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I think I need T3 but doc says no way
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I think I need T3 but doc says no way

I have been taking synthroid for about 2 months now after finally being diagnosed. I started on .5 and within a week started feeling better. However...after the third week started feeling run down again. Called the doc and he increased to .75. Started to feel better again and just had my blood retested. I think I need some t3 added to synthroid but doc says all is normal.

Here's the last labs...

TSH 0.89.....started out at 3.5

FT4 1.1....started our at .9     lab range is 0.8-1.8
FT3  319...started out at 319  lab range is 230-420

Although I'm much better I'm still having hypo symptoms; achiness, joint pain, etc.
My morning temp is still under 97 and my pulse still under 60.

However, My family physician, not the endo that is treating me, has wanted to put me on cholesterol meds for about three years. I wouldn't do it! After the synthroid my levels have dropped from 270 to 183 with LDL and HDL doing the same. On the right track but not quite there yet.
So what do you all think...agree with me or the doc about the t3?

Thanks
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499534_tn?1328707778
Your T4 level is still too low, should be at least mid normal range...... and your t3 level optimally should be high normal range.
Some drs put too much emphasis on TSH which actually shows pituitary function. He should be treating you by your free's which are the actual active thyroid hormone in the body.
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Avatar_m_tn
Totally agree with laura.  Here's some good reading material to reinforce the importance of the "Frees", and the levels necessary to alleviate symptoms.

http://www.hormonerestoration.com/Thyroid.html
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Avatar_f_tn
I don't agree with either you or your doctor, but agree with both the above. All is not "normal", but neither do you need T3.  You need more T4 meds...worry about adding T3 later if symptoms aren't alleviated once FT4 is higher in the range.

Here's an argument for your doctor:  What's the harm in nudging the FT4 higher up in the range to alleviate symptoms?  You'll still be "normal", but you might feel better.  Why stop increasing when FT4 is barely in range?  We have this whole range to play with; why not use it?  
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Avatar_m_tn
Thanks to all for  your comments. I'm writing a letter to the Dr. today asking  him why we are stoping here. I guess my question is....won't increasing just my t4 lower my TSH even more. And...there are some studies that show anything under .5 or so can contribute to heart disease and wouldn't I go hyper with more T4.
I'm also wondering why, with all of the t4 so far have my storage of t4 and my ft3 not gone up.

Thanks All...I'll keep you posted
Here's a copy of the letter I'm sending the Endo


First of all I would like to thank you for diagnosing my hypothyroidism…I feel much better with the medication you have me on. I’m hoping for further improvement of my remaining symptoms in the coming months. My cholesterol did plummet to normal though….hallelujah!

I just have a couple of questions. When I talked with your nurse yesterday, I asked if I could be put on a small dose of T3. I’m sorry that you have to deal with someone who surfs the internet looking for medical answers but, that’s what got me to you! Anyway…I have a lot of faith in you and will ultimately do what I’m told….. Sometimes I just need some answers to cure my curiosity!

Everything that I read says that, for optimum numbers, my Free T3 should be at the top of the normal range and my Free T4 should be in the middle or upper middle of the normal range. This last round of tests showed my FT3 in the middle and FT4 in the low normal. From the previous testing my Free T4 went from 1.0 to 1.1 and my Free T3 actually went down this time from 321 to 319. I know I have an almost perfect TSH now but what the heck is going on with the other numbers; Would a small dose, just a dab, of T3 be beneficial in helping the remaining hypo symptoms? Or...what about just more T4 and the heck with the TSH?


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Avatar_f_tn
I agree with goolarra.

I also think that not enough time has lapsed to really be prescribed a T3 med yet.
it can take up to 12 months for levels to stabilise if not longer.
Two months just isnt long enough to expect a Doctor to put you on a T3 med.
The secret is baby steps, as Ive always said and as frustrating as it is , it is the truth.
I have been down both roads....increases often = Hyper.
Increases slowly = stabilised levels.
If all else fails THEN T3 should be considered.
I just dont think you have given your body enough time to adjust to the T4 med.

But thats just my personal opinion.

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649848_tn?1357751184
I agree with what everyone else has said.  It takes time for your body to get adjusted to the meds and 2 months is not long enough.  

I am on cytomel, which is T3 med but that's only because my Free T3 was very low.  It's now about the same level as yours (mid range).  T3 meds are very powerful and must be used with care.  

At my last visit to the endo, we actually cut back on the cytomel and raised the T4 med.  I am anxious to have my next blood work done so I can see what's what.  I DO feel better, but with Free T4 still only at 0.9 and Free T3 at 320, I still have symptoms.  My problem is that my TSH is SO low (0.19), my endo keeps wanting to lower my T4 meds rather than raise it.  *I* say "forget about TSH and let's get the Free T's in line", then think about the TSH if necessary.  
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549681_tn?1229728099
I also think you need to give this more time, but your FT4 is too low.  I noticed that my symptoms tend to lag behind my labs by a month or more.  That is - I still felt hyper when my labs said hypo.  A month later, hypo symptoms hit after I started Levoxyl.

