New to the Medhelp

[sfguyca]

Hi, everyone.

For a year and a half I have tired to educate myself and get my thyroid levels under control while seeing an Endo.  Not an easy task but I imagine I'm not alone in this.  
I have tried Synthroid and levo (generic) with horrible side effects.  
Also tried Armour 1.5 grain (the skinny pill, I could eat a gallon of ice cream with it and still lose weight the next day) but still had symptoms and my T4 and Free T4 were low not so bad T3 numbers.
I personally prefer Tirosint but not sure it's doing the job.

I'm a proponent of T4/T3 methodology but having a difficult time getting my numbers up.

Currently I'm on Tirosint 125 mcg and Liothyronine (sigma) 10 mcg.  I've tried Cytomel brand but it just made me angry.    Not crazy about Paddock either but prefer it over Cytomel.  Walgreens changes these often.

Unfortunately my Endo doesn't care for Free T3 testing he thinks Total T3 is more accurate.  I disagree with him.

My numbers from my last test are as follow:

TSH         0.41 Range (0.40 - 4.50)
Free T4    0.84 Range (0.7 - 1.7)
Total T3      90  Range (87-167)

I know there are important tests that are missing but that's all I have to work with until my next appt with the Endo.

If I were to answer my own question I would say that I'm highly under medicated.  

But here is the conundrum. I have been on Tirosint with a lower dosage of 100/ Liothyroninel 5 and had a better Free T4 of 0.94 still not great but better than .84.  It's puzzling that the higher the dosage the lower the numbers I get.  Awhile back I was tested for RT3 while I was under Armour and it came in at 13 (8-25).

On to my question:
Should I increase the dosage or do a combination with Tirosint and Armour and drop the Liothyronine?  
With Armour I had a decent Free T3 of 3.03 (2.3-4.2) but low T4,free T4.  
Thanks to my PA he ran a much more robust thyroid panel behind the endo's back.

Lastly if anyone knows of a good Endo in San Francisco.  Please let me know.

Thanks
Jorge

[Barb135]

Don't be surprised if your endo balks at being told what tests to order... many of them don't like their patients to research or go online to find out about their condition.  

He might also balk at being told to increase your dosages... but there's no point in being plagued with symptoms when a simple increase in meds is all that's necessary.  You should probably just try an increase in the Tirosint, because we normally only want to change one thing at a time (if you change too many variables, you don't know which worked).  If you increase the Tirosint and get your FT4 up around mid range, your FT3 should rise as well, because we'd assume there would be some conversion of FT4 to FT3.  As it is right now, you've hardly any FT4 to convert, which is your biggest problem.

Yes, splitting 10 mcg of T3 into 5 doses would do you very little good... in fact, I'm not even sure how you're doing that.  If the pills are 5 mcg/each, splitting them in half would be 2.5 mcg and they're so small, quartering them is nearly impossible without ending up with powder.  If the pills are 10 mcg/each, I can't imagine splitting them into 5 pieces and having them come out anywhere near equal.  However you're managing to accomplish this, 2 mcg at a time is so minuscule that it do minimal good.

I don't chew my T3 pills really well; I simply bite them, to break them up a little -- that seems to be good enough... I've only had a couple of manufacturers though, so they might not all taste the same.  Those made by Mylan work well taking whole; the ones produced by Sigma are the ones I dissolve or bite into...

Check with Walgreen's and see if they can get yours from just one supplier; some pharmacies will accommodate; others will not.

[sfguyca]

Thank you Barb for all your wonderful advice you have given me.
I will tell my Endo to start testing free T3 and to increase my dosage
specially since I still feel hypo symptoms.

I was already splitting my dosages but 5 times a day may have been to much.  I originally thought it would balance me out but no such luck.

I am now down to 3 doses of 5mcg with my last dose at 3pm until I see the Endo tomorrow.  Curious to hear what he wants to do.

Also trying your advice on chewing the T3 instead of swallowing it.  

Yes my reference to Walgreens was they are constantly changing manufacturers.  I will insist on one or call another pharmacy.

Thanks again for the help
Jorge

[Barb135]

I agree that you're under medicated, as long as you have symptoms of being hypo.

Both your FT4 and TT3 are dismal to put it mildly.  Most of us find that we need FT4 to be about mid range and FT3 to be in the upper half to upper third of its range. Your FT4 is only at 14% of the range and your TT3 is only at 4% of its range... Unfortunately, we have no idea what you FT3 would be, but approximately 90-95% of the TT3 is bound by protein and can't be used by the body, so it's safe to say that your FT3 would be equally as dismal.

You might tell your endo that TT3 is obsolete, with the advent of FT3 test that's so much more useful because it lets us know exactly how much T3 is available for use by individual cells, while the TT3 gives both bound and unbound amounts.

All of that said, since you're on the Tirosint and synthetic T3, my suggestion would be to simply increase your dosages. What do you mean "Walgreens changes these often"? Do you mean the manufacturers?  If you tell them you prefer one manufacturer over another, most pharmacies will try accommodate you, check with them and see if they will.  I find that I, either, have to dissolve some of the T3 tablets in a spoonful of water or chew them in order for them to work well.

TSH should not be an issue... it's not the least unusual for TSH to be low or even suppressed when one is on an adequate dose of thyroid hormones, especially, one with a T3 component.  My own TSH runs at
< 0.01 - 0.01 all the time and has for the past 8 yrs.

Most of us on meds with a T3 component, such as cytomel, its generic counterpart (liothyronine) and desiccated hormones find that splitting the dosage into 2 equal dosages - typically, one in the morning and one around noon or early afternoon, works better than taking the whole dose at once in the morning.  The reason for this is that T3 is fast acting, so it enters the blood stream quickly, peaks and is gone within a few hours.  Taking it in 2 doses, keeps FT3 levels stable throughout the day rather than getting it all first thing in the morning, then having it wear off early in the day and having nothing to go on the rest of the day...  

If you're not splitting your T3 into 2 doses, daily, I'd strongly suggest that. You might have to play with the timing, depending on your schedule, but it's not recommended that you take T3 after about 3:00 PM as it's likely to interfere with sleep.