New here - Trying to understand lab results and medication, etc

[sgreene0206]

Hi Everyone!

I am new here and appreciate the wealth of information I have already come across.  A little background on me: I am 31 year old female, no children, diagnosed Hypothyroid in 2013 when I finally convinced my primary physician to test me.

At that time my labs came back as :
TSH 29.04 Range 0.34 - 5.50uIU/mL
Free T4 0.67 .0580 - 1.640ng/dl
T3 uptake  40% range 32.0-48.4%
Thyroid Ultrasound showed nothing.

She started me on 25mcg of Synthroid and 60 days later new labs showed:
TSH 2.38 Range 0.34 - 5.50uIU/mL
Free T4 1.05 Range 0.580 - 1.640ng/dl

9 months after taking 25mcg synthroid and new labs showed:
TSH 1.45 Range 0.34 - 5.50uIU/mL
Free Thyroxine 6.8 Range 5.9-13.1
T3 Uptake Ratio 40.4 range 32.0-48.4%
T4 Total 6.7  Range 6.1 - 12.2 ug/dL

So as you can tell, she never consistently tested me for the same things, with the exception of TSH. I also continued to experience symptoms and was constantly told that it takes a long time for symptoms to go away. For a while I accepted this. At the beginning of this year I moved to a different state and found my symptoms becoming worse than ever. Here is what I am experiencing:

Fatigue- always tired, exhausted. Exercise, eating right and sleep have not helped.
Increased sensitivity to cold - so very cold, even on hot summer days my hands and feet are like ice cubes
Constipation
Dry skin
Unexplained weight gain - 15lbs in 6 weeks
Puffy face
Muscle weakness
Muscle aches, tenderness and stiffness
Pain, stiffness or swelling in your joints
Irregular menstrual periods
Thinning hair and hair loss
Depression and Anxiety

Impaired memory - cognitive ability is horrible. I can't remember anything, I have a hard time paying attention and retaining new information. I feel like I am in a constant fog.

So I decided to go to a health and wellness clinic that advertised treating thyroid issues as one of their specialties. I figured worse case I would have new lab results and have to find someone else to see me.  I had an appointment a week ago and just did a follow up yesterday. I will say so far I am impressed because this is the first doctor who has ever suggested trying Armour or something other than synthroid.

New lab results are:
TSH 1.170 uIU/mL Range 0.450-4.500
Free T4 1.23 ng/dL  Range .82-1.77 ng/dL
Reverse T3  18.0 ng/dL  Range 9.2 - 24.1 ng/dL
Thyroxine Binding Globulin 13 ug/mL Range 9.2 -24.1 ng/dL
Thyroid Peroxidase TPOAb 153 IU/mL reference 0-34 IU/mL
Triiodothyronine 2.2 pg/mL reference 2.0 -4.4 pg/mL

He immediately pointed out the TPOAb and then started talking about Thyrotropin-releasing hormone and Thyroid conversion issues. Unfortunately, I am having a hard time remember all the details. I put a call in to his office and waiting for him to call me back.

He decided that a good course of action would be to take me off synthroid and put me on Cytomel, 25 mcg for 30 days. I take 1/2 at 6 am and the other 1/2 at 2pm. After 30 days he wants to move me to Armour.

I will say I am very excited to try Armour. I just want to feel normal again, whatever that might be.

Does anyone have any input on what might be going on with me? Easy to read links? Experience with Cytomel or Armour?

[goolarra]

25 mcg of Cytomel all by itself isn't a terribly high dose.  T3 peaks a few hours after you take it, and the body promptly neutralizes any T3 that isn't used right away.  So, what you feel 4-5 hours after taking it is probably your T3 level dropping again.  I know timing of your T3 meds is important when you're following a T3-only protocol, so I don't want to make any suggestions, but you might ask your doctor if it's okay to play with the timing on your second dose to avoid that, or even ask about dividing your dose in thirds.

Good luck with this, and please keep me updated.  

[sgreene0206]

Thank you for all that information. It was very straight forward and easy to understand. After hearing back from my doctor, you are exactly right. He is worried about a conversion issue and is treating me with T3 only in hopes of clearing all the RT3. I have read in other places that 25mcg of cytomel is a pretty high dosage. I haven't experienced any serious side effects but I have noticed a few strange things and I can’t help but wonder if it’s the cytomel. I have noticed approximately 4-5 hours after taking it I feel out of it, kind of in a daze and irritable.  I have a lot of gas and belching within minutes after eating. I have to use the restroom frequently but have not experienced diarrhea.  I have noticed some positive side effects; I don’t feel like I am in a brain fog, my memory has improved, overall I feel happier and I am sleeping like a baby.

I just really hope this works. Like everyone else, I just want to feel better!

Thank you again!

[goolarra]

It looks like he thinks you have RT3 dominance.  Your ratio of FT3:RT3 is very low.  RT3 dominance is a very controversial subject as is how to treat it.  T4 is made by our thyroids.  Before it can be used by cells, it has to be converted to T3.  However, T4 can also be converted to RT3 (reverse T3), which is inert.  One theory suggests that RT3 is a mirror image of FT3 and can dock at receptors in cells, blocking FT3 from getting in.  The traditional treatment for this has been to eliminate T4 meds for a while and let the RT3 clear.  As I said, this is one theory, but I think the one your doctor is operating under because of the way he wants to treat you.

Your TPOab is elevated, so it looks like you have Hashi's.

Your FT4 is low of the 50% of range target; it's 43% of range.  FT3 (triiodithyronine) is extremely low of the upper half (50+%) to upper third (67+%) target.  Yours is only 8% of range.  Since your FT4 is relatively good, and your FT3 is so low, this indicates you are not converting T4 to T3 well.

I don't want to overwhelm you with too much information, but feel free to ask if you need any more clarification.