Low TT3, progress update

[btr789]

Hi everyone,

I've done a blood test a month and a half ago, these were the results (pre-meds) -

TSH - 7.58 (range 0.55 - 4.78)
FT4 - 12.45 (range 11.5 - 22.7)
TT3 - 0.8 (range 0.92 - 2.79)

I've redone the blood test a few days ago (after taking 50 mg Eltroxin since the previous test),
these are the results -

TSH - 4.78
FT4 - 14.67
TT3 - 1.1

- The symptoms (neck stiffness, fatigue, hamstrings pain) persist, though there was a mild improvement 2 weeks ago.
- Regarding FT3 - it seems that I need a special referral for a special test in order to check it, is that ordinary?
- I'm seeing an endo in a week and so I wanted to hear some of your thoughts first, to be more informed. Do you think I should have a higher dosage? Does that progress indicate any problems with T4 to T3 conversion?

Thanks!

[gimel]

I'd say that your Free T4 is adequate, but your Free T3 is a bit on the low side.  You can request adding the small dose of T3 med and increasing until symptoms are relieved.  I hope the new Endo is willing to treat clinically as described in the link I gave you above.  

One thing further.  Hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin.  So, it would be a good idea to have those tested as well.

Best to you.

[btr789]

Hi again :)

I finally checked my FT3 levels, along with the rest.

TSH - 1.84 (0.55 - 4.78)
FT4 - 14.84 (10.3 - 19.7)
TT3 - 0.9 (0.92 - 2.79)
FT3 - 4.82 (3.5 - 6.5)

Currently on 75 mg of eltroxin.

My tiredness & muscle soreness (neck area & shoulder blades) improved in the last 2 weeks (maybe the 75 mg increase finally kicked in after 2 months passed). The muscle soreness is still there, though there are times in the day when it's completely gone.

According to what I understand, the FT3 should be in the upper third and FT4 could also use a slight increase. Would it be safe to say that i'm converting well enough? Could an increase to 100 mg be the right move? Or giving 5 mg of Cytomel a shot? I'm meeting a new Endo in 2 days.

Btw, the TT3 is still below range. Weird?

Thanks gimel!

[btr789]

Indeed it is. Can't understand the unwillingess to even consider.
I'm from Israel, I doubt there'd be someone, but maybe.

[gimel]

Too bad that the Endo has a closed mind that won't even consider scientific information that differs from his beliefs.  If you will please give us your location, perhaps a member can recommend a good thyroid doctor for you.

[btr789]

Well I've been to the Endo yesterday. He decided that i'm balanced and that the below-range TT3 levels are of no consequence, considering my normal TSH. He also didn't give importance to the fact that the FT4 are below the middle of the range. Needless to say, he ignored my notions about these.

He told me to stay on the 75 mg, and because I complained I still suffer from fatigue and muscle cramps, he changed my med to Euthyrox (which is supposed to have better absorption I guess).

As I see it, my to-do list consists of getting my FT3 level tested and find a good endo who treats according to FT3 & FT4 levels and might consider Armour Thyroid a legitimate treatment (not sure how to go about that).

Appreciate your thoughts,
Thanks!

[gimel]

There are so many different symptoms that can be related to hypothyroidism, I guess we could rationalize that as yet another, in view of your low T3 level; however, there are many other possibilities also.  I really don't have any specific suggestions.  Try a separate question, as you mentioned, and see if you get any ideas from other members.

Also, I did search this Forum for the mention of stiff neck, and found this.  


Avatar_n_tn
Carrie Anne

Aug 03, 2007
To: smart9426
The stiff neck is just another lovely side effect of hypo-thy, I still get it now and then but I assure you once your meds get adjusted you'll feel like  new

[btr789]

Hey, thanks for the quick response..

I tested for "Anti-TPO" & "Thyroglobulin Ab" which are both in the normal range. Does there have to be some sort of a condition to cause hypo or could it be just a "lazy gland" transferred genetically? (my mother is also hypo).

Regarding the T4 & T3 dosages - alright, that's what I thought.

And regarding the FT3 correlation to hypo symptoms - I mentioned my desire to test for FT3 and mentioned the research about the FT3 correlation to hypo-symptoms. He dismissed it with a slight contempt towards my trying to interfere. I'm doubtful that bringing it printed would change his mind. I'm looking forward to see how he'll react to the non responsiveness of the TT3. I doubt increasing the eltroxin dosage will have any effect (seeing that the 2 previous ones barely had any).

Btw, I'm thinking of posting a question to the community about the possibility of a stiff neck being a hypo-symptom. Any ideas regarding the possiblity? (it's aweful and no amount of Yoga/good-sitting-posture seems to make it go away).