This idea is controversial, and board members with Hashi may slap me for saying this.  How about a kelp supplement?  Since your body uses iodine to convert T4 to T3, iodine can boost your T3 naturally.  I've heard some say that iodine can further damage a diseased thyroid gland.  Others say it has been a life saver.  It is certainly less costly than arguing with a Dr. who refuses to give you T3.
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Avatar_f_tn
Actually, T4  is converted to T3 by LOSING, not gaining iodine.  The 3 and the 4 actually represent he amount of iodine in each version.  T4 has four atoms of iodine, T3 has 3, and yes, there are 2 and 1.  So, once T4 is made, no more iodine is required.  
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Avatar_f_tn
You are a brilliant source of info goolarra lol (and I mean that nicely).
Goolarra is 100% correct.

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Avatar_m_tn
Thanks for all the input. You are probably correct BUT patience is not one of my virtues!!!
I guess a few more months won't hurt anything...I've been suffering with hypo symptoms (unknow to me of course what it was) since 1981 right after a nodule popped up on my thyroid. Doc says a lesion is still there. Was a firefight and had to retire because of the headaches and fatigue. Ugh! I'll keep you all posted what happens and again, thanks for all of your imput AND...keep it coming
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Avatar_m_tn
Hey...it's me again. Talked with my doctor's nurse today in answer to the letter I sent him. She stated that all of the test numbers were "in limits and within the range of error".Whatever the heck that means!
He was trying to keep my TSH at 1.0 and believes that the treatment at this time is doing it's job. Sooooo, what do you think? Should I wait patiently to see if he's correct, find a new doctor, or badger him some more. He is listed on the top docs of the about thyroid website. What do you think of the dr. on the hormone restoration website. Would he be worth contacting? I am a pilot...I can fly to Pennsylvania!!

Thanks
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Avatar_f_tn
I'd get specific numbers on all those results "in limits" and their reference ranges.  If they're "in limits" like the last labs you posted, you still have lots of room to tweak meds to get rid of your symptoms. A 1.0 TSH may just not be right for YOU.

You do have to be patient, but you don't have to be foolhardy!

I don't know enough about Lindner to comment.  His article seems to reflect some good ideas, but who knows how he is as a clinician.

I'm working on a short (?) commentary I wrote about the proper use of reference ranges.  I have some editing to do, but when I'm finished, I'll post it to you.
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Avatar_m_tn
The numbers are the same as I posted except...I was mistaken on the FT3. It actually went down from 321 to 319 six weeks after starting treatment.  I'm also borderline low on Testosterone, DHEA, and B-12.
I was low in Vitamin D but took 50,000 units once a week and got it up to 50.

thanks

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Avatar_f_tn
Your FT4 is still quite low, and you've only just started on levo a couple of months ago.  It can take a long time for meds to stabilize in your system...we all wish it didn't  I think you need a fine-tuning T4 increase, but still think it's too early to try T3.  It can help, but it has it's own set of problems.  

I'm editing my article after lunch...will PM it to you..  
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865758_tn?1285956504
I would love to read the article too!!!!!
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Avatar_m_tn
Sooooooo, actually all the T4 has done right now is suppress my TSH?
Should I feel better in the coming weeks as my FT4 comes up...and I actually convert to FT3? I'm  feeling a bit better now...the body stiffness that I had is going away after years and I'm definately not as tired. If my T's didn't go up...how did I improve? Just trying to learn....

Thanks
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Avatar_f_tn
Well, your FT4 has actually gone up from 0.9 to 1.1.  That's a significant improvement (20% of the range from low limit to high limit).  However, as I said above, there's still plenty of wiggle room to increase meds a bit and push that FT4 up a bit more in the range, until your symptoms are all alleviated.  I don't think it will take a huge adjustment, either.  My guess is perhaps to 81.5 (1/2 an 88 + 1/2 a 75, or 75 and 88 on alternating days) or even 88.  Don't forget, although a low TSH often indicates hyperthyroidism, it is not the TSH per se that makes you hyper.  It's high levels of T4, and especially T3, that make you hyper.  You are no way near the upper limits on either of these two.

You should feel better as your FT4 comes up.  Your free's WILL go up with meds increases.  Never heard of anyone who increased their levo and didn't increase their FT4, unless they were taking their meds with something (food, drink or other meds) that blocked absorption of the levo.  You're not doing this, are you?

You also have to remember that if you have been hypo for years and years, it is going to take a while for your body to heal.  You also have to remember, Mr. Impatience ;-), that you've only been at this for a couple of months.  I think your progress in two months is excellent.
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649848_tn?1357751184
I'd like to see your article as well.  Is it possible that you could just post it?  Or if you can't do that, could you PM it to me also?  Thanks
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Avatar_f_tn
Don't forget, this is my opinion, and I am not a doctor!

