Wrong dosage and labs

[thethinme]

Saw my doctor and realized I've been taking my meds incorrectly for the last 2 months. Ugh! He had changed my meds in June 7 as I was taking before - Armour in the morning and 1 Cytomel 5 mcg in the afternoon - and my RT3 sky rocketed to 442 (range was up to 350).

Was supposed to be taking 2 Cytomel pills in the morning and 2 after lunch... But I took half of that instead :( Only 1 in the morning and 1 in afternoon.

Ugh! I guess that's why my labs came all low:

TSH: 0.952 (0.270-4.200)
Free T4: 0.60 (0.83-1.62) ~ low
Free T3: 2.2 (2.5-4.3) ~ low
Reverse T3: 103 (90-350) ~ normal again, sky rocketed to 442 in April 18 while on Armour...
Ferritin: 23 (10-291) ~ kinda low but normal range
Cortisol AM baseline: 17.7 (5.0-25.0)
250H, vitamin D: 29.5 (32-100) ~ low

Will the dosage I was supposed to take improve my labs and feeling? (upping Cytomel only, not adding T4 at all).
On the wrong dose, I still felt tired although better than before... probably because the RT3 got normal again. I inquired about the low T4 and he almost wanted to add Armour to Cytomel, but I said I didn't feel well on it. He said okay, Cytomel only is fine, he said T4 should not worry me (even though it's low).

He told me to take iron and vitamin D...

FYI, he's on Mary Shomon's preferred list and is considered a local thyroid star hehe.

[goolarra]

Yes, RT3 can be high without thyroid meds.  There are only two ways that our bodies can get rid of excess T4:  convert it to T3 or convert it to RT3.  RT3 wasn't put there just to torture us !  LOL  It does have a function in real life.  For example more T4 is converted to RT3 in times of trauma, some diseases, starvation, etc.  You can see where it might be beneficial to survival to lower metabolism at those times, and that's what higher levels of RT3 do (by keeping T3 levels lower).  

RT3 does not lower T4, but high levels of T3 (whether from meds or naturally occurring ) can make TSH go down, which in turn makes T4 go down since the thyroid isn't being stimulated to produce it.  

Regarding your comment on your eating habits...note my comment above about RT3 increasing when your body is in "starvation mode".

It takes a while for us to learn exactly how we each react when over- or under-medicated, so lab work to help us decide is an excellent idea.  It also helps us see trends, and trends are more important than a snapshot number.  Once you're more stabilized labs and visits can be spread out more, but while you're still in flux, Id request labs every time you see your doctor.  Otherwise, the appointment can be a bit "wasted".  It's kind of interesting that you think he might be concerned about ordering excessive testing in the eyes of the insurance company, but he doesn't seem to be worried about "excessive" office visits...follow the money trail.

I also meant to comment further up on the meds history you posted:

"- March 26 to April 23: 1 grain of 30 MG Armour in the morning, 1 grain of after lunch = total of 60 MG per day.

- April 24 to June 7: 1 grain of 30 MG Armour in the morning, 1 grain of Cytomel 5 mcg after lunch.

- June 7 to August 2: 1 grain of Cytomel 5 mcg in the morning, 1 grain of Cytomel 5 mcg after lunch.
Misunderstood dr., took meds wrongly, less than recommended by Doctor, by mistake.

- August 2nd: 2 grains Cytomel 5 mcg in the morning, 2 grains Cytomel 5 mcg in the afternoon. (we realized I was taking less meds than recommended and upped to what it was supposed to be in June 7)"

I'm pretty sure I know what you mean, but lots of people who don't have a lot of knowledge about thyroid read these threads, so I wanted to clarify for them.

Armour is measured in milligrams (mg) or grains.  A grain is an apothecary measure and equal to 60 mg of Armour.

Cytomel is measured in micrograms (mcg).

So, what I got from your history was this:

"- March 26 to April 23: 1/2 grain (30 mg) Armour in the am, 1/2 grain (30 mg) Armour after lunch= total of 1 grain (60 mg) per day.

- April 24 to June 7: 1/2 grain (30 mg) Armour in the am , 5 mcg Cytomel after lunch

- June 7 to August 2: 5 mcg Cytomel in the morning, 5 mcg  Cytomel after lunch.

- August 2nd: 10 mcg Cytomel in the morning, 10 mcg Cytomel in the afternoon.

Did I get that right?

[thethinme]

Oh thanks a lot goolara! You have no idea how appreciate it.