Thank you so much. Again.

[gimel]

Just a couple of questions and comments for you.

First did the doctor ever test you to try and determine the cause for you being hypothyroid?  For example the most common cause for diagnosed hypothyroidism is the effect of thyroid antibodies associated with Hashimoto's Thyroiditis.  The tests for Hashi's are Thyroid Peroxidase,and Thyroglobulin antibodies, denoted as TPO ab and TG ab.  Have you had those?

Even with the 75 mcg of T4 med, your Free T4 is still not up to the middle of its range, which is recommended.  Even more important, it does not appear that you are adequately converting the T4 med to T3.  If an additional increase continues to show low in the range T3 results, then you likely will need to add a source of T3 to your meds.  


If you give the Endo a copy of the link I gave you above, about the correlation of Free T3 to hypo symptoms while Free T4 and TSH did not correlate, and he still refuses to consider even testing you for Free T3 and treating clinically, you need to find a good thyroid doctor that will do so.  

[btr789]

I'll appreciate your opinion as well, I summed up everything in the previous comment. Thank you very much!

[btr789]

Hi again,

I've done another blood test and wanted to keep you updated, i'll appreciate  your thoughts regarding the relationship between the meds and the TT3 levels.

First blood test -

TSH - 7.58 (range 0.55 - 4.78)
FT4 - 12.45 (range 11.5 - 22.7)
TT3 - 0.8 (range 0.92 - 2.79)

Second blood test (after taking 50 mg Eltroxin) -

TSH - 4.78
FT4 - 14.67
TT3 - 1.1

Third blood test (latest one, after taking 75 mg Eltroxin) -

TSH - 2.64
FT4 - 14.2
TT3 - 0.9

I've had an improvement with my fatigue but the stiff neck is still there. I don't know if I should consider the latter a symptom or not.

(The endo treating me doesn't consider FT3 levels crucial so I don't have those unfortunately).

[gimel]

In addition to Red_Star's comment, consider that the T4 meds are sold by the big pharmaceutical companies, who also provide a lot of funding to the professional organizations that maintain that T4 is all that is needed.  Those same large companies provide a lot of the funding for scientific studies that, guess what, found that T3 had no benefit over taking T4 only.  And in every one of those studies that I have gone through in detail, the design of the study was flawed, and the patient did not really end up with a Free T3 level high enough to have any effect.   Wonder why.  LOL

By the way there are also some scientific studies that concluded that the addition of T3 along with T4 improved relieved symptoms for some of the study participants.   I think mostly it depends on the patient's ability to convert the T4 med to T3 adequately.  When it is not adequate, then T3 is beneficial.

[Red_Star]

"why do doctors prefer treatment with T4 medicines, instead of natural dessicated thyroid, which contains both T3 & T4?"

Medical school training. I read a comment on here that one doctor had never heard of NDT. But NDT was the only treatment for thyroid disease until synthetics was introduced. What is old is new again.

[btr789]

By the way, why do doctors prefer treatment with T4 medicines, instead of natural dessicated thyroid, which contains both T3 & T4? The fear of becoming hyper?

I'm referring to the PDF you referred me to earlier - http://hormonerestoration.com/files/ThyroidPMD.pdf
in which the doctor prescribed natural dessicated thyroid (40mcg T4 & 9mcg T3).

It's only been a week since I began the new dosage, and so I know the effect is still 3-5 weeks ahead of me, but the symptoms are bothering me as ever. Trying to find some comfort with some education.

Thanks again, appreciate your help.

[gimel]

I'd stick with what the doctor wanted.  You want to maintain a good working relationship as long as possible.  The prior dose was 50 x 7 = 350 mcg per week.  The new dosage is 550 mcg.  that is almost a 60 % increase.  I'd give it a chance and see how you feel after the new dose has time to build up and have an effect, say 4-6 weeks.  Believe me, I know you are anxious to feel better, but it is far better to go slowly instead of moving too fast and risking a reaction.  

[btr789]

Would you consider the dosage raise too conservative? (would it not make sense to try 100mg throughout the week?)

I read the abstracts of the articles and ill try to pitch them to him.
Thank you so much for the ongoing help! It really makes it easier for me.

[gimel]

I wouldn't give up on this Endo quite yet.  Even the fact that he mentioned responding to symptoms, along with test results, is better than heard from most, it seems.  So as long as you are getting increases in your meds, you might as well stay there.  I think it will get a bit more difficult for you when the TSH level gets into the very low end of the range, or below.  Then if he wants to start reducing your meds, on the assumption you have become hyper, then that will be the time to refuse to reduce dosage and also time to leave.  You become hyper only if having hyper symptoms due to excessive levels of FT3 and FT4.  

