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Hypo - could I use additional T4 treatment?
Hello all,
I was diagnosed hypo early this year and have been on armour for most of this time (started with synthroid and switched).
Most of my symptoms have persisted throughout this time. I have a couple other medical issues addressed which has helped some. However; I still have terribly dry hands, some fatigue, difficulty losing or maintaining weight (my body wants to pack on all the pounds it can), constipation (this is getting worse with low carb diet), hoarse voice, weakness (loss of muscle mass) and worse of all terrible forgetfulness. It is to the point that I am not able to function like I used to. I am forgetting common things that have happened recently and it's affecting my work.
My latest labs were:
TSH .007
Ref Range .45 - 4.5
Free T3 4.5
ref Range 2 - 4.4
Free T4 0.92
Ref Range 0.82 - 1.77
My antibodies were negative.
I am on 90 mg armour twice daily. I have read that symptoms may persist with the Free T4 being low. I asked my GP to add a little T4 only medication even if it meant reducing the amount of Armour. He is reluctant to do so. In the mean time I am struggling to get through the days.
Do you feel it would be beneficial to add some synthroid? Is there any literature out there to support this so I can show the Doc?
My dr's are out of ideas what to do (I think they all assume that some thyroid treatment means it's no longer an issue and move on).
Thanks in advance!
I was diagnosed hypo early this year and have been on armour for most of this time (started with synthroid and switched).
Most of my symptoms have persisted throughout this time. I have a couple other medical issues addressed which has helped some. However; I still have terribly dry hands, some fatigue, difficulty losing or maintaining weight (my body wants to pack on all the pounds it can), constipation (this is getting worse with low carb diet), hoarse voice, weakness (loss of muscle mass) and worse of all terrible forgetfulness. It is to the point that I am not able to function like I used to. I am forgetting common things that have happened recently and it's affecting my work.
My latest labs were:
TSH .007
Ref Range .45 - 4.5
Free T3 4.5
ref Range 2 - 4.4
Free T4 0.92
Ref Range 0.82 - 1.77
My antibodies were negative.
I am on 90 mg armour twice daily. I have read that symptoms may persist with the Free T4 being low. I asked my GP to add a little T4 only medication even if it meant reducing the amount of Armour. He is reluctant to do so. In the mean time I am struggling to get through the days.
Do you feel it would be beneficial to add some synthroid? Is there any literature out there to support this so I can show the Doc?
My dr's are out of ideas what to do (I think they all assume that some thyroid treatment means it's no longer an issue and move on).
Thanks in advance!
Best Answer
After we find out more about your ferritin level it will help evaluate if low cortisol is a possible contributor to your hypo type symptoms occurring even with your high free T3. I am sending a PM with a good link on cortisol deficiency and its effects. It might provide some good info for you. To access, just click on your name and that takes you to your personal page. Then click on messages.
Hmmmm..... That's interesting.
I did have the 4 point cortisol test. It shows that my cortisol is low (never getting out of the lower third of the range).
My GP doesn't want to treat it feeling that the treatment may be worse than waiting it out and hoping the adrenals start working correctly again.
I brought it up to my endo, but he is unfamiliar with the treatment.
I did have the 4 point cortisol test. It shows that my cortisol is low (never getting out of the lower third of the range).
My GP doesn't want to treat it feeling that the treatment may be worse than waiting it out and hoping the adrenals start working correctly again.
I brought it up to my endo, but he is unfamiliar with the treatment.
The ferritin test would be a good idea. I have read that inadequate levels of iron/cortisol will cause T3 to build up in the blood rather than getting to your cells. One thing further that I recalled reading.
"Low cortisol/adrenal disfunction. AD often accompanies hypo and gives low T4 with much higher t3: Free t3 is pooling in the blood unable to reach cells due to low cortisol. A saliva (or urine) four-point cortisol test can confirm this." So that is something else to ask the doctor about, a four point saliva cortisol test. Many doctors won't do those, but will instead insist on a singe serum cortisol test, which is not nearly as revealing. If no other way to get it done, you can send away for a test kit and get it done yourself. Does cost about $130.
"Low cortisol/adrenal disfunction. AD often accompanies hypo and gives low T4 with much higher t3: Free t3 is pooling in the blood unable to reach cells due to low cortisol. A saliva (or urine) four-point cortisol test can confirm this." So that is something else to ask the doctor about, a four point saliva cortisol test. Many doctors won't do those, but will instead insist on a singe serum cortisol test, which is not nearly as revealing. If no other way to get it done, you can send away for a test kit and get it done yourself. Does cost about $130.
My reverse T3 was good. I can't find that set of labs, but it was done in July. I think it was middle of the range or thereabouts.
I don't believe I have had a ferritin test done yet. I will try to remember to ask for that on my next set of labs.
It sounds like the T4 med may not be as helpful as I thought. I keep hoping and praying to find the answer to help me feel normal again. It's been so long now I don't really know what normal would feel like.....
Thanks for your help!
I don't believe I have had a ferritin test done yet. I will try to remember to ask for that on my next set of labs.
It sounds like the T4 med may not be as helpful as I thought. I keep hoping and praying to find the answer to help me feel normal again. It's been so long now I don't really know what normal would feel like.....
Thanks for your help!
In view of that I suggest that you should test for Reverse T3, along with Free T3 and Free t4 again. Reverse T3 is a normal product of conversion of T4. It is the mirror image of T3 and is biologically inactive.
Under some conditions an excess of Reverse T3 is produced, which interferes with how Free T3 is metabolized. The recommended way to evaluate is to calculate the ratio of Free T3 to Reverse T3. Dependent on the source the ratio is recommended to be 1.8 or higher. A ratio that is too low is uncommon, but a high Reverse T3 level can result in hypo symptoms, even if Free T3 is high in the range. Since your Free T3 is at the high end of the range and your Free T4 is lower than I would have expected with your dose of Armour and your Free T3 level, that made me wonder about excess Reverse T3.
If you are able to get the tests done, please post results and we will be glad to help interpret and advise further. Also would be a good idea to test for Vitamin D, and ferritin. Low levels of either can cause symptoms and low ferritin is one of the possible causes of excess Reverse T3.
Under some conditions an excess of Reverse T3 is produced, which interferes with how Free T3 is metabolized. The recommended way to evaluate is to calculate the ratio of Free T3 to Reverse T3. Dependent on the source the ratio is recommended to be 1.8 or higher. A ratio that is too low is uncommon, but a high Reverse T3 level can result in hypo symptoms, even if Free T3 is high in the range. Since your Free T3 is at the high end of the range and your Free T4 is lower than I would have expected with your dose of Armour and your Free T3 level, that made me wonder about excess Reverse T3.
If you are able to get the tests done, please post results and we will be glad to help interpret and advise further. Also would be a good idea to test for Vitamin D, and ferritin. Low levels of either can cause symptoms and low ferritin is one of the possible causes of excess Reverse T3.
The last time I took armour was around 3pm the day before. The tests were taken around 9am.
Some of my symptoms have improved, these have persisted or gotten worse.
Thanks for the response!
Some of my symptoms have improved, these have persisted or gotten worse.
Thanks for the response!
Your Free T4 is lower than we recommend, which is middle of the range, at least. But I doubt that would cause the symptoms you mention. Your Free T3 level makes me wonder if you take your med before the blood draw for your thyroid tests? If so, with T3 type meds, that can cause your Free T3 result to be artificially higher than normally expected? Please answer that question before we go further.
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