Proper Use of Reference Ranges in Treating Hypothyroidism:  Some Ideas to Discuss with your Doctor

Many hypo patients or undiagnosed hypo patients have an array of hypo symptoms, yet their lab work (free T3, free T4 and TSH) indicate that they are within the reference ranges that doctors erroneously refer to as “normal”.  TSH is often high in the range (or maybe even above the range according to the latest standards of 0.3-3.0 which many labs and doctors still refuse use) and FT3 and/or FT4 are low in their ranges.  Many doctors think that if labs are anywhere within ranges, their job is done...patient is no longer hypo, any remaining symptoms are not thyroid related, patient is fat and lazy.  NOT TRUE.  

Please see illustration below.  Each of us has a personal reference range within the population reference range at which we are euthyroid (neither hypo nor hyper).  A shift in lab values of the individual outside of his or her individual reference range, but still within the population reference range, is not normal for that individual.  Many don't feel well until FT3 and FT4 are in the upper half of the ranges.  After all, the population ranges of FT3 and FT4 are statistically determined distributions of patient results; by definition, approximately half the population will be euthyroid in the top half of the range and approximately half in the bottom.  If you are one of the people whose personal range must be in the top of the ranges, and your doctor won’t treat you or won’t fine-tune your medication when your results are in the bottom of the range, you are left hypo.  Your doctor may tell you your labs are "normal", but they are NOT “normal” for you.

Reference ranges of test results do not imply that everyone is going to be well as long as they are anywhere in the ranges.  The ranges are broad (e.g. 0.6-2.0 for FT4).  If your personal FT4 reference range was 1.6-1.8 when your thyroid was functioning properly, does it really make any logical sense at all that now that you are on replacement hormones, you should feel comfortable with an FT4 of 1.0?  No, it doesn't.  We all have a set point that is optimal for us...doctors should be finding it and adjusting medication to it.

If labs are within ranges, it's time for fine-tuning (or initiating a low dose trial)...increasing meds slightly if hypo symptoms are still present.  This will move FT3 and FT4 up in the range and alleviate symptoms…that’s the goal.  The ranges define the universe in which we can freely adjust medication; its entire breadth from lower limit to upper should be used for this purpose.  The patient will still be in the reference ranges, but he or she will no longer be symptomatic.  

Illustration:
                                                   Personal
                Current                      Reference
                  Level                  Range
0.6               1.0                       [1.6……1.8]          2.0
|------------Population Reference Range---------------|

With an FT4 of 1.0, patient is still hypo according to his/her personal reference range.
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649848_tn?1357751184
Thank you very much for posting that.  It's an excellent article and I agree with you 100% and this is exactly the problem I'm having right now.  

My Free's are in the normal range (FT4=0.9; FT3=320).  We had to cut back on my cytomel because I was having rapid heart rate and palps, so we raised my T4 med - against the wishes of my endo.  He wanted to cut the cytomel completely and leave the T4 med the same in spite of me still having some hypo symptoms.  Fortunately, he was relatively easy to convince.  

Since my original TSH of 55.54 prior to meds, my TSH has been running very low (0.19), which was up from the 0.01 the previous blood work, so my doctors are very reluctant to do anything but lower my med.  

Now we just have to find a way to convince doctors that not everyone fits the textbook example........



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Avatar_f_tn
I may be advocating for people in your predicament since we hear this so much of the time.  But, my case is actually the dead opposite.  My hypo symptoms went away as soon as my free's got into range (very low range).  However, my TSH remained high (high teens at best).  I finally found out I have a pituitary issue as well as Hashi's.  My TSH will never go down.  In the meantime, my PCP had just kept saying, "Need more thyroid".  Tried to kill me!  There are others with the same issues as mine, but we are fewer...or at least we hear less from them since they are "corrected" lower in the ranges.

Text book cases...NO!
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Avatar_f_tn
I did find out something about my levels and symptoms.

I found that if my tsh is lower than 2.3, I get hyper symptoms...regardless of the FT4 & FT3 levels and if the TSH goes over 2.5 I ache like he//. (hypo).

So I concentrate on my Free's first THEN my TSH.
If I keep my FT4 is the mid-upper level I am good and if I keep my FT3 in the high range I am good.

It is my TSH that cause the symptoms...not my FT3 and FT4.

Its taken a long while to figure that one out for me so I dont take much notice of my TSH unless I start to ache then I know the TSH is 'out of whack'.

Everyone is different as none of us have the same DNA.
The sooner Doctors realise this, the sooner we may have more quality in our lives.
I am lucky to have a Doc who goes by symptoms and not the TSH.
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393685_tn?1325870933
Great article goolara....

I may have missed it in there, but did you go into discussing the "real" validation of the TSH at all?

