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So these results look good or bad? short of breath hair don't grow...
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So these results look good or bad? short of breath hair don't grow

I have hashimotos for some time now.  Lately been having shortness of breath. These are my current lab report

tsh 0.463  range 0.450-4.500
Free t4 1.29      0.82-1.77
t4   9.0              4.5-12.0
t3   73               71-180
Free t3   2.18       2.0-4.4

I am taking 100 mcg levothroxine (levothyroxine)  for years..  yesterday I lowered it to 88 because I have been short of breath and besides that  I have been trying to grow my hair for 3 years and it just won't grow breaks off and falls out.  Doc is no help  he tells me to adjust my dose to how I feel because with hash's he said its not about the tsh..
41 Comments Post a Comment
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649848_tn?1357751184
Your doctor is right; it's not about the TSH; it's about the Free T3 and the Free T4, but mostly, Free T3, which is the hormone used by the individual cells, while Free T4 is a storage hormone that must be converted to Free T3 prior to use.  Free T3 correlates best with symptoms.

Your symptoms are still hypo, even the shortness of breath.  It appears that you have a conversion issue.

Rule of thumb (where most us feel best) is with Free T4 at about mid range (50%); yours is right at 50%, so you're good there.  Rule of thumb for Free T3 is upper half to upper third (50+%) of its range... yours is sitting at the very bottom at 9%.  

Not all of us convert adequately and have to add an outside source of T3; it looks like you're a good candidate for this.  A typical starting dose is 5 mcg, split into 2 doses of 2.5 mcg each, one taken in the morning and one taken late morning or around noon.  That's a pretty small dose, so an increase could likely be warranted after a month or so, but you'd need to retest before increasing.  

Ask your doctor if he's willing to give you a script. Make sure it's for 5 mcg tablets, so you can split/mix/match as needed.

Once your FT3 levels are adequate, your shortness of breath should go away and your hair should start growing back.  

Often, when we're on a medication containing T3, TSH is completely suppressed, but it doesn't sound like that would be too much of a surprise to your doctor.  Mine has been sitting at < 0.001 - 0.01 for the past 6 yrs.  As long as you don't have hyper symptoms, and your FT levels aren't too high, you aren't over medicated.
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252327_tn?1250187576
I have cytomel 5 mcg.. My doc had me on that too.  I stopped it myself I  didn't think it was doing anything.  Guess I should restart it..sometimes I would get chest pain and I thought it was that but I went to a heart doc and had all the tests done and it was fine.  Only downside with that is you don't get much sleep
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649848_tn?1357751184
How much cytomel were you taking and were you taking it all at once?  

I take it every day and sleep like a baby.
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252327_tn?1250187576
I was taking one 5 mcg in the morning with levothroxine (levothyroxine) and another around noon.  I stopped it I read somewhere that it caused bone loss but since I stopped it my cholesterol has gone way high.  I emailed my doctor to see what he thinks.  He emailed me back saying I have subclinical hypothyroidism he said he likes t3. He said he will call me later..In the meantime this morning I took a 88 levothroxine (levothyroxine) and added one half of a 5mcg cytomel amazing my brain is already working better.
I thought this website would email me when there is a response but it does not I have to check on the website
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Avatar_m_tn
I agree.. you need T3.  It sound like you have an extremely rare Dr who actually doesn't bow down and kiss the feet of TSH as being nearly god like in its almighty power.  Also you have a Dr who believes in T3.  He probably has hens teeth too as it is so rare to find such a Dr.

The fact that you have T3, and you took it, and T3 acts past meaning that it peaks about 4 hours after you take it and you are already feeling better seems like a sign that it is the right thing to do.

Cholesterol is often linked inversely proportional way. That is when Thyroid (Free T3) is low, your cholesterol is high.  So what that means is that if you get your thyroid levels right, your chigh cholesterol MAY go away or at least it should improve the stituation.

Understand that with Thyroid symptom relief can take a long time especially hair growth.  it takes time for the body to mend.  And you don't ultimately know where you will finally end up with a dosage of T3.

Also if you had the near perfect mid-range Free T4 at 100 mcg, then you may want to consider staying at the 100 mcg dose.  But it is up to you if you want to stay at the reduced 88 mcg.  General rule is to change only one thing at a time so you know what response it had.  Having taken the 88 for only a day or two isn't a change as it takes 6 WEEKS to stabilize in your blood so I wouldn't think too much of going back to the 100 and adding in the two doses of 2.5 T3 a day and see how that goes for a few weeks.