I was surprised with the low FT4 as well! Can RT3 be high without thyroid meds? (and suppress FT4 even w/o meds?) I didn't even know that... Interesting.

Sometimes I wonder if it's the way I eat as well - I don't eat a lot now that I'm thin again, perhaps I'm not well nourished or so...

I see my thyroid doctor every 6-8 weeks. Last week I asked him to order new labs for next visit and he said he didn't like to order them all the time. I don't get it, although I agree that symptoms are more important, I don't trust myself to access my feelings as I've been depressed for a while and I never know what is thyroid and what is depression etc. My guess is it's something related to how insurance works. Perhaps doctors who order too many exams get penalties or letters from them?

--
Btw: Incomplete February and March labs ordered by my GP, who doesn't even understand the importance of FT3/T4 ;)

[goolarra]

Unfortunately, there is no FT4 in the March labs, but, you're right it didn't look bad in February.

In February, your total T3 (no FT3) is very low in the range despite a respectable FT4.  It didn't change between February and March.  With your FT4 in February at 40% of range (and let's assume it would have been about that again in March), your FT3 and TT3 were already low before you started meds, which suggests that RT3 might have been high even then.

I'm kind of surprised your FT4 is so low now.  It seems your thyroid has taken a real nose dive since Feb/Mar.  It was at 40% in Feb with no meds,  Now, on just Cytomel, it's below range.  I don't think (don't quote me!) that 10 mcg of Cytomel per day should suppress your FT4 that much, especially with your FT3 also below range.

How often do you see your doctor?  When I was actively adjusting meds, I saw my doctor every 5-6 weeks and I had labs before every appointment.  Of course, symptoms are most important, but I don't think there's any reason to throw the baby out with the bath water and completely ignore lab results.    

[thethinme]

Oops meant to post this simplified version of old labs for easier reading:

Results from FEBRUARY 15 2012 lab: 

- Tests: (3) TSH W/FREE T4 RFX (43562A) 

TSH [H] 4.68 MIU/L  (0.40-4.50) 

T4, FREE 1.2 NG/DL   (0.8-1.8) 

- Tests: (4) Total T3 (30536R) 

T3,TOTAL 79 NG/DL (76-181) 

Also, LDL colestherol came back high for the first time in my life: 
- Tests: (1) Lipid Panel (CPT-80061) 
CHOLESTEROL,TOTAL [H] 208 MG/DL (125-200) 
LDL CHOL, CALCULATED [H] 130 MG/DL     (<130) 


--

MARCH 12 2012 lab: 

(1) TSH W/FREE T4 RFX (43562A) 

TSH  3.88 MIU/L  (0.40-4.50) 
   
TSH REFERENCE RANGE - FOR PREGNANT PATIENTS: 
FIRST TRIMESTER         0.20-4.70 MIU/L 
SECOND TRIMESTER    0.30-4.10 MIU/L 
THIRD TRIMESTER         0.40-2.70 MIU/L 

(2) T3,TOTAL  79 NG/DL  (76-181) 

(3) T3,FREE   2.8 PG/ML  (2.3-4.2) 

(4) THYROID AB (ATA,TPO) 
THYROID PEROXIDASE AB  <10 IU/ML       (<35) 
THYROGLOBULIN AB           <20 IU/ML       (<20) 

(5) TSI 
TSI     29 % BASELINE           (<140)

[thethinme]

Thanks goolara, very interesting. My sixth sense was telling me it is probably unusual to be on T3 only long term. I shouldn't have jumped when doctor told me to go nbakon Armour but somehow I feel it is what caused my RT3 to sky rocket, as T4 was quite normal before I took any thyroid meds. Old labs, for reference:

MARCH 12 2012 lab: 


Tests: (1) TSH W/FREE T4 RFX (43562A) 
! Send Out                  "Result Below..."                            *1 
      RESULT: Sent to reference lab. 
  TSH                       3.88 MIU/L                  0.40-4.50        *2 
   
        TSH REFERENCE RANGE: 
         FOR PREGNANT PATIENTS: 
          FIRST TRIMESTER         0.20-4.70 MIU/L 
          SECOND TRIMESTER        0.30-4.10 MIU/L 
          THIRD TRIMESTER         0.40-2.70 MIU/L 

Tests: (2) Total T3 (30536R) 
! Send Out                  "Result Below..."                            *3 
      RESULT: Sent to reference lab. 
  T3,TOTAL                  79 NG/DL                    76-181           *4 