I bet if you added the TSH true information and having people tuned in on the TSH and pitutiary function you may spread the word farther :)

Excellent reading material. You have a great gift.
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Avatar_m_tn
Thanks again
Nope...no food or drink, except water, with the meds.
I set my alarm for 6a every day, take the meds, lay there another half hour. Get up, feed the horses, take a shower, then eat. Over and over and over again...kinda like the movie Groundhog day!! All makes much sense to me...thanks for helping. Why though, do you think my FT3 actually has gone down since on the meds or is it just with-in the range of error?

GC
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Avatar_f_tn
I think the change in FT3 from 321 to 319 is totally insignificant.  It has to move more than that before you feel it.  I'd call it "flat".  

Well, most of us aging baby boomers don't have much more exciting lives!  And adjusting your morning routine around taking a silly little pill doesn't help a thing.  
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Avatar_f_tn
Thanks.

Believe me, if I said all I have to say about TSH, I could write a book!!!!  I was trying to stick to just the one subject and keep it relatively short (only limited success on both).  TSH may have to be a subject for another day!
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393685_tn?1325870933
I'll join in on the writing if you want. In fact I am looking for a mentor to start article writing goolara..

got some pointers on how I can break into this....

I know for sure - I'll have to slow down and use my grammer better if I move forward on this venture.

Hypothyroid s#cks
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Avatar_f_tn
Well, we'd have to make sure we agreed before we agreed to collaborate!  I think we're all pretty much on the same wavelength as far as TSH is concerned.  If you want to write something up quickly and pay little attention to spelling and grammar, I'd be happy to play editor.  I think it's best when one person is in charge of the content...less fighting!  I could make suggestions, but you'd be the ultimate decision-maker.

Your're right hypo does s*ck (I can't believe my cr*p the other day was bleeped - is this cencorship new, or is my language just deteriorating?).
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393685_tn?1325870933
ROTFLMAF - nice twist...

Yes the word cr@p is off limits....

let's hook up.. Do you write for a living?

Please PM me if your interested....  
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Avatar_m_tn
So....what does it mean that my ft3 is be flat? Shouldn't it have gone up some when my FT4 went up, what'd did you say....20%? Is there a chance that my free's are already in my personal reference range? Hope not...I'm just beginning to feel better.

Thanks...just trying to learn  and you seem to have a lot of the knowledge that I want! LOL!
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Avatar_m_tn
One more thing if you would....This last Sunday I severly pulled my groin muscle riding my horse. It had been tender for weeks but last week I did it in. I've heard a lot of horror stories about Synthroid and it's generics...could there be any association in your opinion. And...what do you think about the synthetics?

Thanks again
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Avatar_f_tn
So...it sounds like you've been hypo for quite a long time.  You can't expect everything to just drop into place and start working perfectly right away.  It could also be that you will eventually need some T3 to make you feel well.  But, you are not at that point yet.  You want to try to stabilize the FT4 before you start adding T3 to the meds mix and confusing things even further.  If you've been hypo for a long time, a year is not at all unreasonable.  I know you don't want to hear this, but trying to rush it just makes things so much worse.  I'd give your FT3 a while longer and nudge your FT4 up a bit before coming to the conclusion that you're not converting...FT4 is still very low.

By definition, you DO feel well in your personal reference range.  You just have to find it.  What I'd give to have a baseline reference of what my thyroid levels were all my life before hypo...maybe several levels over several years...a little graph!

All I can say is...that's what you get for getting on a horse at your age!  ;-)  I don't quite see if that connects with Synthroid vs. generics???  I assume you just switched one way or the other.

Brand name vs. generic:  lots of endos won't use generics citing "inconsistency" in actual drug content of as much as 15%.  Also, generics may come from one company this shipment and another next, further mucking up the content.  I've been on Synthroid, Levoxyl (currently - it pacifies my endo) and generic.  I see absolutely no difference in any of them.  Do they reall vary?  Or did Big Pharma just run an excellent propaganda campaign to smear the reputation of their competition?  I don't know.  My endo won't use generics, and I have other battles more worthy of fighting, so I don't argue the point.

All the T4-only meds, along with Cytomel (T3) are synthetics.  My guess is you're asking about dessicated pig thyroid, like Armour and Naturethroid.  They help a lot of people.  The main issue with them, as far as I'm concerned, is that they contain a LOT of T3, compared to what the healthy human thyroid produces (Armour = T4:T3::4-or-5:1, human 20:1).  If you need to add T3, it's much easier to control with symthetics.  However, some people swear by it.  It was all there was for the first half of the 20th century.

Hope that helps.