Just my opinion
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649848_tn?1357751184
My apologies... I did the calculation on your FT4 and while I calculated it correctly, I didn't type in the correct calculation.  Instead of your FT4 being right at 50% of the range, it's at 66% and in your position, I'd probably not want to increase T4 med back to 100, at this point.

I am happy to see that you did add back in some of T3 and that your doctor approves of it.  I suspect that you will need to add back some more, but give it a few days... better to go too slwo than too fast.
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252327_tn?1250187576
Thank you so much for your input, you are the only one who responded to me and I appreciate it.  I am going to continue the t3 and I will let you know in a couple of days how my profess is doing.  thank you again
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252327_tn?1250187576
Barb  I was on the 88mcg and added 2.5mcg cytomel for the last three days.  I have been getting heart palpitations and feeling just not right although I was able to breathe better and think clearer.    This morning when I got up I debated and then I took just 100mcg levothroxine (levothyroxine). I did go to a heart doctor in December and she tested everything including a 24 monitor and my heart was fine.  I don't know what i should do. Am I just t3 sensitive? I know I have taken it before up to 10mcg a day.. Any suggestions??
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649848_tn?1357751184
In my opinion, 3 days is not enough of trial to know whether or not you can tolerate T3 or not, or even if the T3 is the issue.  Anxiety can also cause heart palps and when we are uncertain about something like this there is surely anxiety involved, even when we don't specifically feel it.  Sometimes, we simply have to ride out the symptoms until our body gets used to the medication.

With an FT4 already at 66% of its range, I certainly would be hesitant to take more T4 med.
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649848_tn?1357751184
I meant to add that you are the only one who really knows how you feel, so it's a decision that only you can make.
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252327_tn?1250187576
I really enjoy reading this forum. I agree t3 needs time to adjust so today I started it again today I took 88mcg levo and added 1/4 of a 5mcg cytomel. In a couple of days I will up it to 1/2 of a 5mcg cytomel.  After a couple of weeks will eventually increase it to the whole 5mcg cytomel.  Hopefully after 6 weeks I will retest my blood.  I am hoping when the t3 goes up my cholesterol goes down. Looking at old lab reports when my t3 and free t3 were higher my cholesterol was within normal limits.  I will come back and let you know the results, and once again thank you for this forum..
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252327_tn?1250187576
Just wanted to give you a update on how things are going.  Well I am still taking the 88 Levothroxine (levothyroxine) adding 5mcg cytomel after breakfast and it seems to be helping although I was getting palputations and shortness of breath occasionally . But then my doc called me he read my labs more in depth.  He said I am suffering from B12 deficiency . I told him I took b12 everyday.  He said my body wasn't absorbing it.  He said that most likely would be causing my problems.  So I started on b12 injections yesterday once a week,  He said that there are also lots of kinds of b12 injections and this one don't need your body to convert it, its already converted.  Luckily I know how to inject myself being a phlebotomist for 25 years. I believe I am on my road to recovery and I am so happy I was able to talk to you . This forum is great and I am sure it helps many many people.  I will follow up in a few weeks...thanks again

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Avatar_m_tn
Do you have B-12 blood levels to provide evidence that in fact it is B-12 or is your Dr just making an assumption?
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252327_tn?1250187576
It came back in blood tests
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252327_tn?1250187576
I went to the doctor today I have had 3 weeks of the b12 injections and just for the heck of it he's doing a b12 test to see what the numbers are. Also did a few other tests folate, ft3 and ft4, tsh .  He said it really didn't matter in my case if I lower the levothroxine (levothyroxine) or not because being my body isn't converting it that it didn't matter.  I should get the results today or by Monday at the latest. He told me if I thought I needed it I can increase my cytomel to twice a day. He said the usual dose is 25mcg.  I will let you know what happens.  He didn't recheck the cholesterol again , he said its too soon to tell if the cytomel has brought it down.  I go back in 3 months unless I feel like I need it tested sooner. I will put my labs up when I get them.
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Avatar_m_tn
Do you mean 2.5 mcg or Cytomel or 25 mcg of cytomel?

Because 25 mcg of T3 Cytomel is a significantly large dose.

I want to be sure becaue 25 mcg of T3 is common dose. But most pople have to work up and may never get to 25 mcg of T3 (Cytomel).

