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Question about levels
I'm told I have Hashi's and my recent labs showed a normal T4, with T3 that is too high, and TSH is 0.01. Doctor said if I reduce my T3 intake that the TSH should go higher. Does anyone know if that's the case? Also, how soon should I be tested again now that I've made the adjustment in meds?
flyingfool, thank you for the additional information. I'm in the NW suburbs of Chicago, so there has to be someone around who knows what they're doing. It's just a matter of finding that right doctor.
How long before a draw should one stop taking T3?
How long before a draw should one stop taking T3?
Bottom line here is that your Dr is NOT testing you correctly and is looking at the wrong test result for the wong conclusion.
Your symptoms are all indicating HYPO. I didn't see a single symptom you list as potentially being too high of a dose. overall.
It is not only common for TSH to be suppressed on thyroid medication thus rendering it useless. Suppression of TSH is almost assured when taking T3 medication such as cytomel or Armour. At least at some point.
Again it seems like your Dr is shooting in the dark and does not know this. And is relying upon the rudementary med school training that teaches that TSH is the gold standard and that little or nothing else needs to be looked at.
getting tested for Free T3 in additio to Free T4 is critical. Not testing for T3 at all when a person is on medication with T3 borders on malpractice in my opinion. At least your Dr was testing for total T3 which is something, but not nearly as good as testing for FREE T3.
Free T3 is the ONLY molecule that is used by your body's cells.
Total T3 is like measureing the amount of fuel in your cars fuel tank. Sure its important to know there is fuel in the tank. But your engine only runs on the amount of fuel that ACTUALLY gets to your engine, not what is left in the tank. If the fuel line is blocked or partially blocked your engine will run terrible or not at all even if your tank is full of fuel.
Testing for the Free T3 is like testing your bad running car engine amount of fuel that arrives at the engine. Similarly Free T3 is the only thing that gets to your body's cellular engine.
You do NOT want to take any medication prior to testing when on a T3 medication. This is because T3 gets into the blood stream almost immediately. In fact it peaks in the blood about 4 hours after taking it and then starts to fade away. This is why it is recommended that you take T3 medication twice in the day. to help even out this rollercoaster so that you don't get a blast of it in the morning and then crash in the afternoon when it is all used up.
T4 on the other hand takes about 6 WEEKS to achieve stability in the blood. So taking a T4 only medication prior to getting a blood test is no big deal. As the blood levels of T4 is at the dosage of what you were taking 6 weeks ago, not what you took earlier in the day.
Your symptoms are all indicating HYPO. I didn't see a single symptom you list as potentially being too high of a dose. overall.
It is not only common for TSH to be suppressed on thyroid medication thus rendering it useless. Suppression of TSH is almost assured when taking T3 medication such as cytomel or Armour. At least at some point.
Again it seems like your Dr is shooting in the dark and does not know this. And is relying upon the rudementary med school training that teaches that TSH is the gold standard and that little or nothing else needs to be looked at.
getting tested for Free T3 in additio to Free T4 is critical. Not testing for T3 at all when a person is on medication with T3 borders on malpractice in my opinion. At least your Dr was testing for total T3 which is something, but not nearly as good as testing for FREE T3.
Free T3 is the ONLY molecule that is used by your body's cells.
Total T3 is like measureing the amount of fuel in your cars fuel tank. Sure its important to know there is fuel in the tank. But your engine only runs on the amount of fuel that ACTUALLY gets to your engine, not what is left in the tank. If the fuel line is blocked or partially blocked your engine will run terrible or not at all even if your tank is full of fuel.
Testing for the Free T3 is like testing your bad running car engine amount of fuel that arrives at the engine. Similarly Free T3 is the only thing that gets to your body's cellular engine.
You do NOT want to take any medication prior to testing when on a T3 medication. This is because T3 gets into the blood stream almost immediately. In fact it peaks in the blood about 4 hours after taking it and then starts to fade away. This is why it is recommended that you take T3 medication twice in the day. to help even out this rollercoaster so that you don't get a blast of it in the morning and then crash in the afternoon when it is all used up.
T4 on the other hand takes about 6 WEEKS to achieve stability in the blood. So taking a T4 only medication prior to getting a blood test is no big deal. As the blood levels of T4 is at the dosage of what you were taking 6 weeks ago, not what you took earlier in the day.
Thanks, Gimel. I think I see what you're saying. This conversion stuff is confusing, so I appreciate the time you give to folks like me. I will contact my doctor to discuss. Or maybe find a new doc who knows about this stuff.
Each grain of Armour contains 39 mcg of T4 and 9 mcg of T3. You said you were taking 2 grains of Armour plus 75 mcg of T4. So that equals 39+39+75=153 mcg of T4. The effect of one mcg of T3 is approx. equal to 4 mcg of T4. So I added the 153 and (4 times 9 times two grains =72) and that was how I came up with your dose being equivalent to 225 of T4.
Your new dose, as I understand it, would be 1/2 grain of Armour, which is 19.5 mcg of T4 and 4.5 mcg of T3, plus 150 mcg of T4. That would be only 169.5 of T4 and 4.5 of T3. Expressed as T4 equivalent, that would be equivalent to approx. 187.5 (169.5+(4.5 times 4)). If my understanding is correct, that would be a large reduction in med.
