IM injections?

[Butterbean556]

I had a Thyroidectomy 6/2009 due to a small Papillary cancer. Was started at 175mcg of Synthroid and as my lab numbers have not been right , it has been slowly increased to my current dosage of 350mcg. I take it at 6am every morning ( I set my alarm as I'm very punctual with my meds) and take Nexium at 8am, then at 9am take other medications (Prednisone,Placquenil) for UCTD with my main problem being Polymyositis with Anti-Synthetase ILD.

I have Esophageal Dysmotility, that I believe is the main problem, that my medications are not moving through my digestive system and thus not being absorbed properly or mixing with the other meds.

My last set of labs were: TSH was 30.24, T4 was 7.7 and T3 was 45. Do you think Intermuscular  injections  might be a better way for me to take the medication? If so what mcg would you think I should start at? I am reluctant to continue to go up and up on the oral tablets since 350 is such a large dose. Thank you for any advise you can give.

[goolarra]

You are absorbing your meds just fine!  As you can see, your FT4 is over the top of the range.  FT3, on the other hand, is dismal...just barely into range.  Your cells cannot us T4.  It first has to be converted to T3.  Some of us convert too slowly, and you appear to be one.  The rule of thumb for FT3 is upper half to third of the range.  You have a long way to go.  Also, ideally, FT3 should be higher in its range than FT4 is in its.  So, your FT3/FT4 balance is quite "upside down".

I think its absolutely clear that you need to add a direct source of T3 (either synthetic Cytomel or dessicated) to your meds.  At the same time, since FT4 is so high, you should reduce your T4 meds.  T3 is about four times more powerful than T4, so for every 5 mcg T3 added, you should reduce T4 by about 25 mcg (perhaps more in your case since your FT4 is SO high at the moment).  T3, unlike T4 that has to build in your system for several weeks, is very fast acting and neutralized by your body if not used promptly.  For that reason, most people split theit T3 dose into at least two throughout the day.

Many doctors are reluctant to use T3 meds.  However, your doctor ordered the FT3 test, so let's hope that indicates that she is familiar with the importance of T3.  I think you have a very simple slow conversion issue going on...very easy to remedy.

Best of luck with your endo tomorrow.  

[Butterbean556]

Got my lab results:

Thyrogobulin <0.5            (0.5-55.0)

Antithyroglobulin Ab <20  (0-40)

Free T4  1.83                  (0.82-1.77)

TSH     14.150                (0.450-4.50)

Thyroxine  10.7               (4.5-12.0)

Triiodothyronine T3     79      (71-180)

Triiodothyronine Free  2.3     (2.0-4.4)

[Butterbean556]

My labs come back on Tuesday, except for the thyroid ones, those always come in on Wednesday morning. I will post them as soon as I get them.
Thanks.

[goolarra]

Yes, you always need to have the "frees" run.  Perfect on the tests your endo ordered...FT3, FT4, TSH and both antibodies.  If you have the blood drawn on Monday, you might try calling your doctor an Tuesday for results (I always get mine next morning).  If you want to post those before your next appointment, we might be able to give you more ideas on what to discuss with your doctor before your appointment on Thursday.  Best of luck.

[Butterbean556]

I got to thinking about those labs & actually it was my primary doctor ordered those last ones. I asked him to run those as well ask my CPK (which by the way, was over 5000)before I went to see my rheumatologist and endocrinologist later that week. I guess he didn't know which ones he should have done. I don't understand them at all, so I was no help.  I guess I need a crash course in learning about it all.

My endo does usually order the Free T4 & TSH. On the new labwork order she sent me, she has checked boxes those plus for Free T3, Thyrogobulin and Antithyroidgobulin  Antibodies as well. I will have those done Monday before I see her on Thursday.

[goolarra]

Those are total T3 and total T4 numbers.  Total T3 and T4 are considered obsolete tests and offer limited information.  They tell you the total amount of hormones in your blood, but much of that is bound by protein and thus unavailable to your cells.  The "frees" tell you what's actually available.  Ask your doctor to run the frees.

Many of us don't convert T4 to T3 well.  Cells can only use T3.  Even if your FT4 is perfect, if you don't convert well, you will still feel hypo.  Adding a direct source of T3 (Cytomel or dessicated) to your meds can make a world of difference.  

Considering the tests your doctor is ordering, you might have to either educate him or find a new doctor.  Some of them very stubbornly stick to old ways.  I don't think your thyroid issues are going to be resolved using conventionally delivered T4-only therapy.  That's all some doctors know how to do or are willing to do.  Do you suppose you could dash in for a quick FT3 and FT4 before your appointment next week?  Those results would give you a lot more concrete points to discuss with your doctor.  With what you have for labwork at the moment, it's kind of a shot in the dark.

[Butterbean556]

Thank you for the information on Tirosint. I have never heard of it. I will research it and discuss this as well as taking my tablets sublingually with my Doctor next week.

My labs do not say free T3 or free T4.  Here are the ranges listed on the lab report:
TSH was 30.24 uIU/mL (0.450-4.50)
T4 was 7.7 ug/dL (4.5-12.0)
T3 was 45 ng/dL ( 71-180)

Thanks again!

[goolarra]

You might consider a couple of other options first.

There's a new med called Tirosint that is a gelcap, rather than a tablet.  It's both hypoallergenic and more absorbable than tablets.  However, if your meds are not getting to your gut, that won't help.

I'd suggest trying taking your meds sublingually.  Meds are absorbed directly into the blood vessels beneath the tongue, avoiding the gut entirely.  You could try this with tablets, or you could switch to Tirosint AND take it sublingually.  When I last saw my endo and was discussing Tirosint with him, he was really excited by the possibility that it might be really good for his patients who take their meds sublingually due to gut issues.

Since you suspect that you've been absorbing very little, it's really tough to know where to start.  It will probably be almost like starting over.  Your doctor would have to read dosing instructions for initial dose recommendations, which are by and large based on weight.  

Are those free T3 and free T4 numbers you posted?  If they don't specifically say "free" on the lab report, they're total T3 and total T4.  Please provide the ranges as these vary lab to lab and have to come from your own lab report.