Hashimoto's and Low T3

I am a 34 year old woman with Hashimoto's.  I take 112 mcg of synthroid daily.  I've been on meds for 5 years.
I have been exhausted all summer with additional hypo symptoms.  I went for my annual endo appt and my bloodwork results were as follows (with normal lab values in parentheses):
TSH - 0.82 (.4-4.5)
T4 Free - 1.2 (.8-1.8)
T3 Free - 2.2 (2.3-4.2)
The endo office said my fatigue was not due to thyroid.  I asked for a copy of the above bloodwork, and called the office when I saw the FT3 so low.  I asked why I wasn't converting and what I should do.  They said that Free T3 value does not mean anything in a Hashimoto's patient.  What???? I can't believe that this could be true.  How else do I know if my meds are doing what they should be doing?  

[goolarra]

You're right...your FT3 is WAY too low, and your FT4 is actually a bit on the low side as well.  Rule of thumb for FT4 is 50% of range, and yours is 40%.  FT3 is below range, and yes, it does "mean something".  FT3 is the test that correlates best with symptoms as you are proving.  What has your doctor suggested?

[hg143]

Thanks for the confirmation.  I had a hunch since all of my google searches were not leading me anywhere.
The endo office told me to go to GP and take vitamins.  I had already been to GP because I was hoping I was anemic (easier problem to fix than thyroid).  My CBC and iron were normal, so I am not going back there for no reason.
I guess I need to call endo again and insist on better course of treatment.  What should I be asking for?    
I have an appt scheduled for a different endo, but it's not until November.  I can't wait that long!

[flyingfool]

Your body ONLY uses Free T3 at the celllular level. So how in the w orld could they tell you that T3 level is unimportant.

It's not just important its the ONLY thing that IS important really.

You may also want to get other things tested as fatigue can be caused from several other things as well.

Things to consider testing:

Vit B-12
Vit D3
Iron
Ferritin
Selenium

Most of these will have a HUGE wide "normal" range. And many people will need to be well up into the range if not on the very high part of the range, particularly in the B-12 range.

Selenium is known to help with conversion of T4 into T3.  it is not a miracle worker but could help contribute to feeling better and raising the FT3 level.

It does appear to me that you do in fact have a conversion problem. These usually come in one of three different conditions.  1) you don't have enough FT4 to convert so that results in low FT3 or 2) for whatever reason your body just doesn't convert efficiently or 3) your body is converting too much of the FT4 into reverse T3 or RT3.  Thus not leaving sufficient FT3 available for your body to use.

Stress can cause a RT3 issue and possibly the efficiency issue as well.  Stress can be environmental/job related or it can be physical stress of too much exercise or healing from surgery or injury etc.

Your situation is interesting because you may find it difficult to get a Dr to prescribe any medication for you at least Thyroid related. This is because most Dr's believe in TSH almost exclusively and they MAY look at Ft4.  But as you already have witnessed and experienced, they do NOT seem to give a flip about the MOST important hormone which is the EXACT hormone that your body's cells use.

So until you find a Dr who is willing to prescribe medication to you, you may have an uphill battle.  I do not say this to discourage you but to prepare you for what you MAY face and be up against. You need to arm yourself with education and a lot of perseverance.  Be prepared and stick to your guns.

As mentioned above many here have found the best target to shoot for when symptomatic is well up in the range and you need BOTH.

1) Ft4 in the MIDDLE of the range (50%) or slightly higher.

AND - that means in addition to

2) FT3 in the UPPER 1/3 of the range (66.7%)

You are at 40% and BELOW range respectively. So you definatley have some room for improvement.

I would suspect a Dr who is willing to prescribe thyroid will likely give a small dose of a T4 medication (Synthroid or generic Levvothyroxine etc).  This may help. But the risk you run is that that small dose will just bump your FT3 barely into the lower bottom end of the range. And at that point the Dr will see that all three things are now "in range" (TSH, FT4 andFT3)  at which point he will magically declare you "normal" and not want to increase your medication dosage further.