Your new dose, as I understand it, would be 1/2 grain of Armour, which is 19.5 mcg of T4 and 4.5 mcg of T3, plus 150 mcg of T4. That would be only 169.5 of T4 and 4.5 of T3. Expressed as T4 equivalent, that would be equivalent to approx. 187.5 (169.5+(4.5 times 4)). If my understanding is correct, that would be a large reduction in med.
Yes, I just looked at the lab results again and see that it says T4 Free, but T3 Total. I wish I knew this going in, but then thought my doc would know what to test for. She simply ordered a thyroid panel.
I have armour at 38 mcgs, not 39, but close enough. I don't know, however, how you're arriving at 153 mcg of T4 I was previously getting, plus 18 mcg of T3, being equal to 225 mcg of T4. I'm confused.
I'm also confused when you say the new dosage would be 169.5 of T4. I was told to take half an armour, which is 38 mcgs of T4, plus another 150 mcgs of Levothyroxine. Isn't that 188 mcgs of T4? What am I missing?
Symptoms - tired, cannot lose weight, dry skin, cracked heels, and normal temp runs low - usually about 97.5 or so.
Thank you for your help and I apologize for the confusion!
I have armour at 38 mcgs, not 39, but close enough. I don't know, however, how you're arriving at 153 mcg of T4 I was previously getting, plus 18 mcg of T3, being equal to 225 mcg of T4. I'm confused.
I'm also confused when you say the new dosage would be 169.5 of T4. I was told to take half an armour, which is 38 mcgs of T4, plus another 150 mcgs of Levothyroxine. Isn't that 188 mcgs of T4? What am I missing?
Symptoms - tired, cannot lose weight, dry skin, cracked heels, and normal temp runs low - usually about 97.5 or so.
Thank you for your help and I apologize for the confusion!
So your dosage with 2 grains of Armour and 75 mcg of T4 would add 39+39+75 = 153 mcg of T4, plus 9+9 = 18 mcg of T3. This is about the equivalent of 225 mcg of T4. The new dose would be 169.5 of T4 and only 4.5 of T3, or the equivalent of about 187.5 mcg of T4. That is quite a drop from your prior dose, apparently only to increase your TSH level, which is directionally incorrect. Dosage always needs to be high enough to relieve hypo symptoms, but not high enough to create hyper symptoms. I previously said that TSH was irrelevant for you because there are scientific studies that concluded that hypo patients taking adequate doses of thyroid med find their TSH suppressed below range, yet their Free T4 and Free T3 remain within range. So TSH is basically a useless test when taking thyroid meds.
It would have been far more useful to test for Free T3 instead of Total T3. Free T3 correlates best with hypo symptoms. So you should always make sure they test you for Free T3 and Free T4 each time you go in for tests. Also, I asked about when you took the meds because T3 is fast acting and gives false high results when taking it before the blood draw.
So before going further, please tell me about any symptoms you have.
It would have been far more useful to test for Free T3 instead of Total T3. Free T3 correlates best with hypo symptoms. So you should always make sure they test you for Free T3 and Free T4 each time you go in for tests. Also, I asked about when you took the meds because T3 is fast acting and gives false high results when taking it before the blood draw.
So before going further, please tell me about any symptoms you have.
I was afraid I might have confused the issue. I was taking 2 grains of Armour plus another 75 mcg of levothyroxine with it each day.
I did take my meds the day of the draw before the draw was done. They didn't tell me not to and I didn't know I shouldn't. I've probably messed that up. Ugh!!
So you don't think the low TSH is a concern?
I did take my meds the day of the draw before the draw was done. They didn't tell me not to and I didn't know I shouldn't. I've probably messed that up. Ugh!!
So you don't think the low TSH is a concern?
A couple of clarifications please. You said 151 mcg of T4 and 9 mcg of T3. Then you said you were on 2 grains of Armour. Those are not the same, so I assume that it was two different doses at different times, correct?
Did you take all your med the morning before blood draw for tests?
Don't even worry about TSH now. It is irrelevant when taking adequate thyroid meds.
Did you take all your med the morning before blood draw for tests?
Don't even worry about TSH now. It is irrelevant when taking adequate thyroid meds.
Thanks, Gimel. I was taking a total of 151 mcgs of T4 and 9 mcgs of T3. I was on 2 grains of Armour (60mg per grain), and each grain contains 38 mcgs of T4 and 9 mcgs of T3. Doctor is having me go down to 1/2 grain of Armour and 150 mcgs of T4 so that would total 168 mcgs T4 and 4.5 mcgs of T3. Labs were -
T4 - normal range is .8 - 1.8 and mine was 1.3 (normal)
T3 - normal range is 76 - 181 and mine was 209 (high)
TSH - normal range is .4 - 4.5 and mine is .01 (low)
T4 - normal range is .8 - 1.8 and mine was 1.3 (normal)
T3 - normal range is 76 - 181 and mine was 209 (high)
TSH - normal range is .4 - 4.5 and mine is .01 (low)
Hypothyroid patients taking thyroid meds often find that their TSH is suppressed below range. That does not automatically mean you are hyperthyroid, unless you have hyper symptoms due to excessive levels of Free T3 and Free T4. Scientific studies have also shown that to be the case. So, please tell us about your symptoms, and post your actual thyroid related test results and reference ranges shown on the lab report. What meds are you taking and what dosage daily?
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