Aa
How high is to high?
Can anyone tell me how high of FT3 is to high? My Ft3 is just over range and my FT4 are mid range and my TSH was 0.004 I don't have my paper at the moment for the actul numbers on the others but the doctor told me I am on way to much naturethroid and told me to lower to 4 grains from 5. Which I did and almost 2 weeks later and I am so tired I am back to taking a nap during the middle of the day. I never felt hyper or high as she calls it I was still fatigued but I was able to make it through the day. I did have a few palpitations if I am right on what they are but I still have them and it seems to me to be more of an anxiety thing because it happens more when I am nervous or stressed. She also said she doesn't just look at numbers but how you feel but she is insisting I am to high...So how high is to high. if the range ends at like 3.50 I am like 3.75 can't remember exact numbers but it was about that much higher. She wasn't worried about my TSH says you cant' just look at that. THX
Another thought!
Did you take your meds the morning before your bloodwork?
If you did this can make your numbers look higher.
Just in case, next time you test, make sure not to take your meds before you test, only after.
Did you take your meds the morning before your bloodwork?
If you did this can make your numbers look higher.
Just in case, next time you test, make sure not to take your meds before you test, only after.
Hi,
I would think that the reduction from 5 grains to 4 grains was too much of a reduction. Getting the dose right can be a fine balancing act.
The doctor is right in wanting you within range. Just below top of range is also okay. The palpitations are not ok.
Maybe you need to work with your doctor and increase back to say 4 1/2 grains. Tell your doctor how you are feeling and she may well suggest a bit of increase again herself. It is great that you have a doctor looking at more than TSH! Sounds like a keeper to me!
I would think that the reduction from 5 grains to 4 grains was too much of a reduction. Getting the dose right can be a fine balancing act.
The doctor is right in wanting you within range. Just below top of range is also okay. The palpitations are not ok.
Maybe you need to work with your doctor and increase back to say 4 1/2 grains. Tell your doctor how you are feeling and she may well suggest a bit of increase again herself. It is great that you have a doctor looking at more than TSH! Sounds like a keeper to me!
You should make sure that your Vitamin D is above the midpoint of its range. Your FT3 is a bit on the high side, but I forgot to ask if you take your med before the blood draw. If you do it can give a somewhat higher test result than if you wait until after testing to take the med. I do think that it would be a good idea to test for Reverse T3, along with FT3 and FT4, in order to see what the ratio of FT3 to RT3 looks like. When the ratio is too high it can still give you hypo symptoms, even when your FT3 is on the high side. So a good idea to test and rule it out or in.
I think you could also possibly relieve your doctor's concern by giving her a copy of this letter written by a good thyroid doctor for patients that he sometimes consult with from a distance. The letter is then sent to the PCP of the patient to help guide treatment.
For Physicians of Patients Taking Thyroid Hormones
I have prescribed thyroid hormones for your patient because his/her symptoms, physical signs, and/or blood tests suggested that he/she had inadequate levels for optimal quality of life and long- term health. If there were clear improvements, I maintained the thyroid supplementation. Mild-to- moderate thyroid insufficiency is common and an unrecognized cause of depression, fatigue, weight gain, high cholesterol, cold intolerance, atherosclerosis, and fibromyalgia. Thyroid supplementation to produce higher FT3 and FT4 levels within the reference ranges can improve mood, energy, and alertness; help with weight control, and lower cholesterol levels.
Your patient’s TSH may be low or undetectable, even though their free T3 and free T4 are within the reference ranges. Why? We are taught that the TSH always perfectly reflects a person’s thyroid hormone status, supplemented or unsupplemented. In fact, we have abundant evidence and every reason to believe that the hypothalamic-pituitary axis is NOT always perfect. In clinical studies, the TSH was found not useful for determining T4 dose requirement.i The diagnosis of thyroid insufficiency, and the determination of replacement dosing, must be based upon the patient’s symptoms first, and on the free T4 and free T3 levels second. The TSH test helps only to determine the cause. Even here, “normal” may not be good enough. The labs’ reference ranges for free T4 and free T3 are not optimal ranges; but only 95%-inclusive statistical population ranges. The lower limits are below those seen in studies of healthy adults. They define only 2.5% of the population as “low”, but hypothyroidism is more prevalent than that.
T4-only therapy (Synthroid, Levoxyl), to merely “normalize” the TSH is typically inadequate as the H-P axis is often under-active to begin with, is more sensitive to T4, and is over-suppressed by the once-daily oral thyroid hormone peaks. TSH-normalizing T4 therapy often leaves both FT4 and FT3 levels relatively low, and the patient symptomatic. Recognizing this, NACB guidelines call for dosing T4 to keep the TSH near the bottom of its RR (<1) and the FT4 in the upper third of its RR; but even this may not be sufficient. The ultimate criterion for dose adjustment must always be the clinical response. I have prescribed natural dessicated thyroid for your patient (Armour or Nature-Throid). These contain T4 and T3 (40mcg and 9mcg respectively per 60mg). They are more effective than T4 therapy for most patients. Since they provide more T3 than the thyroid gland produces, the well-replaced patient’s free T4 will be around the middle of its range or lower, and the FT3 will be high-“normal” or slightly high before the AM dose.
