High RT3, fainting, cytomel

Hi all. Did first labs after starting on Armour 30 MCG twice a day on March 26. Exams are from April 13 (I know it was kind of too soon to test but I am having insurance issues). The weird thing is the day I went to get Cytomel to change my meds, I fainted at the pharmacy, hit my head on the floor and was taken to ER for 8 hours. They didn't really check anything thyroid related, and said I was probably dehydrated and have orthostatic hypotension.

Besides thyroid hormones, doctor is treating me with Adren-All for adrenal glands, Nystatin for yeast, progesterone 12 days a month for PMS etc (did not do labs for these as he says my symptoms tell I have issues) and also 5000 UI Vitamin D3.

Because my RT3 came so high, doctor changed my meds to: Armour 30 MCG in the the morning, and Cytomel 5 MCG at lunch. Does this make sense?

My brain fog improved significantly, but I am still tired as hell. Started Cytomel generic (pharmacy gave me the generic instead, grr... is it okay???) last Wednesday, 3 days ago.

Is it usual to faint in my situation? I've been having dizziness while standing for months now but never got to the point of fainting.

Doctor said it's perfectly fine to have a really low TSH, did not seem concerned about it.

Labs blood from April 13:

(LO indicates it's lower than range, HI indicates it's higher - both are indicated "abnormal")

Test Reference Units
TSH 0.153 LO                  (0.270-4.200) uIU/mL
T3 UPTAKE (T3U) 35.8 (24.3-39.0) %
THYROXINE, FREE (FT4) 1.5 (0.83-1.62) ng/dL
FERRITIN 24 (22-322) ng/dL
ANTI-THYROGLOBULIN <20 (< or 40) IU/mL
CORTISOL, AM (Baseline) 17.4 (5.0-25) ug/dL
E.SEDIMENTATION RATE 4 (<21) mm/hR
VITAMIN B12 1293  (211-911) pg/mL
T3, FREE (FT3) 3.6 (2.5-4.3) pg/mL
250H, VITAMIN D 32.6 (32.0-100) ng/dL
T3, REVERSE (RT3) 422 HI (90-350) pg/mL
DHEA SULFATE 103 (12-379) ug/dL
ANTI-TPO Ab <10 (<35) IU/mL
Iron, % Sat. 37 (20-55) %
TIBC 263 (228-428) ug/dL

He did exams for a series of things in Chemistry, Cardio and Hematology as well, but only these came abnormal:
(He told me to take an Iron supplement... forgot to tell me the dose lol)

CHEMISTRY:
Creatinine 0.72 LO    (0.90-1.3) mg/dL

HEMATOLOGY:
HCT 38.7 LO     (39.3-52.5) %
LYMPHS 50.8 HI    (12.0-48.0) %

Any advice would be appreciated. I am new to this and would like to confirm doctor is doing the right thing! Thanks!

[thethinme]

ps: I fainted BEFORE starting on Cytomel generic (was taking Armour 30 MCG twice a day plus the other meds). Note: my B12 is high as I'm taking a supplement, will stop it.

Also, I had to have staples in my head because of the wound from fainting on the floor... kind of afraid it will happen again. Would appreciate any input as to why I fainted and how to avoid it. Is it thyroid related? Adrenal glands? RT3? or just dehydration or so?

[thethinme]

not sure if you need it but here is my lab from March 12, 2012. (FYI, Antibodies came normal again on April 13 although my sister found out this week she has Hashimoto's).

March 12, 2012 labs:

(1) TSH W/FREE T4 RFX (43562A)

TSH  3.88 MIU/L  (0.40-4.50)

(2) T3,TOTAL  79 NG/DL  (76-181)

(3) T3,FREE   2.8 PG/ML  (2.3-4.2)

(4) THYROID AB (ATA,TPO)
THYROID PEROXIDASE AB  <10 IU/ML       (<35)
THYROGLOBULIN AB           <20 IU/ML       (<20)

(5) TSI
TSI     29 % BASELINE           (<140)

[Ericamegan]

Dizziness can be a hypo symptom, not sure about fainting.

Getting too much T4 and the inability to convert it to T3 causes RT3, among other things like stress, adrenal or iron problems.  Lowering the T4 and adding more T3 can help bring down the RT3.
What meds were you on before you switched to Armour?

[Barb135]

Your thyroid levels actually are not all that bad... .

