low thyroid hormones and synthroid

[jjohnson5409]

My TSH was 0.94 FT4 0.90 and FT3 232    FT's are on the low end and my TSH is perfect.   Life was not so good, wt gain, very fatigue, thyroid nodule, growing thyroid, no energy at all. low cortisol, low vit d.  My GP put me on a low dose synthroid 50mg or mcg???   I have been taking it for 3 weeks now and I have to say I feel pretty good.  I have not lost any wt but right now just living life is pretty good.  BUT,  shouldn't I be on a t4 and t3 meds?  my ft3 was lower then my ft4.  I am just scared after the 6 weeks of feel good life will disappear again!!!   what do you think?  

[goolarra]

I, personally, would givre the T4 meds a chance to work.  Your FT4 is quite low, and there is no reason to think (at this point) that your FT3 level will not come up along with your FT4 level.  It's 50 mcg, or 0.5 mg (they're equal).  You should have lab work done 4-5 weeks after starting Synthroid, see where your FT3 and FT4 levels are then, and adjust meds if your symptoms are not relieved.  You will probably have a difficult time losing weight until meds are properly adjusted, which can take some time and careful dosage changes to get the amount right.

One of the worst things you can do with thyroid meds and the one that will drag out the dosage adjustment process is flitting from one therapy to the next before the first has had time to stabilize in your system.

[TamraW]

Ideally, our body will convert the Synthroid (T4) to T3 on its own. Ideally. Sometimes, we need the T3 boost like Cytomel. My endo likes to get my T4 levels upped to high/normal, then if my FT3 is still low, he adds Cytomel. It will take time and probably several more thyroid medication adjustments for you to be at the right levels.

I felt great at 50 mcg. Then a few weeks later, I started to feel hypo again. I felt great at 75 mcg. Then after a few weeks, I felt hypo again. I am now on 100 mcg and I feel slightly hyper. I might end up on 88 mcg. We'll see. I'm giving the 100 a few more days. My FT3 was very low before starting Synthroid. Now it's on the high end, so my endo thinks I won't be needing Cytomel. Everybody is different.

It is a good thing the doc gave you Synthroid despite your low TSH, which is a pituitary hormone, and doesn't paint the full thryoid picture.

Are you taking anything for the low cortisol/low D? I don't know much about cortisol, but I take D supplements.

:) Tamra

[jjohnson5409]

Yes, I take a 50,000IU of vit D once a week.  My GP did not want me to take any type of steroids yet.  he thinks that my low thyroid hormones are the cause of the low cortisol.   I can get out of bed much easier now that I started synthroid.  so maybe my cortisol level is up!   hope so.  

ps should my T3 be higher then my T4?  

[magpieannie]

In a perfect world they should line up mid normal range or higher, and the TSH should be on the polar opposite side (low normal). Some people do feel better when the freet3 is slightly higher then the freet4.You will have to see where you are most "symptom free." It's an "individual" thing! Every person is different, it just takes lots of time and patience to get it right for YOU! Keep fighten the good fight and don't settle for less then your best! (Don't rush it though) finding the right med or combo of meds at the right dose is a very slow process of elimination and tweeking! Hopefully you have an open minded doctor who will listen and work with you and not against you. Good Luck and God Bless!

[goolarra]

Your FT3 should probably be higher than your FT4, but as annie said, that's something each of us has to figure out for ourselves by seeing where we are when we have neither hypo nor hyper symptoms.  BUT, when your FT4 is as low as yours is, there is not much available for conversion, so both sink together.  IF you get to a point where FT4 is in the higher end of the range, and FT3 won't budge, then it's time to think about conversion issues.  At the moment, until your FT4 comes up a bit, I'd not worry too much about your FT4 levels relative to FT3.  I think it's too early for that.

[jjohnson5409]

Ok so I will wait it out until my labwork is done.  Is 6 weeks enough time to show if I am converting the T4 to T3?   I just don't want to ask for something else if it is not enough time.  I have noticed that for the last few days I am starting to feel fatigue again.  I have only been on synthroid for 4 weeks.  I am so scared to go back to the way I was feeling and living before.   or I should say not living!  

[goolarra]

Five to six weeks is recommended after a meds change before doing labs again.  When it comes to conversion issues, it's not so much the length of time you've been on a given dose that's important, but rather WHERE your FT4 is in the range.  If your FT4 is still low, then in my opinion, an increase in T4 meds is indicated.  However, if your FT4 is up in the top half of the range, and your FT3 is still wallowing at the bottom, it might be time to look at adding some T3 (if you still have symptoms). I've also found that for me FT3 seems to lag behind FT4.  My FT4 in April and August were exactly the same (no meds changes), but FT3 had gone up a fair amount by August.

Interesting...I've never even looked at my FT3 relative to my FT4 before.  My FT4 is in the lower end of the middle third of the range, and my FT3 is in the upper end of the lower third  So, my FT4 is higher in the range than my FT3, too.  But, as I said, I'm asymptomatic and have been for a while, and my FT3 is higher right now than it's ever been.

I know how tough it is to be patient, and in the meds adjustment process, there may be a week or two here and there when symptoms return briefly before a meds change, but there is just no way to rush the process without ultimately prolonging it.  

[jjohnson5409]

Well my labs did show a raise in both FT4 and FT3 but my FT4 is 1.8 now, was 0.90 and my FT3 is 286 now , was 232. .  so the FT4 went up way more then my Ft3.   230-498 was the reference range for the FT3.  so my doctor raised the synthroid to 75 mcg.  Doesn't the labs relate to lack of conversion?  or is it to early to tell?   Also my TSH is 0.66 and it was 0.94.  Doctor said in two months we will do another bloodwork to see if my ft3 will go up.    Should I ask to add cytomel or just change to Armour?  also the weight went up by 2 lbs!!!  yuck!!  and i even do more exercise since I felt better.  so maybe armour because so many people say it helps with wt loss too!  Does cytomel help also?  Are people getting results?   thanks everyone for your advice!  

[goolarra]

As I said above, my FT3 lagged behind my FT4.  FT4 remained absolutely consistent for those four months, but FT3 continued to rise.  I'm not due to see my endo until February, so stay tuned...

The choice between synthetics and Armour is a very personal one.  Armour has T4:T3 in a ratio of about 4-or-5:1.  The normally functioning human thyroid produces about 20:1.  So, there is a lot of T3 in Armour.  Some people can't tolerate all that T3, and some only do well on Armour.  Also, using Cytomel, the balance of T4 to T3 is a bit easier to control since the dosages can be manipulated separately.  Whether you get your levels to an optimal level using synthetics or Armour, the results for weight loss should be the same.  

Your FT4 really came up quite nicely.  It will be interesting to see if your FT3 follows.