Frankly staring out with a T4 med may be OK. You can then get tested 6 weeks later and see what kind of response that had.  However I suspect that your FT4 may be good but your FT3's may remain low in the range. So what would be needed in that case would be a T3 medication or medication with T3 component in it in order to make you feel well.

Remember that all these ranges including the target ranges above are only that. Something to shoot or aim for. EVERYONE is different and feels well at different levels. So what is ultimately important is symptom relief. Once you feel well, whatever blood levels are is what YOU need to be at. And that is what is most important.  Some people need to be at the very top of the range or ranges, and others feel fine very low in the range.  All we can say is that the target range listed above seems to be a MUCH better aiming point than what most labs use as a "normal" range.  That being that many if not most people who have symptoms need to be up well higher than the very bottom. But some people are fine there.

I hope this helps.

[hg143]

I placed another call to my current endo, and insisted she call me back herself.  She agreed that the FT3 was low, but said that Ft3 is always changing and that lab value was only a snapshot into my blood values.  She suggested 75 (not sure if mg, mcg, etc) of armour.  I will try this for 6 weeks and then have all of my levels retested.  She said that 60 Armour = 100 mcg Synthroid and that Armour only comes in increments of 15.   I should take 60 in the morning and the 15 pill sometime in the afternoon.
Does this sound like a better course of action?  

[goolarra]

"... she said Ft3 is always changing and that lab value was only a snapshot into my blood values."  That's true, but the same can be said for FT4 and TSH levels as well.

75 mg (Armour is measured in mg or grains, 1 grain = 60 mg) is approximately equivalent to 125 mcg levo.  It only comes in 15 mg increments.  

It does sound like a better course of action.  Armour contains both T3 and T4, so it should bring your FT3 up considerably.  Feel free to play with both the exact time you take the second dose and how you split the doses.  Most people try to take the second half in the afternoon, but not so late that the T3 can disturb sleep (around 3:00 pm on a "normal" sleep/wake schedule).  You can experiment with what works best for you.  You can also play with what split works best for you.  Try the 60/15, and if that doesn't quite do it for you, you might try a more even split, say for example 45/30.

When you have your blood work done on Armour, be sure not to take your meds before the draw.  T3 is fast-acting, so taking meds before can artificially inflate FT3 levels.

Good luck with the meds change, and let us know how it goes.

[hg143]

I'm looking forward to feeling better.
Thanks for the info on not taking meds in the morning before the blood draw.  The endo didn't mention that.
I will keep you posted! Thanks so much!

[hg143]

I switched from 112 mcg Synthroid to 75 mg Armour six weeks ago.  For the first few days, my energy levels soared.  I think it was from the Synthroid still being in my system and switching to the Armour.  I stuck with the 60/15 combo with the 15 at 3 pm each day.

My energy levels with Armour are better than Synthroid, but I've had other hypo symptoms getting worse.  Weight gain, puffiness, constipation.  My body does not feel like my own.

I had bloodwork done last week at 5-1/2 weeks after switch, and just received results.
TSH - 2.28 (.270-4.2)
T4 Free - 0.66 (.83-1.62)
T3 Free - 2.4 (2.5-4.3)

Previous results were...
TSH - 0.82 (.4-4.5)
T4 Free - 1.2 (.8-1.8)
T3 Free - 2.2 (2.3-4.2)

I haven't spoken to endo yet, and we're in a hurricane, so I don't anticipate getting a hold of them until Wednesday the earliest. :(

Any idea how much and how they would alter meds to compensate?

Thanks so much!

[goolarra]

I think you simply need an increase.  FT4 is below range, and FT3 has come up a little, but only marginally.  So, both are still low.  Just take it slow...better to increase slowly and have a few hypo symptoms than to go too fast.  A lot depends on how well you tolerate meds in general and how well you tolerated the switch to Armour.