Then you mention T3 taking it twice a day.  So would that then be 50 Mcg of Cytomel total for the day???  I don't htink I've EVER heard of anyone taking that high of a dose of T3.
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252327_tn?1250187576
oh no I am sorry  I am taking 5mcg he said if I want I can increase it in increments of 5mcg...he did say the usual dosage is 25mcg.  So now I am taking 5mcg but he said if I was tired or thought I needed more to add another.  Like you said work up to it..
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252327_tn?1250187576
here are my new results  B12  >2000   211-946
folate       >19.9      >3.0
tsh 0.309         0.450-4.500
Ft4  1.52     0.82-1.77
Ft3  2.4     2.0-4.4
This is after adding 5mcg cytomel and B12 injections for 3 weeks. I have tons of energy I am awake at the crack of dawn ( used to sleep till 10am) and can go go go. I still have a fear of crossing over to hyper but right now I feel great.  One more thing I want to share I am 71 years old.  I am 5'4'' and weigh 113 lbs and to feel great at my age is a plus.
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252327_tn?1250187576
I meant to add NO more shortness of breath at all
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Avatar_m_tn
I think a lot of your energy may be the result of getting the B-12 up high enough.

Is your level really 2000 or did you mean 200?

Your FT4 is at 73% which is great if not even a little higher than the rule of thumb to be 50% or a bit more.

Your FT3 however is still only at 40% when the rule of thumb is 67%.

However those are only rules of thumbs.  If you feel great then that is all that really matters.  With the FT3 at only 40% I'm not too sure you have much to worry about with going hyper.  But what do I know?
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252327_tn?1250187576
Dr called me last night  to give me my results but  I managed to get my results before him ( I have friends)  Yes my b12 is greater than 2000..that is not a error but my blood test was taken 3 hours after my injection too.. My b12 injection is due today but I think I am going to skip it this week.
Doc told me I am slightly hyper and if I felt ok thats fine. I asked him to lower my levothroxine (levothyroxine) to 75mcg. I can feel me getting hyper. I can only sleep for 2-3 hours a night and that even with a ambien  all I want to do all day is go go go. I must say that I am breathing much much better and my hair stopped falling out and my skin is smoother. I have been getting headaches( something I never get).  My goal is to get the ft3 higher thats why the cytomel.
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252327_tn?1250187576
Doc said b12 will never hurt you and you can never over do it.  he said you just pee out the excess
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Avatar_m_tn
Go by how you feel and not so much by what the numbers say.

your body ONLY ultimately uses free T3. So if you think you are on the hyper side of things, I'd personally recommend that you first cut back on the Cytomel for two reasons.

First is that you get a MUCH, almost immediate response as T3 only is used within HOURS.  T4 takes weeks and must go through the conversion process to T3 before being used.

Secondly if you keep the FT4 levels up a bit this is the "storage" hormone and if you body senses the need for more thyroid it has the residual FT4 in the blood ready, willing and able to be converted into T3.

Whereas if you cut your T4 medication it would reduce the amount of FT4 in the blood available to be converted IF NEEDED.

Just my opinion.
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Avatar_f_tn
Hi, I have hashi's and SOB. 2 questions. How are your progesterone levels, and are you on CoQ10. I take both, and both help with the SOB, chest pains and heart pounding. you can take up to 400mg of CoQ10, i take between 200-300, but my symptoms are severe.
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252327_tn?1250187576
I added the coq10 about 3 weeks ago as far as the progesterone don't think I have any or last time it was done it was maybe 2.  I did take prempro years ago and did fine on it, when I stopped it thats when the hash's kicked in.  Since then I have not used any hormones. Lowered my t4 med yesterday to 75mcg and did not take a b12 shot yesterday.  Last night I slept fine..Ill see how it goes in a few weeks.  If I get sluggish I will alternate 75 with 88.  I have done that before
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Avatar_m_tn
Estrogen can "bind" with thyroid and thus take it out of being able to be metabolized by your body.

As women age the Progesterone tends to drop while the estrogen remains the same. The result in many people is that you end up with estrogen dominance which is really another name for progestrone deficiency.

So there is some possibility at least enough to investigate if the very low Progesterone may cause estrogen dominance and binding with and hampers the thyroid metabolism.  Worth checking into at least and talk with your Dr about.


What is "SOB"????.  I'm pretty sure it doesn't mean what common phrase I'm most used to it meaning (Son Of a Bi***).

Cholesterol is used as a precursor to most every hormone.  So if taking a Statin to lower cholesterol it thus would lower the cholesterol available to be used as the building block to making not only thryoid hormone but also estrogen, progesterone or testosterone.  Also taking a statin lowers the coQ10 and thus if taking a statin it is recommended that you supplment with CoQ10.

