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How quickly do most people become hypo?

How long does it take for most people to have their Free T4 and Free T3 fall under range?
I'm trying to figure out how long I've been hypo.
Thx!
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Avatar universal
I was unsuccessful in finding any worthwhile info myself.  I did  run across a site that said they had knowledgeable people available that would review and interpret lab test results.  So, I thought why not try it.  Here is the response.

Interpretation of test results
Question:
Could someone please comment on these test results? Ferritin, Serum: 45 -- range 15-150. Iron Bind Cap. (TIBC): 422 -- range 250-450. Iron Saturation: 55% -- range 15-55%. Iron, Serum: 232 H -- range 35-155. UIBC: 190 -- range 150-375. [Lab Tests Online Question referred from: /understanding/analytes/ferritin/tab/faq]
Answer:

Response:
Thank you for contacting the American Society for Clinical Laboratory Science (ASCLS). We are a team of laboratory professionals who volunteer our time and expertise to assist consumers in understanding laboratory tests and results. We try to answer questions within 72 hours, but due to the large volume, we occasionally need more time. An Iron Saturation of 55% is borderline high. All of your other values are normal. You did not give your age or gender which can have a bearing on interpretation of these test results. Also, iron studies should be done on a fasting early morning specimen and you should be off of any iron supplements for at least a week. If you complied with the above, then I would suggest having the tests repeated just to make sure that the saturation level is correct. If it stays the same (i.e. increased or borderline high), depending on your age and gender, you may want to consider some follow-up testing for the condition known as hemochromatosis, or at the very least, repeat the iron studies in six months to see if the % saturation is staying the same or increasing.
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Avatar universal
I don't recall hearing from a member having both Hashi's and a pituitary tumor.  With Hashi's the thyroid gland sometimes produces nodules that leak hormone faster than normal and causes swings in both the thyroid hormones, and also TSH, as the patient cycles from hypo to hyper and back.    A swing to the hyper side can easily obscure indications of a pituitary tumor, for a while, at least.  So, I'm glad you now have the full picture.  Please keep us up to date on your progress.
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Avatar universal
Well, with more tests in, it appears I have a pituitary tumor.  So, guess I oughta be changing message boards that I lurk around in.  Ha.  

Thank you for your help here, sir!
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Avatar universal
Interesting article.  I do suffer from panic attacks and anxiety disorder, so who knows.  It's all so stressful to me (which is not good for my health, apparently).
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Avatar universal
All I know about stress and high cortisol is from what I read in links like this.  

http://www.psychologytoday.com/blog/the-athletes-way/201301/cortisol-why-the-stress-hormone-is-public-enemy-no-1
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Avatar universal
Sent now for an ACTH test.  Wondering if your knowledge extends to this test, as well?  I am beyond confused.
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Avatar universal
That article talks mostly about low cortisol.  I have high.  I have been under some crazy stress though.  When the results were taken, my father had just passed away.  Unsure if stress can cause that big of a rise in cortisol though.  I had a urinary collection for 24 hours and a blood test in the morning.  Both were high.  I also had a test where I took 1mg of a steroid pill and went for blood in the AM again.  That's the only test that came back "normal", but borderline.  It was right at the cut-off point.  So now I am stressing about stress.

Also, I have upped my Cytomel to 7.5 a day.  I'm taking half of a 5 in the afternoon.  I am feeling much more normal and alive these days.  
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Avatar universal
I have read from several sources that either high or low cortisol can adversely affect hypothyroid patients.  You can get some good info from this link.

http://www.hormonerestoration.com/Cortisol.html

With Free T3 level being so low, I'd suggest 5 mcg., split in half, for the morning and early afternoon dose.
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Avatar universal
Do you have any knowledge/information on the relationship between cortisol and hypothyroidism, as well?

Also -- if I attempted to up my Cytomel, is it best to go by 2.5 mcg or 5 is not too big of a jump? Of course I'll notify my physician, but I'm feeling a bit like I need to take matters into my own hands to feel better.
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Avatar universal
Doctor said he only wants to change one thing at a time, then re-examine in 4 weeks. I suppose it's somewhat conservative, but I am okay with that. Ideally, I'd like to be on the least amount of medicine plausible.

