combination therapy and reverse T3 , TTC

[Macy88]

I was diagnosed with  hypothyroid and was taking synthroid 112mcg. I had 2 failed IVF and one miscarriage this year.

I had blood work for thyroid before going for IVF in october . Here are results.

22 Sept

TSH= 0.254 ( 0.320-5.500 MIU/ML)
Free T4=  1.30 (0.60 - 1.70 ng/ml)

I had IVF in October  and found that very few eggs matured than earlier cycle. At the same time I  found about T3 and reverseT3. I had a blood check again for T3 and reverseT3.

30 Nov

Free T3 = 2.5 ( 2.3-4.2 pg/ml )
Reverse T3 = 17 ( 8-25 ng/dl )
FT3/RT3 ratio = 14.7 ( normal > 20) low
T3/RT3 ratio = 7.2 ( normal > 10) low

I stopped taking synthroid on 30 Nov ( the same day blood was drawn ) and then 15 days later I had blood check up again.

15 Dec

TSH    10.160   ( up)

Free T3   2.5      ( same)

Free T4  0 .77   (down, lower limit)

R T3       12       ( down)

FT3/RT3 ratio = 20.8   Normal



I will really appreciate some insight on my problem. Here are my some questions:

1.      Once I stopped taking synthroid, rT3 levels improved, however FreeT3 still remained the same. So does not it mean that synthroid is doing nothing to bring the T3 level up?

2.      Could it be possible that IVF contributed to reverseT3 issue ?

3.      Am I right in stopping synthroid?

4.      My doc wants me to start on combination therapy of 50 mcg synthroid and 5mg cytomel. He said just see how you respond on 5 mcg cytomel for a week and if you feel ok then add another dose 5 mcg cytomel. Your thoughts ?

So hoping that I will respond ok to combination therapy 50 mcg synthroid and 10 mcg cytomel. If needed more synthroid will be added later on.

5.      I probably have selenium deficiency because once on selenium supplement I felt better. I will get tested for selenium. What are other tests I should get tested for?

6.      I am trying to get pregnant , will armour or combination therapy (synthroid/cytomel) be better?

7.      Anyone had a successful pregnancy  on combination therapy (synthroid/cytomel)? What were your doses?

8.I also want to add that in 2014 I was tested negative for thyroid Abs TPO and thyroglobulin Abs. Even if my T4 and T3 levels are low but still they are in range, could high TSh be problem with pitutary gland?

[goolarra]

Stress, both physical, in the form of trauma, etc., and psychological can increase RT3.  Converting more T4 to RT3 than FT3 is the body's way of protecting itself from too high FT3 levels.  However, your 9/22 FT4 was also on the high side at 64% of range (target is 50%), and high FT4 can also cause RT3 to rise.  Once again, the body protecting itself by neutralizing some of the T4 instead of converting it to T3.

[Macy88]

Hi emily,

Thanks for your prompt response. About ferritin, I am assuming it can be detected by blood test. When you found out your ferritin levels were abnormal, were your iron was in normal range. I will be paying from my own pocket for majority of tests as kaiser insurance wont do them. Should i get both iron and ferritin tests done or just ferritin matters in hypothyroid.

Thanks
macy

[Emily443]

Yes my iron was in normal range, but my ferritin level was way too low.  You need to check both, both are important.

[Macy88]

Thank you so much for your quick response.

Q 2. I was referring to the stress ( biological or emotional, too many injections) caused by IVF. Could stress cause reverseT3?

[Emily443]

Yes stress can cause reverse T3 and your pregnancy as well. You need have your doctor check your cortisol level.

[Emily443]

If you have reverse T3, the better way handle it is by using T3 only medicine. It will take a while, like one or two months to flush out the excess t3 pooling in your blood. You can either use Cytomel or Liothyronine ( pure form of T3 which you can find in compound pharmacy) I wouldn't suggest you to get on to synthroid until you fix the RT3 problem. There should be a reason why you have RT3, you need to find it out. Have your doctor check your
- iron
-ferrittin ( for me ferittin was low when I had the problem)
-Cortisol
http://www.*************************/reverse-t3/
you will get some good information here. I would say look for a good doctor, a doctor with functional medicine or a holistic doctor ( if you can afford paying his bills) you can find good doctors here: http://www.thyroiddoctors.com/
http://www.*************************/how-to-find-a-good-doc/
Fix your thyroid issues first before you try to get pregnant again, otherwise the chances are less. Follow a good diet, Dr. Mark Hyman's protocol is good, Here is what he had to say about infertility https://www.youtube.com/watch?v=RCPWMp96LsA
Just hang in there, get on a healthy diet and fix your health problems first, then get pregnant. Good luck:)

[goolarra]

1.  Not necessarily.  After only 15 days, your hormones would still be in flux.  It's too early to draw any firm conclusions.

2.  Which aspect of IVF are you referring to?

3.  No, it appears not.  Your FT4 really took a nosedive after you discontinued meds.  That's after only 15 days.  It will take 4-6 weeks before it's finished adjusting in your blood.

4.  I think you're doctor's suggestion is valid, although I don't think I'd have dropped your T4 meds from 112 mcg to 50 mcg. But, he has said he'd add it back later if necessary.  I'd take his advice.

5.  In my opinion, other tests should be decided on by symptoms.  However, both vitamin D and ferritin are key in the production of thyroid hormones and their use on the cellular level.

6.  Some people do better with a synthetic combo, some do better on desiccated.  Unfortunately, we have to be our own guinea pigs.  

7.  I wasn't hypo until I was post-menopause, so I have no personal experience, but there have been people on the forum on T4-only, synthetic T3/T4 combos and desiccated who had successful pregnancies.  Anyone else's dose is completely irrelevant to you.  We're all different, and meds depend to some extent on how much thyroid function we have left.

8.  I highly doubt it.  Your TSH went up as your FT4 went down, and that's exactly what it should have done.  Your FT4 is now way too low in the range...50% is the rule of thumb, and yours is only 15%.  Very few of us have to be below range on FT3 and/or FT4 before TSH starts to climb.