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Avatar_m_tn
Thanks again...that is so much good information. Can't give up the horses yet...It just takes a little (lot) longer to heal!!! I'm actually taking the generic form Levoxyl. A little story and my own little test....I was prescribed generic at first and had taken it for about two weeks when I kept reading that Synthroid was the only way to go and not generic. Sooooo, me and my wisdom called the pharmacy and they changed it for me. Well...I took it the following morning and felt like *&%*#@$ all day. Coincidence? Maybe...sooooo, I went back on the generic, made by Lennett, and felt better again. Waited about two weeks and tried again...same thing...felt like *&$%^#@ that day. Ok...one more time but this time it was by accident. Both bottles were on the nightstand and I grabbed the wrong one and took a Synthroid. Felt horrible....must be something in the binders that I can't take? Anyway...thanks for all of your help, I'll try to be a patient patient. I am considering going to Pennsylvania to the hormone guy to address my other issues though; I'll keep you posted!
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Avatar_f_tn
Yes, it does take a lot longer to heal.  Speaking of which, also remember that your body has a lot of residual healing to do now that it can since you're getting your thyroid hormones again.  Systems heal from most important to least important.  When my dogs are sick, the coat is the first thing to go and the last thing to come back.  We're just animals.  Muscles, and their pain, are expendable.

It could very well be that the fillers or binders are your problem.  When I went from generic to Levoxyl, my labs actually got worse.  Probably coincidence, but who knows.  If you felt the difference on the first day, it's almost certainly some kind of mild allergic reaction.  The drug is the same in both, and small differences in drug content take weeks, not hours, to manifest.

Speaking of healing...I managed to roll my ankle last night on the garden hose that was lying across the walkway...tumbled so fast that I never knew what hit me until I was on the ground.  So, today every muscle in my body is protesting.  If I could just stay on my feet!  Pain, pain, go away...  
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Avatar_m_tn
Help...feeling bad again!
The last couple of mornings I've started to feel worse again. Here's some history up to today. Started 50 of generic Synthroid on June 4. Within 3 or four days was starting to feel better. After about three weeks the progress disappeared and I called the doc. He bumped me up to 75 by cutting a 50 in half. After about three days started feeling better...not quite as good as I had but better. One week ago he called in a prescription for 75's. Started taking them and it seems I've started going downhill again. I'm going to go back to cutting the one in half. BUT...they are both made by the same manufacturer; Lennett. What the heck is going on here. Do I need another lab...just had one two weeks ago...is it the new meds. Also...my temp had actually started to climb up...was 96 in the morning and had climbed it's way to 97.5. Now...it's starting back down again.
Slow pulse, aches and pains, stiffness, all getting worse. THIS STINKS. I welcome anyones input!!!

Thanks

Take a look at how I did the damage to my groin... a picture of the old man is on my profile doing what I love to do.
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Avatar_f_tn
Well, Bella lives up to her name.  I'm in the middle of cowboy country.  Ever hear of the Sisters (Oregon) Rodeo?  It's quite the little event.  I've always felt horses were best when being observed for their beauty.  Never did like riding them (a bit acrophobic)

So, the standard questions...Are you taking any other meds that might interfere with absorption of the levo?  Supplements?  Foods or drinks eaten soon after?  Foods that you eat a huge quantity of (compared to the rest of your diet)?  Have you had antibody tests run (I probably should know this from above, but this thread is getting too long to search) and do you know if you have Hashi's?

A new lab two weeks after the last is basically a waste of money unless something really dramatic is going on (like heart issues, etc.) since things just don't happen that fast with thyroid.  Your 75s (whether a whole pill or 1 1/2 50s) really have not had time to make an impact.

My assessment:  you are still hypo.  You're getting more thyroid hormones now than you have in a long time, so you have some very good days.  However, there is a lot of residual healing to be done, and you are going to have your bad days, too.  Also, I suspect you will be increasing again in the not-too-distant future), so your meds are still in the process of stabilizing.  Oh, and those good days when you and Bella do your thing?  They may be contributing to the bad days, too!

We all went through that initial stage, during meds increases, where there were ups and downs.  You get to a point where the good days are more frequent, and the bad less frequent.  Then, after a while, you can't remember just when the last really bad day was.  

Wish I could say it'll all be a downhill ride...
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Avatar_m_tn
I have had two antibody tests....would one of those be for Hashi's? My only vices are a couple of coca colas a day...and a couple cups of coffee. I do take tramadol on occasion for the muscle pain. So....guess I need to be patient! UGH!
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Avatar_f_tn
The two antibody tests for Hashi's are TPOab and TGab (thyroid peroxidase,  somtimes called microsomal, and thyroglobulin).  What were the results?

Have you checked interactions between tramadol and levo on the internet?  You might not want to take them at the same time...don't know.  Usually drug interaction info is both good and easy to find.

Yes, we are going to make you virtuous, and no, it is not always fun.
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Avatar_f_tn
Never take Tramadol and T4 together at the same time.....wait an hour after taking the Tramadol.
I have taken Tramadol a few times for pain (prescribed for shoulder surgery) and it doesnt interfere with my T4 med as long as they arent taken together or an hour after taking T4 med.
I have also found this with my heart meds.
I took both one morning together and felt like I was off my face lol.
Never again!