Also, maybe I am crazy, but I feel better already. Not perfect -- but last night I couldn't even walk from my couch to my bedroom, and I have a ridiculously tiny house, because of joint pain. Today I walked 4 miles, with minimal joint pain. :)
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Avatar universal
I'd like to say right away, but i"d be lying.  Your Free T3 level is so low that I don't expect that 5 mcg is going to do very much for you, except get you moving in the right direction.  So, I would make sure the doctor knows that the full effect on serum Free T3 levels will be evident in less than a week.  So, I'd plan on pushing for  follow-up tests as soon after that as you can convince him to do so.  

With your Free T4 being so low, why is the doctor reluctant to address that?  No reason why you can't take both T4 and T3.

Also, don't forget to get tested for Vitamin D and B12 at first opportunity.
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Avatar universal
I got Cytomel!! Hurray! My FT3 had fallen off the charts and FT4 had dropped even lower, too. He doesn't want to up the Synthroid yet, but instead have me retest in 4 weeks. I'm starting on 5mcg Cytomel. :) When can I expect to feel a bit better?
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Avatar universal
I was diagnosed Hashi's, yes.  Except the only antibodies that came back out of range were TBII.  The others were elevated, but not out of the lab range. The closest to being out of range was actually TSI at 120%. However, I agree with you, that I clearly need thyroid medication when my Frees are in the gutter.  

If he tries to take away my medicine, I'll find a new doctor.  I'm questioning him now, because I asked if iron overload could have damaged the thyroid or pituitary gland, and he said no.  From my, albeit limited, researching on the subject, I know that to be untrue.  It does/can affect thyroid and pituitary.  So, I guess I will see what the hematologist has to say in a few weeks.

I wish he would just treat the endocrine problems and not speculate on anything else, however.  Because I really don't feel like being miserable for another 2 weeks.  :(
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Avatar universal
So your doctor wants to ignore your having Hashi's?   Weren't you tested for Thyroid peroxidase and Thyroglobulin antibodies?

Also, how can he ignore your symptoms and your lab results, shown as follows.

TSH 1.5, range 0.3-4.5.  FT4 0.69, range 0.9-1.6.  T3 Free 1.5, range 2.0-4.0.

And yes, you need the thyroid med regardless of the diagnosed cause.



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Avatar universal
Interesting appointment. He made me run labs again. Waiting now for tomorrow, and he says if FT3 is low then I can begin Cytomel. However, he mentioned maybe it's not thyroid at all -- and potentially wants to take me off ALL medicine. He thinks it may be hemotomachrosis damage. But, wouldn't I still need thyroid meds if damage had occurred from iron?
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Avatar universal
Your test results were pretty recent. Should not need to be done again.  If not tested recently for B12 and Vitamin D, then might be good to do those.  

Yes, you can stay on T3.  T3 is a thyroid hormone also produced by your own thyroid when functioning correctly.  So it is not something unnatural.  There is nothing dangerous about T3 unless you were to take way too much and get your Free T3 way over the range.  But you want to take just enough to relieve hypo symptoms.  If you get too much you will find out rather quick due to hyper symptoms.  So slow and sure is the best approach to thyroid meds.  

You might want to get your doctor to give you a prescription for at least 10 mcg of T3 so that you can start on 5 and work up to 10 after a week or so.  Then you should go back and re-test for Free T3 and Free T4, just to confirm where you are and if needed request another increase..  
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Avatar universal
I called the office and explained all my symptoms (constipation, hair falling out, freezing cold, completely tired, weight gain), and they scheduled me for today.  :)  The receptionist said "sounds like you need to get started on some Cytomel", so I hope the doctor agrees with that, too.

I have my arsenal of printed papers, haha.  Plus, just how crummy I am feeling should be enough evidence in my opinion.  Do you think I will need to do labs again?  Or not necessary, in light of me being symptomatic?

I may have asked this already, apologies if so (brain is not working at optimal capacity), but can you stay on T3 for a very long time/for life?  Or is it dangerous to one's health?
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Avatar universal
Well, in your last labs, your Free T4 was at 50% of the range, yet your Free T3 was only at 10% of its range.  Obviously you are not converting the T4 to T3 adequately.  Just adding more T4 is not going to change that, so you need to add some T3 to your meds.  Yes, it takes 4-6 weeks to get full effect on serum levels from dose changes of T4 med; however that dose change is very unlikely to do much for you.  So with you being so miserable, why wait?  Also, with your Free T4 level, there should be no need to reduce your T4 med.  