Tests: (3) T3,FREE (30510P) 
! Send Out                  "Result Below..."                            *5 
      RESULT: Sent to reference lab. 
  T3,FREE                   2.8 PG/ML                   2.3-4.2          *6 

Tests: (4) THYROID AB (ATA,TPO) (7302A) 
! Send Out                  "Result Below..."                            *7 
      RESULT: Sent to reference lab. 
! THYROID PEROXIDASE AB 
                                            <10 IU/ML                   <35              *8 
! THYROGLOBULIN AB          <20 IU/ML                   <20              *9 

Tests: (5) TSI (30148P) 
! Send Out                  "Result Below..."                            *10 
      RESULT: Sent to reference lab. 
  TSI                       29 % BASELINE               <140             *11 

------------

So I should probably go back on a little dose of Armour in the future, I guess? Depending on following labs of course...

Thing is doctor doesn't want me to do labs every time I see him, probably doesn't look good insurance-wise? Is it common?

[goolarra]

Kind of a loaded question...what isn't?  LOL

T3-only therapy is seldom used on a long-term basis.  The problem with T3-only, of course, is its short half life.  With little to no FT4 available for conversion (and you're already in that category), it's hard to avoid the peaks and valleys of T3.  

The added Cytomel will certainly increase your FT3 levels.  What it does for your FT4 levels is less straightforward.  It depends a lot on how much thyroid function you actually have left.  If your thyroid is still capable of producing some T4, it might build a little since less would have to be converted to T3 (because you'll be tasking more).  However, the only source of T4 will be your thyroid since you aren't taking any.

Will you feel better?  All you can do is try it and see.  We all have to be the subjercts of our own experiments.  Will it make your FT3 and FT4 good?  It'll help your FT3.  I doubt it will do a lot for your FT4.

Now that your RT3 is back down, you might have a much different experience on Armour than you had before.  From what I've seen here, FT4 can't be totally ignored.  Both T3 and T4 are in our bodies in certain proportions...maybe there was a plan!...I think we have to maintain a somewhat "normal" balance of T3 to T4 to feel best.

As I said, T3-only is SELDOM used long-term...you could be the exception to that rule.

[thethinme]

Thanks goolara! I knew I could count on you veterans for help!

Had a look at my records and my meds change were:

- March 26 to April 23: 1 grain of 30 MG Armour in the morning, 1 grain of after lunch = total of 60 MG per day.

- April 24 to June 7: 1 grain of 30 MG Armour in the morning, 1 grain of Cytomel 5 mcg after lunch.

- June 7 to August 2: 1 grain of Cytomel 5 mcg in the morning, 1 grain of Cytomel 5 mcg after lunch.
Misunderstood dr., took meds wrongly, less than recommended by Doctor, by mistake.

- August 2nd: 2 grains Cytomel 5 mcg in the morning, 2 grains Cytomel 5 mcg in the afternoon. (we realized I was taking less meds than recommended and upped to what it was supposed to be in June 7)

Do you guys think that just by upping Cytomel I will feel better and have good FT3 and FT4? does his recommendation that I don't need to take T4 makes sense?

Thanks!

[goolarra]

How much Armour had you been on for a month in April?

Am I correct that you've been taking 5 mcg Cytomel morning and afternoon, and you should have been taking 10 mcg each time?

Your RT3 looks great!

[thethinme]

For reference, labs from April 18 while on Armour for a month:

Test   /    Result   /   Abnormal   /   Reference /     Units
TSH                0.153 LO   (0.270-4.200) uIU/mL
T3 UPTAKE (T3U) 35.8 (24.3-39.0) %
THYROXINE, FREE (FT4) 1.5 (0.83-1.62) ng/dL
FERRITIN 24 (22-322) ng/dL
ANTI-THYROGLOBULIN <20 (< or 40) IU/mL
CORTISOL, AM (Baseline) 17.4 (5.0-25) ug/dL
E.SEDIMENTATION RATE 4 (<21) mm/hR
VITAMIN B12 1293 (211-911) pg/mL
T3, FREE (FT3) 3.6 (2.5-4.3) pg/mL
250H, VITAMIN D 32.6 (32.0-100) ng/dL
T3, REVERSE (RT3) 422 HI (90-350) pg/mL
DHEA SULFATE 103 (12-379) ug/dL
ANTI-TPO Ab <10 (<35) IU/mL