I would go as far as to say...NEVER take anything within half an hour to an hour after taking T4 med.
I've stuck to that policy since the 'moonwalking' day I had with the heart med and had no problems.
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Avatar_m_tn
Can't find anything on the net about not taking thyroid meds with tramadol.
Thyroid Peroxidase Antibodies
<10      according to Quest it needs to be <35

Thyroglobulin Antibodies <20  According to Quest, needs to be <20

Thyroglobulin
12.4      range 2.0-35.0
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Avatar_f_tn
Okay, your antibodies are within range, so it's not Hashi's.

I agree that it's worth the effort to split up any other meds and T4.

I think we're back to patience...
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Avatar_m_tn
I'll work Virtue....not much hope though! I don't take anything but water for at least an hour after taking the thyroid meds....it takes a lot of time to shovel horse &%#@$*%!!
Then it's time for coffee and Cherios!!

Thanks Smilerdeb for your imput also

F4F
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See, this is why I'm perfectly happy that my neighbor has two horses.  I get to enjoy looking at them, and no shoveling, feed bills, vet bills, just pretty little horses.

Don't know if you're serious about the Cheerios, but calcium and T4 meds are supposed to be split up by about 4 hours.  Maybe the milk is a culprit???
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Interesting...never thought of that. I'll set the clock an hour earlier to take the meds.
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Found a new Doc...he's a DO. Specializes in Thyroid and hormone problems. Uses Armour and pays little attention to TSH. At least that is what his nurse said when I asked her the questions. Do you know much about them changing Armour lately and if it still is a viable option. What about Nature Throid?
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I don't follow Armour very much...I have a heart arrythmia which precludes its use for me.  However, I have heard a lot of people on the forum complaining about the new formula (some diehard Armour people), so I guess they really messed it up for some people.  Naturethroid is basically the same thing, but, of course, the formula hasn't changed.  Once again, the drawback for some people is the high T3 content in dessicated pig thyroid products...it can't be regulated.  However, lots of people do really well on it.  A doctor who pays little attention to TSH?  Sounds like a winner and keeper to me!
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Hey...long time no talk! Just wanted your, and everone else's input on my new labs.
I'm getting ready to go to Pennsylvania to the hormone restoration doc there.

I have now been on the increased dose of .75 mg. of Levothyroxine for almost three months and, to keep you from reading this long list...I'll give you the labs histories.

        Initially                                  after three weeks                     new lab
TSH   3.26     range  .40-4.50                0.89                                   0.92

FT3    321      range   230-420                319                                   321

FT4    0.9       range   0.8-1.8                  1.1                                    1.1

Sooooo, my TSH has gone down but....my FT4 has only come up a little and my FT3 really hasn't budged!
I started feeling better after about seven days initially and then nose-dived and the dr. increased the dose to .75. Again, I felt better after a few days and then nosed dived.
I'm better than when I started but still have many hypo symptoms including muscle aches and pains, fatigue, and running out of gas in the afternoon, etc. My morning temp has come up to 96.8 ( from 95.8-96.2) and on some days actually makes it to 98.6 by afternoon.
I would like to see my FT4 come up a little bit more and my FT3 moving towards the top of the range...what do you think? What do I need from here. I'm pretty sure this new doc will put me on a NDT...will this take care of the problem? Why the heck won't my FT3 budge...even a little?

I have no hyper symptoms whatsoever.

thanks

Flys4Food
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This is a wonderful discussion with so many informed members!!!

Flys4Food, I read that you raised your D to a 50. Are you doing anything else now to maintain your D and your other vitamins? Once you get that D up (50 is still low IMHO) you need to maintain it with supplements.

This could alleviate some of this pain in your joints/muscles. It worked for me!

Take care...
:) Tamra
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This is a wonderful discussion with so many informed members!!!

Flys4Food, I read that you raised your D to a 50. Are you doing anything else now to maintain your D and your other vitamins? Once you get that D up (50 is still low IMHO) you need to maintain it with supplements.

This could alleviate some of this pain in your joints/muscles. It worked for me!

Take care...
:) Tamra
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This is a wonderful discussion with so many informed members!!!

Flys4Food, I read that you raised your D to a 50. Are you doing anything else now to maintain your D and your other vitamins? Once you get that D up (50 is still low IMHO) you need to maintain it with supplements.

This could alleviate some of this pain in your joints/muscles. It worked for me!

Take care...
:) Tamra
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This is a wonderful discussion with so many informed members!!!

Flys4Food, I read that you raised your D to a 50. Are you doing anything else now to maintain your D and your other vitamins? Once you get that D up (50 is still low IMHO) you need to maintain it with supplements.

This could alleviate some of this pain in your joints/muscles. It worked for me!

Take care...
:) Tamra
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I have no idea why my computer posted so many times. It just went haywire.

Sorry.
:) Tamra
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Hasn't anyone told your that multiple postings are a symptom of hyper?!!!  :-)
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Good Morning, Problem Child!