Your Free T3 was at rock bottom and Free T3 correlates best with hypo symptoms, like those you are having.  Inadequate conversion of T4 to T3 is a common problem for hypothyroid patients.  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

Maybe a copy of the above link might open the doctor's eyes.  If however, he reverts to the old argument that you can read anything on the internet, then give him a copy of the paper that the doctor presented to the Scottish Parliament.  The paper includes tons of supporting references to scientific studies.  Your doctor won't have any sources to support what he is doing, other than it being what he was told in med school.

http://www.scottish.parliament.uk/S4_PublicPetitionsCommittee/General%20Documents/PE1463_C_Dr_Henry_Lindner_07.03.13.pdf



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Avatar universal
Well, I am considering calling in on Monday and demanding some T3.  I *am* feeling better these days, but not everything is optimized (not by a long shot).

I am just concerned I'll seem a bit loony if I call and demand early appointment time, when he told me I had to wait 6 weeks before we changed anything.  Is it worth waiting for?  I mean, I'm still freezing, I still can't use the bathroom, and I am still having joint & muscle aches.  

Plus I am losing so much hair (from my head).  

Also, will I need to decrease my Synthroid if/when I can get some T3?
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Avatar universal
Just happened to think that you might be able to make use of the info in this link when you see the doctor.

http://worldlinkmedical.com/hypothyroid-symptoms-but-normal-tsh-levels-how-to-treat-symptoms-of-low-thyroid-by-optimizing-free-t3-levels/
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Avatar universal
That small increase of 12 mcg of T4 is not going to do much for you.  Your Free T4 is already around the middle of the range.   Your problem is that your Free T3 is too low in the range.  Clearly your body is not adequately converting T4 to T3.  Continuing to increase your T4 med is very unlikely to get your Free T3 high enough to relieve hypo symptoms.  You need to add a source of T3, and increase as necessary to relieve hypo symptoms.   Hopefully, at your appointment in 6 weeks your doctor will respond correctly to your need for T3.  Personally, with your symptoms, I wouldn't leave his office until I got a prescription for some T3 med.  

Maybe you should do as a member claimed to have done in similar situation.  Threaten to buy a chain and a lock and fasten yourself to the doctor's desk until you get a prescription for T3 med.  LOL
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Avatar universal
Hi & thank you!  How can T4 alone hurt the heart?  I have looked through that website, STTM, and I will look for the book, too.  Thanks for the heads-up.

Based upon my labs from today, what are your thoughts?  Is that the right 4:1 ratio?  TSH 0.025, range .35-4.0. FT4 1.29, range 0.82-1.77.  FT3 2.5, range 2.3-4.3.
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Avatar universal
Thanks for the information!  You've really helped to clear up some questions I had.  I am very grateful.

I had some labs run today, and now doctor says I can go from 88 to 100 mcg of Synthroid, but no Cytomel yet.  I think that will happen after 6 more weeks, depending on labs.  Here were my numbers from today:

TSH 0.025, range .35-4.0. FT4 1.29, range 0.82-1.77.  FT3 2.5, range 2.3-4.3.

Any thoughts?
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Avatar universal
Adding T3 will lower the TSH but as gimel stated that is not the result you are concerned about.  It is the ratio of T4 to T3 which is a 4:1 ratio.  T4 alone will actual over the long term hurt your heart which is another reason to have T3 in conjunction with T4.  

Stop the Thyroid Madness is a book published by a undiagnosed thryoid patient.  Wait until the 2014 edition is available if you are going to purchase it.  Ignore the derogatory comments about doctors and read about the tests and the impact on symptoms experienced by patients when not dosed or under dosed/overdosed.
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Avatar universal
I think as serum thyroid levels change and people become hypothyroid, symptoms seem to show up long before the test results become extreme enough for doctors to agree that you are hypo.  With Hashi';s, the TSH changes in response to less thyroid hormone being produced as the gland is being attacked and destroyed over an extended period.  Within the time frame for this to happen, and given the extremely broad reference range for TSH, een with Hashi's the TSH will remain within the so-called "normal" range for extended periods.  How long is that?  I don't really know how to even estimate it, and wouldn't know where to look for the info even if it was a vital concern.  

For the other major type of hypothyroidism (central), the cause is hypothalamus/pituitary related.  In those cases, the TSH is too low within the range to stimulate enough thyroid hormone production.  The TSH typically will remain low for an extended period, until the patient's symptoms become so bad that a doctor tests for Free T3 and Free T4 and is knowledgeable enough to understand that the patient really is hypothyroid.  
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