TSH has lived at 0.01 - < 0.01 for the past 5 yrs and I've never once been hyper.
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