The last two labs I would consider to fall into the "absolutely no change" category.  Those minute differences aren't even worth talking about.    However, they do offer some valuable information...your labs have definitely stabilized on your current dose.  

I still maintain (it's my story, and I'm sticking to it!) that you need to raise your FT4.  Yes, you're in range, but it needs to come up further.  You are still undermedicated.  Your FT4 is still low enough that your body is still in "rationing" mode.  It protects the vital systems by making sure brain, heart, etc. get adequate supplies...muscles and other less vital systems can wait.

I'm not familiar with the acronym NDT, but I'm assuming you mean dessicated pig thyroid?  Pig thyroid contains a fairly high dose of FT3, so, yes, it should bring your FT3 up.  Once again, you will have to go through the trial and error process of finding the right dose.  However, your current dose of levo should be a good guide for your doctor to base the natural thyroid on.  I also think raising your dose of levo would do the same thing.

I'll be looking forward to hearing what the thyroid doctor has to say.
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Thanks Mom!
Well, at least one of your children has to be a little half witted! LOL!
With more Levo...wouldn't my TSH go down even further? How far down can it possibly go....0? BUT...I guess that really doesn't matter too much now does it? Undermedicated is undermedicated. My appointment is Monday...We'll see what he says. My current doc has quit answering my questions and said "Everything looks fine and I'll see you in six months". Well, if everything is fine then why do I feel like $#*&%@#%? Anyway..I believe you're right...I'm undermedicated.
I thought NDT meant Natural Dessicated Thyroid. Thanks again for your help!
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Do I have to answer you more than once? Sorry...couldn't resist.
I was on 50,000 units once a week for two months. It went from the original 21 to 51. I changed doctors and stopped the 50,000 units and now take 1,000 three to four times per day. I also make sure that I get more sun on my face...living in Ohio during the winter though it will be all supplements.  I just had it tested with these latest labs but it is still pending. We'll see shortly how I'm doing.

My B12 was also low at 308. range 200-1100) with a disclaimer on the lab sheet that some people with a level <400 could show neurological symptoms. (Had them) Even with that the Dr. wouldn't start injections and said it looked ok to him. Knowing that some hypo folks have trouble absorbing B-12 through the stomach, I started on sublingual tabs....1000 per. 3 or 4 times per day. This last lab showed it had come up to 722.
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Taking both T3 and T4 will suppress your TSH.  No, it cannot go negative!  But TSH is not all it's cracked up to be.  It's time it was toppled off it's "gold standard" pedestal.  Your current doctor is less than ideal...the thyroid guy can't be anything but better.

Now, go watch TV or something until your appointment!  
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Ok....the rest of the labs are in Mom and Tamra
On 50,000 units once a week my D level rose from 21 to 51. Then I went on 1,000 units four times a day and it's going back down...latest levels 45. Any idea of what causes low vitamin D levels in the first place? (I've been getting plenty of sun and have a tan like George Hamilton! LOL!) I think the levels should be closer to 80 for optimum...what do you guys think? Now...I'm going to watch TV until my appointment on Monday!

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Sorry, son, vitamins are not my thing.  However, I do have an opinion (what a surprise!!!) on vitamins in general, and I share this opinion with my nutritionist sister-in-law.  Supplements should only be used as a last resort, when you simply cannot get the vitamin or whatever from your food.  Why?  Because the foods naturally rich in a vitamin may contain trace amounts of some other substance that enhances that vitamin's effect on your body.  You can google D foods...mushrooms are little vitamin D bombs...ostensibly because they're grown in the dark.  Just a thought...
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Ok...I flew most of the day and drove the rest but I've been to the doctor!!!
I really liked him. He listened to what I had to say and told me what he thought...then he asked me what I thought of what he thought. He said that he likes patients that were involved in their treatment and that it usually makes his job easier because we live with our bodies 24/7 and usually have some good insight to what is right. Anyway...said I was way undertreated and added one grain of Armour to what I was already taking.  Will do blood testing in 6 wks and go from there. Also said that the government was in the process of killing the natural thyroid products and we may have to go to plan "B" after a while. I was in his office talking with him for 1 and a half hours.
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Wow, sounds like quite a day!  Maybe you should start Hypo Shuttle...you could fly around the country picking up thyroid patients and ferrying them to Pennsylvania!

Well, it sounds like it was worth the trip.  I've read a number of scathing exposes of the health care industry lately.  In one, one doctor was quoted as saying that if you listen to your patients, they will tell you exactly what's wrong with them, and if you listen really hard, they will also tell you how to treat them.  What a great comment.  It's amazing how much we've learned health-wise, and how little it has gained us in improved care.  The art of healing has been replaced by the science of medicine.  There is no replacement for listening to the patient.  Whew!  Just look at the tangent you sent mom off on!!!

It sounds like he will be really good.  I'm anxious to see how you do on the combo therapy.  An hour and a half is almost unheard of.