In the interim you can try to provide info to change the doctor's mind about Free T3.  Here is a link to a scientific study that concluded that of the thyroid tests, Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate at all.

http://www.ingentaconnect.com/content/routledg/cjne/2000/00000010/00000002/art00002

Further info for your doctor about the potential benefit of adding some T3 to meds, when the conversion of T4 is inadequate.

http://www.nejm.org/doi/full/10.1056/NEJM199902113400603

http://jcem.endojournals.org/content/90/5/2666.short

This link is a British Medical Journal study that concluded that "biochemical tests of thyroid function are of little value, if any, value clinically in  
patients receiving thyroxine replacement.  Most patients are rendered euthyroid by a daily dose of 100 or 150 mcg of thyroxine.  Further adjustments to the dose should be made according to the patient's clinical response."

http://www.bmj.com/content/293/6550/808.pdf%2Bhtml

As for the effect of your dosage change, T4 med takes about 4 weeks to build up to over 90% of its final level in your blood.  So you have a way to go yet.  Symptom changes sometimes lag changes in blood levels of thyroid hormone, dependent on the severity of symptoms and how long you have been suffering with low thyroid levels.   Patience is really a requirement for hypo patients.

[btr789]

Hi,
After meeting with the endo, he raised my dosage to 100mg 4 days a week and 50mg 3 days a week. Up until now (since 2 months ago) I used to take 50mg eltroxin.

(reminder) my last test results were -
TSH - 4.78
FT4 - 14.67
TT3 - 1.1

Moreover, unfortunately, my doctor didn't seem to subscribe to the notion that FT3 is an important factor and told me that the treatment according to the TSH, T4 and my symptoms is what's important. I insisted that to my best knowledge, FT3 best correlates to hypo symptoms and therefore vital, but it didn't move him much.

- According to my levels (and the fact that my symptoms persist) do you believe the dosage is right? How long does it take to feel the effect of a dosage change?
- Should I be looking for another endo?
- P.S. Although I felt a pretty significant improvement with my neck stress condition since taking 50mg eltroxin, he didn't believe that the neck stress is connected to thyroid problems. I tend to ignore that notion since I do feel relief and since nothing else is wrong with me, aside from my thyroid imbalance. Any thoughts?

Thank you very very much.

[Red_Star]

To add to gimel's very informative answer, another problem when your cells don't like you. My cells hate me. *cries*  I have optimal lab results so i am assuming i have plenty of reverse T3 clogging up my thyroid receptors and doing a great job i might add.  If you think free T3 is hard to request try reverse T3. ayayaya~!  

[btr789]

I was hoping for such an elaborative answer. Thanks!
I'll take everything into consideration and update in a few weeks.

[gimel]

Your blood test results do reflect some improvement in your Free T4 and Total T3 levels.  So that is good.  Now you really need to get your doctor to switch from TT3 to FT3.  Perhaps you can do that by explaining that only the 'free" portion of Total T3 is biologically active.  Total T3 does not always accurately reflect Free T3 levels.  Since scientific studies have shown that Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate at all, it is important to know Free T3.  

I don't understand why you would need anything like a special referral for a FT3 test, unless your insurance company refuses to cover it.  I would just make the doctor aware of the above info on Free T3 and push for the test.  If  he still resists, just insist on knowing why he can't order it.  

I hate to rain on your parade, but you should be aware that being an Endo does not guarantee a good thyroid doctor.  Many of them specialize in diabetes, not thyroid.  Many of them have the "Immaculate TSH Belief" and only want to test and treat based on TSH.  This simply does not work because TSH is affected by so many things that it cannot be shown to correlate well with either Free T3 or Free T4, much less with symptoms, which are really the most important consideration.  Other doctors will go beyond TSH and test for Free T4, but then want to use "Reference Range Endocrinology", by which they will tell you that a thyroid test result that falls anywhere within the range is adequate.  This also doesn't work.  

As I post so often, 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

I would not expect your symptoms to be significantly better, based on the low dosage of med, plus the relatively low levels of FT4 and TT3.  So you are going to have to get some doctor to increase your meds until symptoms are relieved.

In addition, since Hashimoto's Thyroiditis is the mos common cause for diagnosed hypothyroidism, if not done already you should request tests for the antibodies that cause Hashi's.  Those are Thyroid Peroxidase and Thyroglobulin antibodies,  usually identified as TPO ab and TG ab.  This knowledge will let you kow more bout what to expect as you proceed.

Since hypo patients are frequently too low in the ranges for Vitamin D, b12 and ferritin, I'd request those tests also.  Please keep us tuned in to your progress with the doctors and tests.