It's incorrect to say that the inability to convert T4 to T3 causes RT3.... The body naturally converts T4 to both, T3 and RT3.  The problem comes in when too much is converted to RT3. RT3 is inert, meaning it does nothing.  I don't completely understand the dynamics of RT3 (researching it), but apparently, RT3 can dock in the T3 receptors, which prevents the FT3 from getting in. Treatment for RT3 dominance is usually a T3 medication, in order to prevent the T4 from converting to more RT3.

Your ferritin is low, which indicates that you need more iron.  Your vitamin B12 is high, which is not really an issue, because B12 is water soluble (not toxic) and excess is eliminated in urine.

I don't see anything in your labs that would cause you to pass out, but I doubt it was thyroid related.  Yes, dehydration could cause that; do you drink plenty of water each day? Have you had a heart work up to make sure your blood pressure didn't drop too low?  Have you been tested for diabetes to make sure your blood sugar didn't go too low? There are too many things that could cause a faint, for us to even speculate.

[thethinme]

Erica, I was recently diagnosed so Armour was the first med I tried. Along with that I was (am) taking adren-all for adrenal glands, nystatin for yeast, vitamin D3 and progesterone, all prescribed by my holistic MD.

[thethinme]

Thanks Barb, I also read somewhere that the problem with RT3 is that it blocks T3 from getting where it needs (also still researching but these things seems so hard to understand, ugh).

I have a feeling the fainting is somewhat related to adrenal glands in combination with hypo. There's not much info online about it, but I saw it in a couple of places. Most people call it orthostatic hypotension, which is basically feeling dizzy and lightheaded when standing up.

They did cardiac tests at ER and all was okay. It seems the problem is my low blood pressure when standing. In that specific day I did not drink much water, but I have this kind of dizziness even when I do drink enough.

So I take it it's not common in this forum for people to faint... Meaning it might not be thyroid (or adrenal) related?

One more question: Do you think my doctor is correct in maintaining Armour (T4 and T3) in the morning and switching the lunch grain to Cytomel (T3)? Will this do the trick of lowering RT3 or should he have prescribed T3 only?

[Barb135]

Yes, sometimes standing up too quickly can cause light headed/dizziness. If that's the only time you have it, you might have to change the way you stand up  I used to have that until I learned not to stand/raise up suddenly.  I learned to "take my time" standing up and no longer have a problem.  I do a lot of gardening, which requires bending over...... once bent over, I've learned to bring myself to a standing position slowly, so as to not have the light headed/dizzy feeling.

From what I know about RT3, T3 med has to be higher than normal, because T4 med only produces more RT3...... I'd say you should give the Armour/cytomel a chance.  But you don't say what your doses are, so nobody can tell you if it's right or not.

[kevieb]

do you have any idea what your fre cortisol levels are?  orthostatic hypotension can be caused by adrenal insufficiency.  How did your doctor determine you had a cortisol problem?  You may need hydrocortisone instead of a natural adrenal supplement.  just something to think about.

[thethinme]

Yes you are right - after this incident I started seating first before standing as I do get dizzy even when I sit after being in bed for a while... I feel like I am 80 y.o., lol.

My post was too long and you might not have seen it - doctor changed meds last week, from: Armour 30 MG twice a day (breakfast and lunch - total 60 MG per day); to: Armour 30 MG once a day at breakfast and Cytomel 5 MCG at lunch (totaling 1 grain Armour and 1 grain Cytomel in the afternoon = 30 MG Armour + 5 MCG Cytomel per day).

[thethinme]

Yes I thought about it too, why is doctor treating me with Adren-All instead of HC i.e.? I am not sure. He gave it to me based on symptoms I told him (he's a holistic doctor recommended and interviewed several times by S-homon).

After a few weeks on Adren-All, he sent me for various exams and my cortisol is as follows:

CORTISOL, AM (Baseline)  17.4  (5.0-25.0) ug/dL

I don't know much about cortisol yet... what does this number mean in your opinion?

[thethinme]

PS: in response to your question on how my doctor determined I probably had a adrenal problem (not sure about cortisol), here are the main symptoms I told him about:

dizziness when standing up (this one probably gave him the clue on adrenal issues)
carb / sugar craving
fatigue
depression
cold intolerance
brain fog
history of weight gain
pre-diabetic (before losing weight and normal levels again)
sleep issues