Excessive thyroid dosing causes many negative symptoms, and overdosed patients do not feel well. I suggest lowering the dose in any patient who has developed insomnia, shakiness, irritability, palpitations, overheating, excessive sweating, etc. The most serious problem that can occur is atrial fibrillation. It can occur in susceptible patients with any increase in their thyroid levels, and is more likely with higher doses. It should not recur if the dose is kept lower than their threshold. Thyroid hormone does not cause bone loss, it simply increases metabolic rate and therefore the rate of the current bone formation or loss. Most older people are losing bone due to their combined sex steroid, DHEA, Vitamin D, and growth hormone deficiencies. The solution is not life-long hypothyroidism or bisphosphonates; one should correct the hormone deficiencies.
Fraser WD et al., Are biochemical tests of thyroid function of any value in monitoring patients receiving thyroxine replacement? Br Med J (Clin Res Ed). 1986 Sep 27;293(6550):808-10.
I think you could also possibly relieve your doctor's concern by giving her a copy of this letter written by a good thyroid doctor for patients that he sometimes consult with from a distance. The letter is then sent to the PCP of the patient to help guide treatment.
For Physicians of Patients Taking Thyroid Hormones
I have prescribed thyroid hormones for your patient because his/her symptoms, physical signs, and/or blood tests suggested that he/she had inadequate levels for optimal quality of life and long- term health. If there were clear improvements, I maintained the thyroid supplementation. Mild-to- moderate thyroid insufficiency is common and an unrecognized cause of depression, fatigue, weight gain, high cholesterol, cold intolerance, atherosclerosis, and fibromyalgia. Thyroid supplementation to produce higher FT3 and FT4 levels within the reference ranges can improve mood, energy, and alertness; help with weight control, and lower cholesterol levels.
Your patient’s TSH may be low or undetectable, even though their free T3 and free T4 are within the reference ranges. Why? We are taught that the TSH always perfectly reflects a person’s thyroid hormone status, supplemented or unsupplemented. In fact, we have abundant evidence and every reason to believe that the hypothalamic-pituitary axis is NOT always perfect. In clinical studies, the TSH was found not useful for determining T4 dose requirement.i The diagnosis of thyroid insufficiency, and the determination of replacement dosing, must be based upon the patient’s symptoms first, and on the free T4 and free T3 levels second. The TSH test helps only to determine the cause. Even here, “normal” may not be good enough. The labs’ reference ranges for free T4 and free T3 are not optimal ranges; but only 95%-inclusive statistical population ranges. The lower limits are below those seen in studies of healthy adults. They define only 2.5% of the population as “low”, but hypothyroidism is more prevalent than that.
T4-only therapy (Synthroid, Levoxyl), to merely “normalize” the TSH is typically inadequate as the H-P axis is often under-active to begin with, is more sensitive to T4, and is over-suppressed by the once-daily oral thyroid hormone peaks. TSH-normalizing T4 therapy often leaves both FT4 and FT3 levels relatively low, and the patient symptomatic. Recognizing this, NACB guidelines call for dosing T4 to keep the TSH near the bottom of its RR (<1) and the FT4 in the upper third of its RR; but even this may not be sufficient. The ultimate criterion for dose adjustment must always be the clinical response. I have prescribed natural dessicated thyroid for your patient (Armour or Nature-Throid). These contain T4 and T3 (40mcg and 9mcg respectively per 60mg). They are more effective than T4 therapy for most patients. Since they provide more T3 than the thyroid gland produces, the well-replaced patient’s free T4 will be around the middle of its range or lower, and the FT3 will be high-“normal” or slightly high before the AM dose.
Excessive thyroid dosing causes many negative symptoms, and overdosed patients do not feel well. I suggest lowering the dose in any patient who has developed insomnia, shakiness, irritability, palpitations, overheating, excessive sweating, etc. The most serious problem that can occur is atrial fibrillation. It can occur in susceptible patients with any increase in their thyroid levels, and is more likely with higher doses. It should not recur if the dose is kept lower than their threshold. Thyroid hormone does not cause bone loss, it simply increases metabolic rate and therefore the rate of the current bone formation or loss. Most older people are losing bone due to their combined sex steroid, DHEA, Vitamin D, and growth hormone deficiencies. The solution is not life-long hypothyroidism or bisphosphonates; one should correct the hormone deficiencies.
Fraser WD et al., Are biochemical tests of thyroid function of any value in monitoring patients receiving thyroxine replacement? Br Med J (Clin Res Ed). 1986 Sep 27;293(6550):808-10.
I felt decent better then I have for a long time since I had been on that dose. now I feel like a walking zombie again. But she thinks I am just use to feeling "high"
She did order Vit D which I try and take anyways but not RT3 my iron came back fine last time. I have tried to treat for RT3 a few years back but never noticed any difference after doing so. I remember reading somewhere that desicated can make your FT3 look higher than it really is?
The key question is , how were you feeling at the time? The FT3 level should be high enough to relieve symptoms. In the words of a good thyroid doctor that I highly respect, "the well-replaced patient’s free T4 will be around the middle of its range or lower, and the FT3 will be high-“normal” or slightly high before the AM dose."
In view of your FT3 level and the palpitations you had, I would suggest that you should also test for Reverse T3, Vitamin D, and a full test panel for iron anemia, if not already done, just to rule those in or out as a problem contributing to your fatigue.
In view of your FT3 level and the palpitations you had, I would suggest that you should also test for Reverse T3, Vitamin D, and a full test panel for iron anemia, if not already done, just to rule those in or out as a problem contributing to your fatigue.
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