Somehow, I doubt it's the government that's trying to kill natural thyroid products...much more likely Big Pharma.  They've been attempting that ever since they developed their symthetics.  Nice to be able to ignore the fact that it worked perfectly well for the first half of the twentieth century when there was no alternative.

Keep us posted on how you go.  
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Hey Mom...long time not talk!
Well...here's the update. Couldn't tolerate Armour (1grain) gave me a headache and messed up my stomach, couldn't take Naturethroid (1/2 grain)
gave me a headache and messed up my stomach, now, I've been on Cytomel (5mcg cut in half. one half in the morning the other around 3p.m.) guess what...gives me a headache and messes up my stomach. I haven't called the Dr. yet...just wanted to get your opinion before I do. I have stopped it and gone back on it...(gave it two days) all the symptoms disappeard and then came back when I started taking it again.
I'm still on the original 75 of Levo but...my hypo symptoms have started to get worse again. So what is one to do if he has low FT3 and can't tolerate T3 meds?
HELP!

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Hi, Problem Child.

Have you had any other labs since the ones posted in the very first post on this long thread?

I said way up there somewhere (it's my story, and I'm sticking to it!) that I thought you needed to get your FT4 up.  Your FT3 is almost midrange.  Your FT4 is low.  When FT4 comes up, so will FT3.  If my experience is worth anything, my FT3 increased significantly with a very small increase in FT4. It also continued to increase with no change in FT4 (perhaps FT3 takes a while to catch up?).  I'd increase the levo.  I won't be convinced you need T3 meds until your FT4 is well up in the range and your FT3 remains low.

In my (much) younger days, I worked with emotionally disturbed children in the inner city...no, I'm not comparing you to them!  These kids had a Richard Prior tape that they played so much that I still can recite most of it from memory.  Every time you call me "Mom", it brings to mind his line, "I ain't old enough or ugly enough to be yo' mama!"  LOL

T3 is powerful stuff.  But if you can't even tolerate 5 mcg split into two doses, I'd work on the T4.  And remember, it's not going to happen over night.  Be patient, my son.  
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Thanks mom...actually, I'm listening to Richard Prior right now!!! just kidding

So you don't have to look...last labs after being on .50 for four weeks and then .75 for about eight.

FT4 1.1  (.8-1.8)  

FT3 321 (230-420)

FT3 hasn't budged since the beginning except to go down slighty four weeks after starting Levo. Then back up to the original 321.

I guess I'm in need of some more T4?

It doesn't matter that my TSH is now 0.92 does it? It can actually be zero as long as no hyper symptoms correct? Hopefully the FT3 will go up sometime?

I'll let you know.

How do I know you're not ugly enough  to be my mother...besides, I look like my dad.
What was his name anyway?

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Well, you've been all over the place with your meds.  If there's one thing that's important, it's consistency.  You have to stick with one thing long enough to give it time to do its thing.

Yes, your FT4 is low, your FT3 is midrange (almost).  What's the logical thing to do here, Grasshopper?  As I said, my FT3 took quite a while to catch up.  I'd add some T4, wait four weeks, get retested, and go from there.  

Your TSH doesn't matter a bit to me.  Some people have to be near zero before their hypo symptoms are relieved.  TSH needs to go to sleep.  Hyper symptoms are what you need to watch out for.  

Dad's name, dad's name...let me think...oops hypo brain fog...can't remember.  

Love, Mama
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Thanks Mom...you're the best
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Hey Mom...just wanted to let you all know the Doc stopped all Cytomel and raised my Levothyroxine dose from .75 to 100. (.75 with a 50 cut in half) He says in time it should convert.

Me
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Baby steps lol......
I too thought I had a T4 conversion problem at the start...seems it balanced out in the long run and now I go hyper TOO quickly so as I said.....
Baby steps :)
And a he// of a lot of patience lol
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I'll second Deb's comment...baby steps.  I agree it takes a while for the FT3 to balance out (and cach up).  I've been on a stable dose of levo since March, and my FT3 has continued to rise during that time.  Good luck and keep us posted!

Mom
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I'll go along with what goolarra and Deb said --- baby steps.  

Would also like to try to put your mind at ease a bit about your TSH.  First off as goolarra said - it's not a concern.  MY TSH runs between 0.01 & 0.03 --- almost 0...I'm on 75 mcg levo, alternating with 88 mcg (that's 75 one day/88 the next) + 5 mcg cytomel/day.  Goolarra is the one who put me onto the "alternating" dosage idea and so far it's working - you need to listen to mom.........lol.  I do have a bit of trouble with an "afternoon slump" and driving home from work is sometimes a challenge to say the least...........

That said, I also agree with goolarra and Deb about bringing up your FT4 and your FT3 should follow, but it could take a while - I've been adding cytomel since January and my FT3 is just now at the level of yours - that's NINE (9) months it's taken me to get where you are now........oh, woe is me!!!!            lol

Best of luck and sending patience your way...........
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