Don't know if any of this applies to anyone, just throwing out thoughts/ideas.
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252327_tn?1250187576
I can't take statins I get severe joint pain I have tried. SOB is shortness of breath.  I have also experienced memory loss with statins.  I think if I bring up my ft3 levels it will lower my cholesterol level.  I will check back when I get new results
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Avatar_m_tn
yes cholesterol generally goes opposite of thyroid. WHen thyroid too low your chollesterol will rise.

Also your brain works on cholesterol. So if on a statin which lowers the amount of cholesterol it sort of makes sense to me that would cause brain fog.

Which really causes me to ask the larger question.  We are seeing a pretty significant rise in alzheimer's and dementia.  Well then consider that a very large portion of our population are being prescribed and are taking a Statin.

So this begs the question.  Are we as a society causing cognitive issues because we are starving our brains of cholesterol by the rampant perscriptions of Statins??????  Things that make you say Hummmm
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252327_tn?1250187576
Got my results today its been 6 weeks on the new medication..Yes cytomel lowers your cholesterol .  Now remember my cholesterol was 255, I have not changed my diet. Total cholesterol 224  range 100-199
triglycerides 76 before they were 88 range 0-149
FT3 2.9 before 2.4 range 2.0-4.4
FT4 1.58 before 1.44 range 0.82-1.77
TSH 0.090 low before 0.424 range 0.450-4.500
my question is should I lower the levothroxine (levothyroxine) to 75 and increase cytomel to 2 5mcg a day.  The reason I am wondering if I should lower levo from 88 to 75 is because of severely low tsh or does it matter?
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252327_tn?1250187576
ot my results today its been 6 weeks on the new medication..Yes cytomel lowers your cholesterol .  Now remember my cholesterol was 255, I have not changed my diet. Total cholesterol 224  range 100-199
triglycerides 76 before they were 88 range 0-149
FT3 2.9 before 2.4 range 2.0-4.4
FT4 1.58 before 1.44 range 0.82-1.77
TSH 0.090 low before 0.424 range 0.450-4.500
my question is should I lower the levothroxine (levothyroxine) to 75 and increase cytomel to 2 5mcg a day.  The reason I am wondering if I should lower levo from 88 to 75 is because of severely low tsh or does it matter?
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252327_tn?1250187576
Need help!!!!! Just got my test results please look at them..Still having a little short of breath (went to lung doc and had PFT'S done...nothing wrong with lungs its a thyroid issue)  New lab results
Lipid panel cholesterol 246 high range 100-199
tsh 0.324 range 0.450-4.500
t4 free  1.16  range  0.82-1.77

freet3  2.3  range 2.0-4.4
vit D 66.9  range 30.0-100.0
Right now I have been on 88mcg levothroxine (levothyroxine) and cytomel 5mcg split in two doses.  Having shortness of breath.  I know I am under medicated should I increase levothroxine (levothyroxine) to 88mcg keep cytomel the same or increase cytomel???? I value your opinion.
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Avatar_m_tn
Shortness of breath, often called "air hunger" is a common symptom of being hypo.  As I recall you had other symptoms as well.  Based on your labs you need to increase both your T4 med and also your T3 med.  Free T4 needs to be around the middle of its range, as a minimum.  Free T3 is recommended to be in the upper part of its range, as necessary to relieve symptoms.  So you have lots of room to increase there.  

Have I overlooked any info about your ferritin level?  Low ferritin can also cause hair problems, which you previously mentioned.
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252327_tn?1250187576
I have had the ferritin checked a couple of times and it is always in range.  I agree with you t3 and t4 need to go up.
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Avatar_m_tn
The range is extremely broad.  Ferritin is recommended to be around 60 as a minimum.  What is your ferritin level?
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252327_tn?1250187576
ferritin was 134  range 13-150  so I am good there
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Avatar_m_tn
Your ferritin is higher than I expected.  Are you taking iron supplements?
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252327_tn?1250187576
no iron supplements
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252327_tn?1250187576
So what I did is I raised my levothroxine (levothyroxine) to 88 mcg and I take it in the morning with 5mcg cytomel and at one oclock in the afternoon I take another 5mcg cytomel.  If I take it later than that I can't sleep at night.  I will repeat my labs in about 6 weeks. Do you think that will raise my t3 levels? Seems like there always at rock bottom..I would  think this wouls help, don't you?
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Avatar_f_tn
Hi, what were your symptoms for thyroid and is yours under or over
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Avatar_m_tn
Yes, that should raise your Free T3 levels, but more might be required after you re-test in 4-5 weeks, and also as you monitor the effect, if any, on symptoms.  
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252327_tn?1250187576
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